Bowel Dysfunction

Bowel dysfunction can have many causes and can present as a wide range of symptoms including diarrhea, constipation, pain, bleeding, and difficulty evacuating the bowels.

Causes of Bowel Dysfunction

• Myofascial tension
• Diet-related factors
• Lack of movement
• Inflammation and irritation of the gut
• Stress and anxiety
• Neurological conditions

Types of Bowel Dysfunction 

• Irritable Bowel Syndrome:
  • Characterized by pain before, during, and after a bowel movement.
  • Pain is sometimes lessened with evacuation.
  • Gas and bloating.
  • Mucus in the stool.
  • Feeling of incomplete evacuation.
  • Three categories of IBS:
    • IBS-D: diarrhea-predominant
    • IBS-C: constipation-predominant
    • IBS-M: alternating diarrhea and constipation
  • Inflammatory Bowel Disease
    • Crohn’s Disease and Ulcerative Colitis
      • Characterized by inflammation of the digestive tract.
      • Abdominal pain and/or cramping
      • Diarrhea
      • Blood and/or mucus in stool
      • Fever
      • Fatigue
      • Weight/appetite loss
      • Malnutrition
    • Other Types May Include Dysfunction Driven By:
      • Muscle and Soft Tissue Dysfunction:
        • Tension
        • Weakness
        • Lack of coordination
        • An overactive, stressed-out nervous system
      • Not all bowel concerns are categorized or given a specific diagnosis.

Signs and Symptoms of Bowel Dysfunction

• Diarrhea
  • Loose, watery, unformed bowel movements.
  • Evacuation of stool occurs more than 3 times daily.

• Constipation
  • .

• Abdominal Pain Due to Bowel Dysfunction
  • Pain and cramping from a variety of factors:
    • Bloating and/or cramping from gas
    • Myofascial tension
    • Fecal retention
    • Inflammatory bowel disease or irritable bowel syndrome

• Hemorrhoids
  • Swollen veins in the anal and rectal area.
  • May be internal (inside the rectum) or external (around the anal opening).
  • Symptoms/signs: Rectal pain and bleeding with bowel movements, rectal itching.

• Fissures 
  • A small tear in the lining of the anus.
  • Potential cause: Passing hard or large stool during a bowel movement.
  • Symptoms/signs: Rectal pain and bleeding with bowel movements.

• Faecal Incontinence
  • Inability to control bowel movements, resulting in the leakage of stool.
  • May range from a small amount of stool lost to loss of the entire contents of the bowels.
  • Can be due to:
    • Fecal impaction as a result of severe constipation
    • Weakness of internal and external anal sphincters

• Dyssynergia
  • A lack of coordination of muscles.
  • In the case of bowel dysfunction, the pelvic floor muscles contract instead of relaxing when attempting to evacuate.

• Difficulty Evacuating
  • This could range from lacking the urge to evacuate the bowels, difficulty initiating evacuation, or failure to fully evacuate.
  • Prolapse of the rectum can result in difficulty evacuating because stool can get stuck in the “pocket” of the prolapse.
• Pain During or After a Bowel Movement
  • Could be due to many factors:
    • Persistent pelvic pain conditions
    • Bowel conditions such as Irritable Bowel Syndrome
    • Inflammatory bowel diseases such as Crohn’s Disease or Ulcerative Colitis
    • Endometriosis
    • Tension in the pelvic floor muscles
    • Anal fissures
    • Internal or external hemorrhoids

Treatment for Bowel Dysfunction

Pelvic health physiotherapy is an essential component in the treatment of symptoms associated with bowel concerns. Treatment may include:

• Hemorrhoid/fissure care education
• Bowel and bladder education
• Toileting/evacuation positioning and techniques
• I-L-U abdominal self-massage
• Pain education
• Diet modification
• Therapeutic exercise
• External myofascial techniques
• Internal myofascial techniques
• Pelvic floor muscle training
  • Proprioceptive training
  • Strengthening muscles
  • Lengthening/relaxing muscles
• Treatment of the nervous system

Bowel concerns can have a major impact on one’s daily life, but the treatments above can offer an understanding of how your body works, ways to improve its function, and increased control over your symptoms.