Continence Awareness Week : Bowel Problems

The bowels are part of your digestive system and help you to process your food, helping you to absorb nutrients and water. When working well, you should empty them from 3x per day to 3x per week. Anything outside of these ranges could signal problems such as constipation, urgency, food intolerances, prolapse or irritable bowel syndromes.

Problems relating to your bowels can be embarrassing, making you feel nervous when leaving the house. Some of my clients have struggled with their jobs due to bowel issues. It's definitely a problem that needs effective treatment. But the average time taken to seek help is up in the decades, often due to difficulties knowing where to go, who to speak to and embarrassment of talking about the bowels with a stranger.

So, first of all, let's look at bowel problems and put a name to them. This will help you to articulate your problems when seeking help:

1. Constipation
A slow moving bowel often leads to frustration and sometimes pain and bleeding when emptying. If you are emptying your bowels less than 3x per week or if you struggle to initiate a bowel movement, it's likely that constipation is your problem. If you have to strain and push to be able to empty your bowels, this will have a weakening effect on your pelvic floor muscles. Regular and intense episodes of straining can risk prolapse of your pelvic organs into your vaginal walls.

You need to look into the possible causes of your constipation:
> Are you drinking enough water?
Water is key to normal bowel function, aim to drink approximately 2L of water each day. Gradually increase this intake over time and see how it changes your bowel function.
> Are you eating enough of the right fibre?
Fruit and veg are obvious choices for bowel health, but make sure you have a mixture of soluble and insoluble fibre. Watch out for foods that may irritate your bowel in particular. Completing a month long food diary can be really useful. I love the Bowelle App that's available on iPhone. There are other App's available on android that will do the same thing.
> Are you listening to your bowel?
The gastrocolic reflex (movement of the bowel muscles) is strongest in the morning and especially after breakfast. Do you give yourself enough time after breakfast? Take time to listen to your bowel and don't rush your time on the loo.
> Are you sitting on the loo correctly?
Sitting on the loo is the first thing...don't hover! Sitting allows the pelvic floor to relax and open up the angles in your rectum and release the anus. 
Try sitting with your feet on a stool, so that your knees are higher than your hips. Lean forwards and rest your forearms onto your thighs...and breathe! This position straightens your anorectal angle, making it easier for the stool to leave the bowel.

2. Urgency
A sudden and strong desire to empty your bowels can take you by surprise and leave you feeling nervous about leaving the house if you haven't emptied your bowels. 
A weak and thin pelvic floor can allow the stool to rest lower in the bowel and trigger urgent sensations. Therefore, pelvic floor muscle training can help to bulk up the cushioning and reduce the urgency that is due to heaviness. The same stands for urgency relating to posterior pelvic organ prolapse (rectocele).
Again, make sure you avoid eating or drinking anything that irritates your bowels and causes urgency. Drinks including caffeine can cause urgency, so that double can espresso from the coffee shop could be a trigger for you!

3. Bowel Incontinence
Leakage from the bowel can be very distressing. Weakness and dysfunction of the anal sphincters and pelvic floor are often the cause for this problem. A 3rd or 4th degree tear at childbirth can be a starting point for this weakness. Again, pelvic floor and core training can help to improve the support and closure pressure of the bowels, reducing leakage and improving your sense of control.