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This week is Women’s Health Week and Jean Hailes for Women’s Health has a brilliant webpage dedicated to promoting this week. I encourage you to head to this page as it has lots of fantastic information on it- practical advice that will benefit young women, older women, active women and those looking to start the process of improving their health.

Today’s topic is devoted to Silent Issues affecting Women’s Health – and quite frankly there are so many it’s difficult to know where to start? Faecal incontinence? Urinary incontinence? Prolapse? Sexual pain? Constipation? These are all issues which confront women who have had babies (mostly) on a daily basis and ones which have evidence-based treatment strategies to considerably improve their impact on women if not cure them.

Back in 2013, I wrote this blog on All About Bowels because bowel dysfunction is very distressing for many women and it isn’t something that people really want to sit down and have a coffee and chat about. It’s a classic silent problem. So I thought I’d re-post the blog here to summarise all the different issues wrapped up in bowel dysfunction.

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 fugax – 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. (I have included a new chapter on The Early Years in the new edition of Pelvic Floor Essentials.)

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 one of the pelvic floor muscles called puborectalis) to release the stool will make it easier to completely evacuate the bowel motion. In both of my recently updated books in the  Pelvic Floor Recovery series, (Pelvic Floor Essentials Edition 3 and Pelvic Floor Recovery: Physiotherapy for Gynaecological and Colorectal Repair Surgery Edition 4) I go through in detail these three elements to effective, pain-free and more complete evacuation. I have included the diagram for the adult defaecation position below.

Defaecation Position

Copyright Sue Croft 2018

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 puborectalis and the external anal sphincter (ie. creates a funnel to release the stool).

Eating enough dietary fibre is an important first step when managing stool consistency. Seeing a dietitian for assistance with a FODMAPS diet can also successfully manage too loose a stool, too firm a stool, excessive gas production or bloating. Using a product to normalize the bowel motion can be helpful 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 laxativestimulant laxative and so on.

Proctalgia fugax can be considered a chronic or persistent pain condition so teaching about the science of pain is very important for the patient. Of course the mechanics of defaecation have to be corrected and this decreases the tractioning of the nerves from straining at stool.  For some patients a  medication like Endep* (prescription item definitely discuss with your doctor) can help with decreasing the constant messages from the pelvic region and most importantly relaxation of the pelvic floor muscles and anal sphincter, general body relaxation and belly breathing will be helpful. 

Poor gas control and faecal incontinence is distressing and can lead to people leaving their chosen employment, becoming very anxious and even agorophobic. 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 it may pay to look at portion size as one of the strategies to help excessive gas production.

Simple strategies such as using a flushable wipe (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 (dispose of in the sanitary product bin), 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.

*Please discuss the taking of any preparations/medications with your GP, medical specialist or pharmacist.

I hope some of these hints are helpful and share it with a relative or friend if they have confided in you that they have bowel problems!