Nothing causes more misery in people’s lives than bowel problems. Whether it be constipation, incomplete evacuation, faecal incontinence, sneaky gas, rectal prolapse, haemorrhoids, pain from anal fissures or proctalgia fujax – and sadly, some people can have some or all of these conditions. One of the more famous people who reportedly suffered with major constipation was Elvis – his personal physician writing in his book that he had obviously a huge redundant bowel, that he sometimes soiled when performing and claimed he in fact died of constipation. It’s quite difficult to chat to people about your bowel problems – it’s just too much information even for your closest loved ones. So I thought I’d devote a whole blog to bowels.
I’ve said it before that for many kids, toilet training for ‘poo poos’ means being plonked on a potty with Mum and/or Dad making lots of grunting noises. Not a lot of science.
There are 3 key elements to effective evacuation: Firstly the correct position, secondly the correct dynamics for emptying your bowels and thirdly the correct stool consistency. Getting the angles right and the coordination of the abdominal and pelvic floor muscles (external anal sphincter and pubo-rectalis) to release the stool will make it easier to completely evacuate the bowel motion. In both my Pelvic Floor Recovery books, I go through in detail these three elements to effective, pain-free and more complete evacuation. I have included the diagram for the position below.
Defecation dynamics means gaining effective coordination between the abdominal muscles and the pelvic floor muscles. Instead of pulling your tummy in and pushing down with your pelvic floor (ie straining), the idea is to gently bulge the abdominal wall which causes an opening and relaxation of pubo-rectalis and the external anal sphincter (ie.creates a funnel to release the stool).
Using a product to normalize the bowel motion is critical whether you are helping constipation or faecal incontinence. Doing something simple like a corn test to see what the transit time is like is an important first step when assessing the correct potion to take. To do the corn test, have no corn for a week, then a whole cob of corn, making sure you don’t chew it very well (as opposed to advice normally to always chew your food well always) and then no more for another week. You are looking to see when you first see the corn and when you last see it. If it takes longer than 47 hours to see all the corn, then you have some slow transit time happening in your bowel.
Products range from fibres which are good for softening the stool such as Normafibe* (which is also very helpful if your stool is too loose- it acts to bind the stool), Benefibre*, Metamucil* and many others, to osmotic laxatives such as Osmolax* and Movicol* which help bring more water into the bowel to soften the stool through. Adult Glycerol suppositories* are a wonderful help if someone is very constipated, to assist with defaecation and prevent the patient from straining (remember avoiding straining is the best advice particularly if you have rectal or vaginal prolapse, anal fissures, proctalgia fujax, haemorrhoids or have had gynae repair surgery………actually never strain is the best motto). Remember all products have different names in overseas countries so you need to check with your pharmacist going by category – fibre (soluble/insoluble), osmotic laxative, stimulant laxative and so on.
Proctalia fujax can be considered a chronic or persistent pain condition so once the mechanics of defaecation have been corrected, then sometimes a medication like Endep* (prescription item definitely discuss with your doctor) can help with decreasing the constant messages from the pelvic region, while the new defaecation pattern is decreasing the tractioning on the nerves from straining at stool and chronic pain education.
Poor gas control and faecal incontinence is distressing and can lead to people leaving their chosen employment, becoming very anxious and even agoraphobic. I have covered in a previous blog the importance of dietary management, regular pelvic floor exercises (particularly the external anal sphincter) and Imodium to help control the incontinence. Overeating can also cause excess gas production and having just emerged from a notoriously bad time for overeating (Christmas) it may pay to look at portion size as one of the strategies to help excessive gas production.
Simple strategies such as always using flushable wipes (they live in the toilet roll aisle and come in a large size for the home toilet and a purse or pocket size) to complete the cleaning phase on the toilet, often assists when post defaecation soiling is a constant issue. There are also new types of pads for patients with faecal soiling which have odour control qualities and it is important to use barrier creams to protect the skin (such as Sudocrem) if soiling is a daily problem.
I hope some of these hints are helpful and may all our portion sizes be what they should be in 2013!
*Please discuss the taking of any preparations/medications with your GP, medical specialist or pharmacist.