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Remember this series of blogs relates to a talk I did for the public a few weeks ago and Part 4 of the 5 Step Plan is all about bowels.
Bowels Bring Down Prolapse (and cause failure of operations): WHY?

  • Never taught correctly as a child how to defaecate
  • Bad habits- stool wrong consistency, always strains or leans back to defaecate (can be equivalent of having a little baby every day!); dyssynergia – a lack of coordination between the external anal sphincter and one of the pelvic floor muscles (pubo-rectalis) so the anus tightens instead of releasing the stool.
  • Birth Damage: Weak pelvic floor muscles (nerve damage); Levator Avulsion leading to ballooning of vaginal hiatus during defaecation-resistance from PF to enable effective defaecation lost
  • Too much mobility of the perineal body (between the vagina and the anus)-lack of support, short perineal body.

Good management of bowels is all about maths (angles) and physics (correct displacement of forces)
ano-rectal angle  (1)   anorectal angle2 (2)
Defaecation Dynamics

  • Respond to first urge, don’t defer.
  • Use correct posture
  • Relax your tummy.
  • Gently further bulge your abdominal wall.
  • This action opens and relaxes the anal sphincter.
  • NEVER STRAIN!
Defaecation Position

Defaecation Position (3)

So to help manage your prolapse well, get your bowels in order!
1. Women’s Health: A Textbook for Physiotherapists. 1998 Sapsford R, Bullock-Saxton J, Markwell S. London; Sydney : WB Saunders.
2. GastroenterolHepatol (N Y). 2008 November; 4(11): 807–817. PMCID: PMC3104390 Management of Fecal Incontinence Adil E. Bharucha, MBBS,
3. Pelvic Floor Essentials: Sue Croft 2012

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