Obstructed defecation is a condition in which there is difficulty having a complete bowel movement. It is common to feel like the poop is ‘there’, but the urge isn’t strong enough to get it out. When you finally do pass a poop, it doesn’t all come out. This can lead to discomfort, a messy finish, a need to go lots of times, and sometimes an accident because the leftovers ‘sneak’ out later.
If you have been diagnosed with obstructed defecation, the problem is likely to be in the rectum and/or the anus, i.e., the last 15cms of the colon. However, sometimes the colon is also slow at moving its contents along. This is referred to as a transit problem and will add to your woes.
What are the causes of obstructed defecation?
1. Anismus
This condition occurs when the anal sphincter, which controls the release of poop, contracts instead of relaxes during defecation. This is an example of ‘dyssynergic defecation’, which really just means that the pelvic floor muscles are not well coordinated with the rectum. A ‘paradoxical puborectalis contraction’ is a similar diagnosis, but in this case the inappropriate contraction is occurring in the hammock layer of the pelvic floor rather than in the sphincter. People with this condition tend to strain harder and harder for less of a result, and they may cause other problems such as haemorrhoids or prolapse, in the process.
This video will help you understand the mechanics of normal defecation and what it means to be unco-ordinated:
2. Rectocele
A rectocele is a bulge or herniation of the front wall of the rectum into the back wall of the vagina. It is caused by a weakening of the tissue between the rectum and vagina. The weakness is often caused by childbirth even though it may not become apparent until many years later. Straining or working with heavy loads or high impact activities over time will weaken the tissue more.
Everyday loads and straining can trap the poop in the herniation, which acts like a kind of pocket’. Women with a rectocele may need to press up on the undercarriage, or insert their fingers in to the vagina in order to get all the poop out.
3. Enterocele
An enterocele is a herniation of the small intestine towards the vagina, caused by a weakness in the tissue at the top and back of the vagina. It can happen after a hysterectomy because the uterus is no longer there to take up the space.
4. Pelvic Floor Muscle Weakness
A brisk ‘snap back’ of the pelvic floor muscles close to the end of bowel emptying helps the last bit of poop to come out, and ensures a cleaner finish. Weakness of the pelvic floor muscles will therefore make it more difficult to fully evacuate the last bit.
5. Tight, Short Pelvic Floor Muscles
Some people hold tension in their pelvic floor muscles for long periods of time, even perhaps when they are asleep!. When a muscle is worked hard it will get tight and short. Just think how the backs of your thighs feel after a hard run! A tight short pelvic floor won’t be able to lengthen well enough to allow the anorectum to open completely. Less commonly, scar tissue after radiotherapy or surgery can also prevent the rectum from opening properly.
6. Low Tone Rectum
Over time, ignoring the signals to poop and ‘holding on’ can result in an overstretched rectum that loses both sensation and power. The rectum can’t feel the poop entering, so you won’t get much of an urge, and the rectum doesn’t have the strength to contract to evacuate so the emptying will be incomplete.
A build-up of hard, dry stool in the rectum can even cause faecal impaction, which can cause difficulty with bowel emptying. Sometimes loose poop can sneak its way around the hard mass, and leakage can occur. Faecal impaction in the rectum needs to be treated from the top down with laxatives, and from the bottom up, with enemas and suppositories.
How Can Pelvic Floor Physiotherapy Fix Obstructed Defecation?
1. Pelvic Floor Muscle Rehabilitation
Your therapist will assess the function of your pelvic floor muscles to determine any muscle imbalances or weaknesses that may be contributing to the problem. Sometimes the muscles need to become stronger. Sometimes they need to relax more completely. Sometimes they need to have more length and become more flexible. Sometimes they have tender points that need to be released. Sometimes there are scars that need to be mobilised.
2. Biofeedback Therapy
Your pelvic floor physiotherapist may use biofeedback therapy to help you learn to coordinate your pelvic floor muscles during defecation, which can improve emptying. The biofeedback can take the form of electromyography (EMG) with skin electrodes or an internal probe. An anorectal balloon can be used to retrain sensation or relaxation and co-ordination for expulsion in cases of anismus or dyssynergic defecation.
3. Posture and Pushing Education
Your therapist can teach you proper toilet posture and the best body mechanics to use for defecation. The anorectum is bent at a 90-degree angle at rest, but you can learn how to straighten out this angle as you push. You may need to learn to use your abdominal muscles and diaphragm (breath) differently. This video might help you:
4. Integrating a Bowel Management Program
Your bowel will empty best if your colon moves well, and if your poop is a good consistency. Your therapist can work with you to develop a bowel management program that includes a proper diet, appropriate fluids, stool regulators, stress management, and good bowel habits to give the rectum the best possible chance of emptying
Conclusion
If you’re experiencing obstructed defecation, seeing a pelvic floor physiotherapist can help improve your bowel movement. There are several things your therapist can do to manage any issues and develop a proper program to improve your bowel function. Book with us today and we’ll help you get started.
