Bowel Dysfunction

The pelvic floor and bowel function

Effective bowel function depends on precise coordination between the pelvic floor, the anal sphincter, and the abdominal muscles. Problems arise when this coordination breaks down, either because the pelvic floor fails to relax at the right time (causing constipation or difficulty evacuating), or fails to stay closed (causing urgency or leakage).

Conditions we treat

• Constipation and difficult evacuation, often driven by pelvic floor coordination difficulty, where the muscles tighten rather than release during defecation attempts. Treatment focuses on relaxation, optimal toileting position, and breathing coordination, not simply laxatives.
• Fecal urgency, a sudden, strong urge to defecate that is hard to hold back. Related to anal sphincter function and pelvic floor coordination.
• Fecal incontinence, involuntary loss of stool or gas. Can be related to sphincter weakness, nerve function, or poor timing and coordination of the pelvic floor.
• Incomplete evacuation, the sense that a bowel movement is incomplete. Often related to pelvic floor tension or suboptimal toileting mechanics.
• Obstructed defecation, difficulty with rectal emptying, sometimes associated with a bulge of the back wall of the vagina (posterior vaginal wall prolapse).

Treatment approach

• Pelvic floor relaxation training, learning to fully release and lengthen pelvic floor muscles to allow the the angle of your rectum to open.
• Breathing and pressure coordination, using the breath effectively to manage internal pressure in your abdomen during defecation.
• Toileting position, optimizing posture on the toilet to reduce straining and improve anorectal mechanics.
• Real-time muscle feedback, visual feedback on sphincter and pelvic floor activity to support re-coordination.
• Diet and fluid guidance, practical recommendations based on your specific pattern of dysfunction.

How physiotherapy can help manage fecal incontinence

Fecal incontinence, the involuntary loss of bowel control, can bring considerable distress and impact daily life. Physiotherapy offers a range of evidence-based strategies designed to strengthen, retrain, and restore function to the muscles and nerves involved in continence.

One of the cornerstones of physiotherapy for fecal incontinence is pelvic floor muscle training. Physiotherapists teach tailored exercises that target the muscles supporting the rectum and anus. Through regular practice, these muscles become stronger and more coordinated, helping patients regain control over bowel movements.