Problems with normal bowel function can be distressing and interfere with your lifestyle considerably. There are many ways to address bowel dysfunction with physiotherapy. These treatment options are simple, safe

and effective.

Types of bowel dysfunction

• Constipation

• Faecal incontinence

• Flatulence incontinence

• Obstructed defecation. It may feel like there is a barrier to emptying. This can be caused by:

• Rectocele / Posterior Wall Prolapse

• Rectal prolapse

• Intussception

• Excessive perineal descent

• Anal pain, anismus or proctalgia fugax

How do we assess bowel dysfunction?

Subjective questioning. This makes up the majority of our assessment.

• We will ask for detailed questions on when you empty, how often you empty, the stool consistency (how hard or soft it is, on a scale called the Bristol Stool Chart).

• We will ask symptoms around bloating, gas, and abdominal pain.

• We will ask how much effort is involved in emptying (do you strain), do you feel an urge to go, do you feel you empty completely, is there excessive wiping.

• We will ask about diet, fluid intake, exercise, mood and stress as all of these factors can impact on your bowel function.

Internal examination

• An internal or vaginal assessment can be very useful in evaluating the pelvic floor muscles. These muscles impact on the opening around the anus, the anal sphincter and therefore your bowels. It is also important to understand if there are any mechanical changes such as with prolapse which might affect the ability to empty the bowels well.

Transperineal Ultrasound

• In the clinic we can visualise the muscles of the anal sphincter and the pelvic floor muscles with the Realtime Ultrasound. This can be very useful as a way to retrain motor patterns in how to empty your bowels efficiently and effectively.

Rectal assessment

• In some cases a rectal assessment is useful to understand the strength, tone and sensation of the anal sphincter muscles. When these muscles are too tight this can cause pain. When these muscles are too weak or have poor sensation there may be problems with incontinence.

How we can help

• Explain the anatomy of the colon, anorectum and vagina and what the muscles should do when we empty our bowels well.

• Teach you how to empty your bowels well (defecation dynamics) to minimise straining.

• Show you how to implement a bowel routine to maximise the body’s natural reflexes that aid with emptying.

• Provide you with strategies to manipulate stool consistency to aid emptying. This may include using stool softeners in some cases, lifestyle and diet advice.

• Manage prolapse symptoms with muscle retraining and/or pessary management.

• Teach specific exercises to improve the strength and endurance of the anal sphincter muscles if weakness is a problem.

• Teach specific exercises to down-train overactive muscles in some cases. This might include exercises to improve breathing, abdominal wall tone and sometimes other parts of the body that may be contributing to the problem.