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August is a very special month for preventative health. The Australian Physiotherapy Association (APA) in conjunction with Steel Blue have created Tradies National Health Month – Don’t Ignore The Pain, to help provide valuable information for Tradies on the importance of full body health and safety. These two organizations felt there was no dedicated health and safety information centre for Tradies. So they have teamed up to create a month that focuses on full-body health and safety for Tradies to improve awareness and support in this area. There’s a great website with downloadable handouts on all sorts of things: Preventing low back pain, ankle injuries, knee pain, the effect of noise and lots more. The best part is Dave Hughes (comedian extraordinaire) has done a brilliant Tradies anthem to celebrate Tradies month
But there is an important area that I would like to talk about and that’s the potential for damage to the pelvic floor of the Tradies. Working on a construction site involves lots of squatting, lifting heavy objects and straining while holding a heavy object in place to secure it – and all these manoeuvres place a tremendous load on the pelvic floor- particularly the rectum and anus. Rectal prolapse and haemorrhoids can be a common problem and many times the man may not even be aware that a Continence and Women’s Health Physiotherapist (yes the name is a bit of a turn off for the male patient!- no mention of Men’s Health) is able to give great advice to help treat and prevent recurrence of these debilitating and painful conditions.
Rectal prolapse is when the lining of the rectum starts to pull away from the rectal wall and bulges down towards the anus and can protrude out of the anus. It makes defecation difficult, can lead to soiling, bleeding and worse still intractable pain. Most people associate prolapse as something only caused by childbirth but the things required on a building site such as lifting excessively heavy weights and prolonged squatting can  be a common cause of rectal prolapse.
Haemorrhoids are often described as the varicose veins of the anus and rectum. There are two types: internal and external and they are enlarged bulging blood vessels in and around the anus and rectum. They can bleed and be very painful and can make defaecation more difficult and cause great discomfort.
So what would help them? What are the conservative strategies that a Continence and Women’s Health Physiotherapist would go through with a Tradie if he presented for treatment?

  • Apart from reducing the heaviness of the weights and sharing the load between two workers instead of always lifting by themselves (perceived as a sign of weakness?), a crucial strategy would be for them to learn how to brace or engage their deep abdominal muscles and their pelvic floor muscles, specifically their anal sphincter, prior to lifting the heavy construction materials.
  • Ensuring that they are using the correct position and dynamics of defaecation to prevent further worsening of their haemorrhoids or rectal prolapse when passing a bowel motion (straining is a common pattern adopted when there is bulky tissue there and of course this makes things worse!)

Male toilet position

  • Using a product to keep the bowel motions very soft and easy to pass is critical when you have these problems (and also to help any constipation or faecal incontinence). Doing something simple like a corn or beetroot 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/beetroot test, have no corn/roasted beetroot for a week, then a whole cob of corn/large serve of roasted beetroot, 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/purple bowel motion and when you last see it. If it takes longer than 47 hours to see the tagged stool, then you have some slow transit time happening in your bowel.
  • Products range from fibres which are good for softening the stool such as a natural fibre called psyllium husks, Normafibe* (which is also very helpful if your stool is too loose and there is faecal incontinence – 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 prolapse, anal fissures, haemorrhoids or have had colorectal repair surgery). If the pelvic floor damage progresses due to a lack of intervention(conservative treatment) then things such as poor gas control and faecal incontinence can occur. These conditions are distressing and can lead to people leaving their chosen employment and becoming very anxious. 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 and poor food choices at lunch can also cause excess gas production and it may pay to look at portion size and a healthier diet 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 also a pocket size) to complete the cleaning phase on the toilet often assists when post defaecation soiling is a constant issue. It is important to use barrier creams to protect the skin (such as Sudocrem) if soiling is a daily problem.
  • *Please discuss the taking of any preparations/medications with your GP, medical specialist or pharmacist.

Discussing these very personal problems is never easy- they are very private and particularly difficult for men to discuss. But the more we, as health professionals, bring them out into the open and alert clients to the (sometimes) easy interventions that can make a huge difference, the more confident they will be to seek help from a Continence and Women’s (and Mens’s) Health Physiotherapist. If you wish to Find a Physio to help with any problems go to the APA website.
I hope some of these hints are helpful for all the Tradies (and their partners) in August and I congratulate the APA and Steel Blue on this great initiative.