Patient Information Leaflet



Patient Information Leaflet

Happy Bowels

DRAFT

Produced By:

Pelvic, Obstetric & Gynaecological Physiotherapy

Constipation and faecal incontinence

Chronic constipation is frequently a cause of damage to the pelvic floor muscles and fascial support (ligaments.)  In some cases, chronic constipation can also cause stretching of the pudendal nerve due to prolonged and repetitive straining (leading to pelvic floor weakness secondary to nerve damage.)

Constipation also creates more pressure on the bladder and urethra which may cause increased urinary frequency or retention. 

When you are constipated modifications such as dietary changes, toilet habits and positions, and exercise and bowel mobility exercises such as the ‘I Love You’ massage should be considered before laxatives or stool softeners are used.

General Recommendations:                                       

• Fluid intake should be around 24mls per kilogram of body weight of non-caffeinated fluid and not including alcohol.  Most of your fluid intake should be water and should not include sweetened beverages as refined sugar contributes to constipation. 

• Fibre intake should be approximately 30-40 grams/day.  If your intake is below this recommended level of fibre, increase your fibre slowly so as not to cause bloating and pain. 

• It is important to eat insoluble fibre.  This includes lots of leafy green vegetables.  This gives looser more fibrous stool. (Please note that some medication absorption is affected by increased fibre.  For example, Calcium, Potassium, Iron and Thyroxin are more poorly absorbed when taken with a high fibre meal because it attaches to the fibre and is expelled. Take these medications at a different time than when you eat food which is high in fibre.)  Eating foods such as spinach, rhubarb and prunes can be helpful in stimulating the intestines.  When you are constipated, you should avoid white rice.

• Regular exercise is important for healthy bowel motility.

• Use the ‘I Love You’ (ILU) massage 1-2x/daily to increase the processing speed of your food through your intestines. Sluggish bowels can contribute to constipation.  Just like leaving a cake too long in the oven can cause the cake to dry out, the motility (movement of food) of your bowels can also contribute to your constipation.  If the waste materials are left in your bowels for longer periods of time, more water is extracted, and you become constipated.

• Use Knee to chest stretches to stimulate bowel motility (movement of food and waste materials.)  Do these stretches every morning to help stimulate your bowels. Lie on your back, straightening one leg, and drawing the other knee to your chest, hold this position for 30-60 seconds; repeat on the other side.  Then repeat the stretch by bringing both knees to your chest at the same time for 30-60 seconds.

 Awareness Training for Faecal Urgency:

• Be aware of the reflexes that create an urge to empty the bowels (usually 10-30 min after a meal; occasionally, it can take up to 60 minutes)

• This urge may occur once or twice a day after a meal, or every 2 days depending on the speed of transportation of the bowel contents to the colon

• The urge to empty our bowels occurs each time a portion of the stool reaches the rectum

• This urge results in relaxation of the pelvic floor muscles (if the muscles are weak, you may become incontinent)

• If the reflex is suppressed because of rushing around and finding no time to go to the bathroom when the urge occurs, then the stool will dry out and become constipated

• To retrain this reflex, sit on the toilet 20 minutes after every meal, for 2-3 minutes, practicing deep breathing and relaxing the pelvic floor

• Retraining proper bowel evacuation is a process which may take many months, but the result is gratifying and rewarding.

Emptying our Bowels

In normal bowel function, digested food moves from the stomach into the small intestine where nutrients are absorbed, the waste then moves into the colon where water is extracted before continuing to the rectum. This stretches the rectum, stimulating an awareness of the need to evacuate.

The 2 main components of bowel opening are:

• Increased abdominal pressure

• Relaxation of the anal canal and pelvic floor muscles

If our stools are very loose, the rectum can be emptied without a raise in our abdominal pressure.

Practicing the best technique can help to improve the system mechanics and improve bowel control. Here’s how:

Best position:

1. Sitting with your knees higher than hips, leaning forwards with elbows on knees and a straight spine

2. Allow your tummy to relax, letting it bulge out

3. Tighten and relax the pelvic floor muscles around your back passage whilst pushing down with your elbows

Tips:

4. Saying ‘glug’ as you let go relaxes the jaw and pelvic floor and helps with downwards pressure

5. Contract the pelvic floor as you finish emptying. This will improve the closing reflex, turning the off switch.

If you have problems emptying, you can repeat the process several times but you should avoid straining.

Regular bowel habit

Learning to work with your natural body rhythm can also help. Eating and drinking stimulates bowel movement 20-30 minutes after a meal. After breakfast is when these reflexes are strongest so this is the best time to try.

It is important that you are not rushed and if nothing happens after a few attempts, it is best to stop and try again after your next meal or the next day.

Remember, normal frequency for bowel opening is between 3 times a day and 3 times a week.

You can find more information about the Pelvic, Obstetric & Gynaecological Physiotherapy service online and on Facebook

pelvicfloor.iow

Visit iow.nhs.uk search Pelvic Floor and click on top result

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