Constipation - Functional Management

Constipation is the difficulty with passing a bowel motion that can be related to hardened faeces BUT it can also be due to dysfunctional bowel motion control: 

Dyssynergic Defaecation

• This occurs when​ the pelvic floor muscles contract instead of relax when you are emptying your bowel. 

• This obstructs the passage of faeces from rectum to anus.  

Ineffective Passage of Faeces ​

This may be from: 

• Motor and sensory changes within the rectum and/or anus

• Post-partum perineal descent

• Prolapse

• Defaecation mechanics (ie how you actually empty your bowels)

​​

Faecal Incontinence

​This is the involuntary leakage of faeces.  It may be

1. Passive - you don't feel it happening

2. Stress related - coughing, sneezing, lifting, carrying

3. Urge related - if there is a defect in the sphincter, insufficient pelvic floor muscle strength or a neural dysfunction

It may occur as a result of giving birth, having a weak pelvic floor, anal sphincter defect, neural dysfunction or secondary to chronic constipation

​​

Flatal Incontinence

This is the involuntary leakage of gas/wind/farts

​

Faecal Urgency

This is when your normal bowel urge comes on too quickly or strongly causing you to race to the toilet. It can be caused by neural dysfunction, weak pelvic floor muscles or anal sphincter defect.  

​

Anorectal Pain

Dyschezia

• Pain passing a bowel motion

• Usually related to other pathologies (anal fissures, haemorrhoids or pain syndromes)

Chronic Proctalgia​

• Ongoing rectal pain or aching lasting >20mins

• Caused by tightness of one of the pelvic floor muscles (puborectalis)

Proctalgia Fugax

• Repeated episodes of pain in the anus or rectum lasting a few seconds/minutes with no pain between bouts​

• Can be related to history of chronic constipation

• May be a spasm of the anal sphincter or puborectalis

​

All the above issues are treatable with Pelvic Health Physiotherapy