Prevention and Management of Bowel Dysfunction by Physiotherapy

Do you or anyone dear to you suffer from bowel incontinence? Is it due to intake of different kinds of medications or after having undergone a certain surgery? Then a proper assessment followed by the treatment is necessary to relieve the condition. Physiotherapy can be one of the interventions. A physiotherapist will help you to retrain your pelvic floor muscles and thus regain normal function.  In this blog, we will spread some light on the physiotherapy techniques used for bowel dysfunction.

 

Bowel Dysfunction

Bowel dysfunction or bowel incontinence is the loss of bowel control. The pelvic floor muscles play a significant role in bowel function. These muscles prevent stool leakage and gas by voluntarily controlling the anal sphincter. Constipation can be induced by different kinds of medications, including oral contraceptives, iron supplements, NSAIDs, antihistamines, and antidepressants. Dehydration can lead to firmer stools, which are more difficult to pass and cause more straining, which can lead to bowel dysfunction. Gastrointestinal distress can affect the pelvic muscles. The absence of voiding regularly can lead the bowel wall to become over distended, which can reduce its ability to contract effectively to propel stool out, resulting in bowel dysfunction.

Certain surgeries can also be a cause for pelvic floor dysfunction, such as surgery for rectum or anus cancer, hemorrhoids, or abscesses. Childbirth procedures like forceps or vacuum delivery, episiotomy, tear in the perineum while giving birth can also be a reason for bowel dysfunction. Injury to the nerves that control the pelvic floor muscles, bowel, or bladder can also cause dysfunction. Brain injuries, spinal cord injuries, multiple sclerosis, spina bifida, and neurogenic bowel or bladder and hormonal changes can also be one of the reasons.

Patients experience the following symptoms:

 

• Pain with bowel movements
• Bleeding
• Straining with defecation
• Fecal  incontinence
• Abdominal bloating
• Fecal urgency and frequency
• Irritation around the anus
• Burping, reflux, difficulty swallowing
• The emotional state of fear, embarrassment, anger, or depression

 

How does physiotherapy for bowel dysfunction help?

Physiotherapy helps to keep the pelvic floor muscles working in shape. The physiotherapist works in coordination with the other specialists to provide the best treatment program. As many contributing factors can cause bowel dysfunction, therefore there can be many different kinds of treatment that can be helpful. The patient first undergoes an evaluation with the physiotherapists for the most effective and individualized program.

 

Diaphragmatic Breathing

The diaphragm and pelvic floor muscles are linked like a piston.  The patient is asked to hold his breath, this stops the diaphragm from moving and hence stops pelvic floor muscles from relaxing, allowing to poop. The therapist teaches how to breathe effectively to poop in the right way.

 

Pelvic Floor Muscle Exercises

Pelvic floor strengthening exercises for the muscles are done to support the rectum. This group of muscles is called the sphincters and they control bowel continence. Weak pelvic floor muscles can cause incontinence. Doing strengthening exercises can lead to control of bowel movements. This is done by tightening the sphincter muscles as if one is stopping a bowel movement. While squeezing tightly, hold for a count of 10 and then relax for a count of 10. This constitutes a step. Repeat this exercise 10 times and do 10 sets per day.

 

Motor Control Training

Motor control training helps to effectively engage and relax the pelvic floor muscles. Effective use of pelvic floor muscles helps to control the bowels. Contract to hold in a bowel movement, and relax to void without straining. The physiotherapist will work by using different techniques to effectively contract and relax the pelvic floor muscles. Biofeedback is a safe and effective tool to manage mild-to-moderate bowel incontinence associated with traumatic sphincter injury.

 

Balloon Training

Balloon inserted into the rectum can be a common tool to assist training for bowel dysfunction. The balloon is inflated to simulate the pressure of an impending bowel movement. The patient is taught to contract the pelvic floor muscles by holding the balloon and relaxing to void the balloon out. In patients with reduced rectal sensation physiotherapy improves rectal sensation and may enhance coordination between perception improving an appropriate urge and holding that urge in patients with reduced rectal sensation.

 

Myofascial and Abdominal massage

Patients with chronic constipation are found to have more trigger points. Restrictions of muscles throughout the pelvic girdle can influence bowel function. The rectum should be able to expand to accommodate stool. When there is damage to these tissues by bowel surgeries, radiation for the treatment of cancer, Crohn's disease, the rectum can lose some of the flexibility. Manual therapy can be used to release the restricted rectal tissues.

 

Stress Management

Increased stress causes increased cortisol levels, which has a negative influence on bowel and pelvic floor function. Relaxation and breathing exercises can help improve the body's homeostasis and keep everything functioning well.

 

Urge Retraining

Due to repeated pushing ineffectively over time, the body can lose sensitivity to urge. Ignoring the urge to poop regularly, can lead to chronic constipation. Repeatedly ignoring the urge to poop, causes the body's intrinsic poop triggers not to get triggered easily because the rectum becomes less sensitive to the incoming signals

 

Physiotherapy interventions used for bowel syndrome, focus on alleviating its symptoms, by maintaining the exercise program designed to reduce anxiety and stress and thus should be followed by the patient on regular basis.

This Blog was earlier posted at CB Physiotherapy