Pelvic dysfunction physiotherapy is the assessment and treatment of problems involving the pelvic region of the body by a physiotherapist who has specialized training in pelvic conditions.

Bowel Problems

Fecal incontinence: This is the loss of bowel control, resulting in a loss of gas, liquid or solid stool. It can affect men and women of any age.

It can be a few ‘skid marks’ in the underwear, being unable to control the passing of gas, losing small ‘pellets’ without being aware of the loss, or having an extreme urge to get to the washroom and not making it in time.

Whatever the problem, the embarrassment and anxiety it can create can severely affect your confidence, with the fear of repeated accidents always in the back of your mind.

There can be many different causes of bowel leakage. These are the most common causes:

Muscle Weakness: Weakness of, or damage to, the rings of muscle which circle the anus. These are called the external and internal anal sphincter muscles, and they sit just below the pelvic floor muscles.

The external anal sphincter works to delay a bowel movement if an urge is felt, but it’s not convenient to go to the washroom right away. If it is weak you will have an urgent need to get to the washroom immediately and may lose some bowel contents if you can’t get there in time.

The internal anal sphincter works to keep the anus closed throughout the day, unless there is an urge to empty the bowels. If it is weak you may lose small amounts of stool without being aware that it has happened. This may occur when you’re being particularly active (lifting, running), or after you’ve just emptied your bowels.

Either one or both of these muscles can be damaged. The most likely cause of damage is childbirth, when the muscles may easily be stretched or torn. If there is a tear at the back of the vagina (often called a 3rd or 4th degree tear), forceps are used, or the baby is very large, damage is more likely to have occurred.

You may be aware of difficulty controlling your bowels immediately after the birth, or problems may develop many years later as the pelvic floor muscles (which also help with bowel control) and sphincter muscles gradually weaken with age or recurrent straining.

The muscles may also be damaged during surgery to the rectum or anus, and may be weakened by years of straining to empty the bowels.

Diarrhoea: If stools are watery it takes much more muscle control to hold the stool safely in the rectum, and it becomes even more of a problem if the pelvic floor or anal sphincter muscles are weak.

Constipation: Surprisingly, constipation can also result in bowel leakage. If there is a large accumulation of stool sitting in the rectum, mucus can seep around the stool and escape through the anus, often accompanied by small pieces of stool.

PHYSIOTHERAPY TREATMENT OF FECAL INCONTINENCE

Physiotherapy is always carried out in a private treatment room, always with the same Physiotherapist, providing sensitive, professional treatment. It starts with a thorough assessment. You will be asked detailed questions about your bowel control, your medical and surgical history, pregnancies and births, your diet and lifestyle. A physical examination will then follow, which may include looking at your posture, back, abdominal muscles and likely an internal examination.

Once the examination is complete, a discussion follows, explaining the findings and exploring treatment options. It is a good opportunity for you to ask questions to gain a better understanding of your problems.

The goal of Physiotherapy is to teach you to regain control of your bowels. Treatment will always involve a lot of education, to teach you simple measures which can make a big impact on your bowel control.

Treatment may focus on various groups of muscles which are involved in maintaining bowel control – the pelvic floor muscles, the abdominal muscles and the anal sphincter muscles. The muscles may need to be strengthened, taught to work together in a coordinated way, or taught how to relax. Biofeedback may be used as a tool to improve muscle and bowel awareness.

Treatment may also look at food and drink intake, discuss techniques to avoid straining when passing a bowel movement, and look at the overall posture and muscle support. A home exercise program will always be an important part of your treatment.

Frequently there may be a combination of bowel and bladder problems, both can be helped with treatment. See bladder problems for more information.

Throughout treatment you will be given support and encouragement as you begin to learn and use new techniques to gain control of your bowels.

Caroline Allen P.T.
Registered Physiotherapist