Your bowels are pivotal in helping to maintain your pelvic floor function. When your bowels are not functioning optimally, they can affect your bladder function, as well as increase the stresses on your pelvic floor muscles, ligaments and fascia (connective tissue), which can predispose you to pelvic organ prolapse, haemorrhoids and incontinence.

What does a healthy bowel look like?

A healthy bowel consists of passing a ‘sausage’ like stool, with minimal effort (no straining), and feeling like you have completely emptied after you have finished. The frequency of passing a bowel motion can vary from 3 times per day to 3 times per week.

 

What is constipation?

Constipation can present in a number of different ways:

– Reduced frequency of bowel motions (fewer than 3 per week)

– Difficulty and / or straining when passing bowel motions

– Passing small, hard, lumpy stools

– A feeling of incomplete evacuation, or inability to empty the bowel fully

– Bloating or abdominal pain

What are some causes of constipation?

– Not consuming enough dietary fibre

– Not drinking enough water

– Hormone changes (e.g. increased progesterone with the luteal phase of the menstrual cycle, which is the two weeks prior to your period)

– Pregnancy

– A change in daily routine (e.g. going on holiday)

– Pelvic floor muscle dysfunction

– Side-effect of some medications

– Other medical conditions

 

What is bowel urgency and incontinence?

Bowel urgency is when you experience a sudden and urgent need to pass a bowel motion, which you find difficult to control or reduce. It is common for people to experience incontinence of their bowels when they have bowel urgency.

What are some causes of bowel incontinence?

– Loose or pasty stools

– Weak or injured pelvic floor and anal sphincter muscles

– Inability or altered ability to sense and detect stool in the rectum

– Damage to the nerves that supply the pelvic floor and rectal muscles

– Chronic constipation and straining

 

The role of the pelvic floor muscles in maintaining a healthy bowel

The pelvic floor muscles are a group of muscles that are found at the bottom part of your pelvis. They are connected from your pubic bone at the front, to your coccyx bone at the back of your spine, and they attach from the two ‘sitting bones’ on either side of your pelvis. Your pelvic floor muscles support your pelvic organs (bladder, bowel, uterus), they help to maintain control of your bladder and bowel, and they also relax when you want to empty your bladder and bowel.

 

How do the pelvic floor muscles contribute to constipation?

When your pelvic floor muscles are too tight and do not relax properly, they can lead to constipation, as they obstruct the full emptying of the contents of your bowels. Often when an individual has tight or overactive pelvic floor muscles, they strain to try and push past the resistance of the tight muscles.

The way an individual pushes / strains to empty, may cause these muscles to tighten further, resulting in a tightening of the emptying muscles, rather than a relaxation. As a result, your stools may look thin, chopped short and you are left with that feeling of not being completely empty.

How do the pelvic floor muscles contribute to bowel incontinence and urgency?

If your pelvic floor muscles are weak or damaged, it can be much harder to control your bowels when you have an urge to pass a bowel motion. The muscles are not able to effectively squeeze, hold and delay the urge to empty.

 

Tips to maintain a healthy bowel

– Drink enough water.

Aiming for 1.5-2.0L of water per day

– Ensure adequate dietary fibre intake.

1 – 2 green kiwifruits, with skin

P fruits: pears, prunes, peaches

1 tsp of chia seeds

Oats

1 tsp of barely max fibre

– 5 – 10 minutes sitting on the toilet, to ensure that you get a full empty of your bowels.

– Use a good toilet position.

Sit with legs wide apart

Knees higher than hips

Relax your belly

– Daily pelvic floor exercises.

It is important when you complete your pelvic floor exercises that you can feel your muscles contract and relax

 

What can a pelvic health physiotherapist do to help maintain good bowel health?

– Advice and education regarding good bowel and bladder habits

– Functional strength and endurance training of your pelvic floor muscles

– Help to establish a good bowel routine individually for your needs

– Biofeedback to help retrain your pelvic floor muscles to help strengthen or relax the muscles and help to retrain your urge to empty.