Bowel and bladder health

--What are common issues with bowel and bladder health?

The most common issues include the following conditions. Treatments are different for everyone, and usually involve education and specific exercises.

Incontinence

21 per cent of all Australians above the age of 15 years have urinary incontinence (UI), faecal incontinence (FI) or both.

UI is accidental leaking of urine from the bladder. The most common causes of UI are physical stress, like exercise or coughing—stress urinary incontinence (SUI); an urge to run to the toilet and not making it on time—urinary incontinence (UUI); or because you can’t empty the bladder properly and it becomes too full.

FI is accidental leaking of gas, leaking from the bowels (faeces) or staining in your underwear.

In men, urinary incontinence (UI) can be common after prostate surgery/radiation. In women, UI can be common after childbirth. There is also a high number of younger women who have UI, or FI, who are involved in high-level sports. So, it is not just an age-related problem. And ‘common’ doesn’t mean ‘normal’—you do not have to live with it.

Urinary frequency, urgency or excessive urination during the night (nocturia)

This is going to the toilet a lot (more than 5–7 times/day), feeling like you have a sudden or very strong sensation that you have to empty your bladder immediately, or waking more than once during the night to empty your bladder. Some people may have what is called an ‘overactive bladder’ where the bladder contracts too often, others may not be emptying their bladder fully.

Constipation

Difficulty with emptying your bowels/hard stool form. This may feel like you can’t go at all, you can’t empty it all out or you have to strain a lot to empty.

Pelvic organ prolapse (POP)

Women can have a dropping of their bladder, bowel or uterus into their vagina. One in five Australian women will have surgery for POP in their lifetime, including (although rare) in women who have not given birth. Symptoms include feeling like there is a lump in the vagina, an ache or heaviness in the vagina, low back pain, and, in more serious cases, discharge and bleeding.

Pelvic pain

Pelvic pain affects many Australian men and women. This includes issues like pain with emptying bladder or bowels, pain with sex, severe pain with periods, any other pain in the pelvis area, and, sometimes, urinary tract infections.

--What might be the cause behind my problems?

More often than not, there is more than one reason why these problems happen.

The reasons range from:

• poor lifestyle habits (like being overweight, unhealthy eating, what exercise you are doing)
• poor posture, in general or during exercise
• weak pelvic floor muscles
• unrelaxing your pelvic floor muscles
• damaged spinal or pelvic nerves
• damaged connective tissue, and even guarding reactions from your brain working extra hard to protect you if it thinks something may be in trouble.

--How do I know if my issues require physiotherapy or other medical attention?

If you experience a sudden loss of control of your bladder and bowels (incontinence and/or constipation of bladder or bowels), severe back pain, and numbness in your ‘saddle’ area (ie, the part of your groin, bottom and inner thighs that would touch a saddle), you need to seek medical attention immediately. These symptoms can be due to a rare, but serious, condition that involves extreme swelling around the nerves of the spinal cord. Otherwise, your physiotherapist specially trained in bladder and bowel health will be able to diagnose and treat you, as well as communicate with other medical professionals as needed.

--Should I be worried if I can’t control my bladder and bowel after surgery?

Certain surgeries may increase your risk of developing poor bladder or bowel control.

For example, up to 87 per cent of men can have urinary incontinence after having prostate surgery, but most men are better, or cured, within a year after surgery. Removing the prostate during surgery, or destroying it through radiation treatment, can change how well the bladder can hold urine.

Women are also at risk for poor bowel control if they have had a third- or fourth-degree perineal tear (into the anal sphincter muscles) during childbirth. However, this lack of control may not happen until they reach menopause.

--How can physiotherapy help my continence issues?

Pelvic floor physiotherapy can help continence issues through:

Education and advice 

Explaining why this is happening and working out how to change some lifestyle habits if they are contributing to the problem

Pelvic floor muscle and abdominal exercises

These can help by strengthening or relaxing the muscles that support and close off the bladder and bowels.  Abdominal muscle exercises may be important for proper breath control, core strength or helping the pelvic floor muscles. A strengthening or relaxation program will be specifically designed for you, including how to include them into your general daily activities or other exercises you enjoy doing

Pessaries

Some women may be able to use a silicone device that sits up inside the vagina and helps bladder control. It can be like a tampon where it is placed inside the vagina and you don’t feel it once it is in place. This can be used daily or just when needed in exercise.

--How effective is physiotherapy for bowel and bladder conditions?

Research shows that doing pelvic floor muscle training helps bladder and bowel control in both men and women. 

Some women who have urinary incontinence have found that using a specific type of vaginal pessary that is worn inside the vagina helps with their bladder control and sometimes symptoms of pelvic organ prolapse.

Specific assessment and treatment tools that physiotherapists use in bowel problems (such as certain types of constipation and incontinence) have been shown to improve symptoms and make a difference in their quality of life.

--What can I do at home to help my condition?

Toilet posture

Use blocks, books or small stools to put under your feet (to keep your knees higher than your hips) when you sit down to go to the toilet, especially to empty your bowels. Keep your back straight and tummy relaxed, arms relaxed on your legs.

Stop straining to empty bladder or bowels

You need to be relaxed first, this includes your pelvic floor muscles (see instructions below). If nothing happens when emptying your bowels, try making the sound ‘mmmooo’ like a cow (your tummy should bulge outwards, not get tight and pull in).

Bristol Stool Chart

This tool shows seven categories of stool. Everyone has different bowel habits, but the important thing is that your stools are soft and easy to pass. 

Be aware of your pelvic floor muscles in different positions 

Lying on your back, sitting, standing, during lifting type exercises

Pelvic floor muscle contraction and relaxation

In any position you are comfortable, imagine trying to hold onto urine (squeezing and lifting the pelvic floor muscles below) then slowly relax them. Be aware of the sensation of both contracting and relaxing. Try changing how you breathe by breathing in to relax, then breathing out to contract. Or holding a gentle contraction for 3–5 seconds before relaxing. Try 5–10 of those.

The knack

Get into the habit of quickly squeezing and lifting your pelvic floor muscles before you blow your nose, cough, sneeze, lift up a toddler, get up from a chair, et cetera.

--How long until I feel normal again?

Every person is different. Your ‘normal’ may not be someone else’s. Most people find that small changes make a big difference to their symptoms and feel they are improving within the first month. Recovering fully, if this is a possibility, can take up to a year for some people.