'Your Gut Feeling'
In this first of a two-part blog I will talk about IBS and how it can affect you. And more importantly how we can help you.
Irritable Bowel Syndrome (IBS) is often characterised by stomach cramps and an unpleasant bloated feeling in the abdomen. Plus susceptibility to diarrhoea or constipation. Or, if you are really unlucky, both.
I imagine it is not necessarily something you would consider seeing a Physiotherapist for!
However, some of the symptoms of IBS can be improved with physiotherapy. Read on for more details.
What is IBS?
IBS is considered a functional gastrointestinal (GI) disorder. Functional GI disorders are related to problems with how your brain and your gut work together (more about that in Part 2). They can cause your gut to be more sensitive.
During episodes of diarrhoea this can lead to difficulty controlling bowel movements causing episodes of bowel urgency or leakage of stool.
During episodes of constipation, this may lead to spending prolonged periods of time on the toilet, straining at stool and feelings of being unable to empty the bowel fully. Straining puts pressure on the muscles and connective tissue which support your bowel and pelvic organs. Over time this can cause weakening/stretching and this may contribute to pelvic floor problems. These problems may include pain, incontinence or symptoms of prolapse.
Depending on your presenting problem, a specialist physiotherapist with expertise in managing bowel conditions can help you with retraining coordination of the pelvic floor muscles. In addition to this, discussing lifestyle, diet and liaising with your GP or specialist nurse regarding medication may also be necessary. A nutritionist or dietician may also help with identifying any foods that may be impacting on your bowel problem.
Bowel Urgency or Incontinence
Your pelvic floor muscles should tighten at the right time so that you are able to make it to the toilet. The two muscles at your back passage; the internal anal sphincter and the external anal sphincter, work as a team. The first muscle ‘samples’ what has arrived; wind, formed stool, loose stool and lets you know. This is when you realise it is time to go to the toilet.
The external anal sphincter then gets the message that there is something there and closes tightly, until it is convenient for you to empty. Obviously we do not want to override the internal anal sphincter’s messages for too long as this can eventually cause constipation.
If there is weakness in the external anal sphincter muscle, the job of closing the door properly maybe affected. If your stool is particularly soft, it can then make it very difficult to suppress the urge to empty your bowels and get to the toilet in time. Sometimes stool leaks out.
Physiotherapy treatment techniques involve strengthening this muscle complex and the rest of your pelvic floor, to improve your awareness and control. There are also devices such as anal pugs that can be helpful for increasing confidence in the meantime.
Straining at Stool
A normal bowel movement requires coordinated abdominal, pelvic floor and external anal sphincter muscle control.
The puborectalis muscle (part of your pelvic floor) is like a sling that keeps the lower part of your bowel at an angle (around 90 degrees) to prevent stool coming too low when you are not ready to empty your bowels.
If this angle stays at 90 degrees whilst you try to poo and if you are unable to release it, it is going to be very difficult to empty your bowel effectively. This is known as pelvic floor dyssynergia; where the muscles that control defecation work in the wrong pattern/order.
You may also find that you hold your breath, tense or brace your abdominals and the more superficial muscles that you need to relax around your back passage.
To help you with these problems a specialist physiotherapist may use treatment techniques. What are these techniques I hear you ask? Altering toileting posture and bowel habits, modifying breathing, releasing tension in the pelvic floor or abdominals to name a few, as well as utilising biofeedback devices to re-educate the pelvic floor muscles. Not to mention retraining those pesky muscles that may have become weak from straining.
If you have concerns about your poo (or lack of) please get in touch.
Happy Pooping ,
Email me at – firstname.lastname@example.org
‘Gut’ – The inside story of our body’s most under-rated organ, by Guilia Enders 2017. An easy, entertaining, informative read about the gut!