There are a collection of bowel issues that are treatable or manageable. Some exmples are below:

Constipation:

Not just about straining or having hard poos.

You may have constipation if you experience 2 or more of the following:

• less than 3 bowel motions a week

• lumpy or hard stool

• need to strain or bear down

• not feeling empty after, and maybe feeling like you have to go again

• the use of fingers or thumbs to help empty your bowels.

Long term constipation can contribute to other issues such as pelvic organ prolapse and bladder leaking.

Bowel urgency

Fecal Smearing

Bowel Leaking (wind or poo)

Rectal or anal pain

This depends on the issue you have. Some common reasons for bowel issues can be due to:

• Structural support your vaginal walls, or position of your cervix

• Overactive pelvic floor muscles (or tight muscles)

• Coordination of your pelvic floor muscles

• Pelvic floor muscle strength

• Anal sphincter muscle compromise

• Some medications

• Impaction or size of bowel movements

Your pelvic floor muscles are responsible for supporting the organs in your pelvis and controlling the sphincter that hold in poo and wind. Incontinence or difficulty with control might be a sign that these muscles lack in strength or coordination.

Neurological presentations, such as Multiple Sclerosis and Parkinson’s Disease will often present with bowel dysfunctions due to the muscles and nerves not communicating properly.

Bowel issues can affect a person of any age or background.

Some issues can be associated with other diagnosis like endometriosis or pelvic pain, and others can be linked to pregnancy or delivery trauma.

Factors that may increase a risk of bowel urgency or control issues include:

• Having a baby >35yo

• BMI >30

• Having bowel control issues in pregnancy

• Spontaneous vaginal delivery

• Having a baby >4kg

It is important to find out why someone is experiencing bowel issues, and the history of it.

There is no one size fits all answer to anal or bowel issues. Some treatments work very well for some groups, but not for others.

Questions need to be asked about when it happens, what might be the situation surrounding it happening and if it has changed over time.

Depending on the type of bowel concern a person has will navigate the type of treatments available.

Treatment can include:

• Pelvic floor muscle/anal sphincter release

• Pelvic floor muscle/ Anal Sphincter coordination or strength training

• Urgency suppression techniques

• Containment & garment advice & education

• Bowel sensory retraining

• Biofeedback therapies

• Electrical Nerve Stimulation (ENS)

• Sacral Nerve Stimulation (SNS)

• Lifestyle and behavioral modifications

• Exercise

Conservative management (like those described above) is the recommended first line of treatment.