Bowel Complaints

30 Jan Bowel Complaints

A number of bowel complaints: bowel urgency, faecal or anal incontinence, constipation, irritable bowel disease, and rectal prolapse, are amidst some of the many bowel problems both women and men are struggling with today.

Statistics on Faecal Incontinence Statistics

• Faecal incontinence affects 6% of Australian men and 10% of Australian women
• 62% of those with faecal incontinence in the community are women
• 44% of women living in the community with faecal incontinence are aged under 50 years

(Key statistics on incontinence CFA)

Definition: Faecal incontinence is the accidental leakage of solid or liquid poo (faeces). Anal incontinence is the accidental leakage of gas.

What causes faecal incontinence?

• Faecal incontinence affects one in 25 (or four percent of) women who have given birth.
• It affects women who have had an obstetric anal injury during childbirth or a perineal tear of Gr 3+ during a rapid 2nd stage or extremely slow 2nd stage labour.
• During this stage of pushing- damage to the nerves and anal sphincter (ring of muscle around your anus) occurs. These are primarily responsible for opening and closing your bowels.
• It can greatly affect your quality of life. Many women find it so embarrassing that they don’t seek medical help; however, there are a range of treatments that can help.

Faecal Incontinence is categorised as :

• Urge faecal incontinence: due to a hypersensitive rectum and sphincter and Pelvic floor dysfunction.
• Passive faecal incontinence- due to impaired sensory awareness and linked with internal anal sphincter dysfunction.
• Faecal seepage: often related to impaired evacuation or faecal emptying.

Other causes of Faecal incontinence include:

• Frequent constipation (infrequent bowel movements, passage of hard stools (poo) which may or may not be accompanied by difficulty emptying your bowels and or use digital maneuvers to do so.   This may persist for several weeks or longer.
• A prolapse of your back passage (or rectum) where it ‘drops down’ through your bottom hole (or anus) or prevents your ability to fully empty your bowels .
• An inflammatory bowel disease (e.g. ulcerative colitis, irritable bowel or Crohn’s disease)
• A fistula or haemorrhoids
• A condition that affects your brain’s ability to send messages to your bowel (like Parkinson’s disease, multiple sclerosis or a stroke).

How is faecal incontinence diagnosed?

Your Physiotherapist will:

• Ask you questions about the history of your health, including your gut, bowels, obstetric history and surgery
• Perform a vaginal, rectal or transperineal real time ultrasound examination with your consent
• Ask you to prepare a bowel diary and assess for pelvic floor muscle strength.
• If the Physiotherapist needs further investigations they will refer you back to your GP requesting:
• An ultrasound to get a picture of the area around your back passage.
• An anal manometry test to check your anal sphincter muscles. This involves putting a small, flexible tube the size of a thermometer into your back passage. This tube has a small balloon at the end which is inflated so you can squeeze it or try to push it out.

How is faecal incontinence treated?

The kind of treatment you have will depend on:

• How long you’ve had faecal incontinence or anal sphincter damage
• How severe it is
• Your age, health and medical history.

Physiotherapy treatment includes :

• Pelvic Floor Exercises: individualised and progressive pelvic floor muscle education and training – from positions of lieing to sitting and standing .
• Client education: how the bowel works, promoting a bowel routine and stool manipulation following the completion of a 3-5 day bowel diary .
• Defaecatory training: teaching brace and bulge techniques to enhance abdominal and anal sphincter relaxation and effectively evacuating & emptying your bowels.
• Rectal balloon therapy: balloon catheter and device used as an effective evidence based therapy tool to improve:
  • Defaecatory training,
  • Co-ordination of sphincter and pelvic floor co-ordination,
  • Anorectal sensation
  • Constipation and treat faecal incontinence, to desensitise and improve urge resistance training to reduce bowel urgency.
• Lifestyle changes: analysing bowel diary and suggesting soluble and insoluble fibre and increasing water in your diet.
• Apperients: to help with stool softening, bulking or movements.

If you suffer with any of these conditions or have any questions regarding the information above- please don’t hesitate to contact us at Western Women’s and Men’s Health and speak to one our our physiotherapists.