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Bowel problems are a common symptom of pelvic floor dysfunction, and can affect women of any age.

Faecal incontinence 

Faecal incontinence is the loss of bowel control, resulting in involuntary passing of wind, liquid or solid stool.

Some women notice a few ‘skid marks’ in their underwear, or are unable to prevent passing wind.  Others may lose some stool without being aware of the loss, or have an extreme urge to get to the toilet and not make 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.

Faecal incontinence is commonly caused by:

Muscle weakness or damage may affect the pelvic floor and the external & internal sphincter muscles which 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 toilet. If it is weak you will have an urgent need to get to the toilet 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.

The most likely cause of damage is childbirth, which can cause the muscles to be stretched or torn. Damage is more likely to have occurred if there is a tear at the back of the vagina (often called a 3rd or 4th degree tear), forceps are used, or if the baby is very large.

You may be aware of difficulty controlling your bowels immediately after the birth, or problems may develop many years later as the pelvic floor and sphincter muscles gradually weaken with age or from years of straining to empty the bowels.

The muscles may also be damaged during surgery to the rectum or anus.

If stools are watery it takes much more muscle control to hold the stool safely in the rectum. As a result, incontinence is more likely with diarrhoea if the pelvic floor or anal sphincter muscles are weak.

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.

Alternately, chronic constipation that results in years of straining to empty the bowels can weaken the pelvic floor and sphincter muscles. Over time, this can cause difficulty in controlling the bowels and result in bowel incontinence and prolapse.

What can I expect from a physiotherapy treatment program?

At Winmalee Women’s Health Physiotherapy, we have clinical expertise in the assessment and treatment of bowel problems. Our treatment programs are individually tailored to your condition and are based on current research.

Physiotherapy is always carried out in a private treatment room; always with the same physiotherapist, providing sensitive, professional treatment. Your initial appointment will involve a thorough assessment, including questioning about your pelvic floor function and habits. This may be followed by an internal examination.

The goal of Physiotherapy is to teach you to regain control of your bowels and resolve problems such as constipation. Treatment will always involve a lot of education, helping you to understand your condition and address lifestyle factors which can improve your bowel function. Areas addressed may include food and drink intake, techniques to avoid straining, and overall posture and muscle support.

Treatment is often focused around the groups of muscles which help to maintain bowel function. These include 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.

Often women have a combination of bladder and bowel problems, both which can be helped with treatment.

A home exercise program will always be an important part of your treatment.