[1] Introduction

[2] Disclaimer

[3] Hello my name is Jana, and I am a registered nurse in the Calgary Pelvic Floor Clinic. Welcome to this video about lower bowel management and your pelvic floor. We will explore 2 common bowel problems: chronic constipation and anal incontinence.

[4] After watching this video, you will be able to:

- understand how your bowel works,

- know the symptoms of constipation and anal incontinence,

- understand changes you can make, such as food and lifestyle changes, that may help with your symptoms; and

- know how physiotherapy can help.

[5] We'll talk about these common bowel problems in a general way.

If you have questions about your bowel health, talk with your healthcare provider, such as your family doctor or nurse practitioner.

[6] Be sure to talk to your healthcare provider if you have any bowel changes such as blood in your stool, weight loss for no reason, or constipation that isn't getting better with treatment.

These can be signals of bowel disease.  

[7] Bowel problems, such as chronic constipation and anal incontinence, are very common and can be challenging to live with.

Your large bowel is a complex part of your body.

There can be many reasons for bowel-emptying problems.

These include stress, certain foods, lack of fluids, low levels of activity or exercise, straining on the toilet, certain over-the-counter and prescription medicines, certain diseases, and damage to certain muscles or nerves from childbirth or other trauma.  

A prolapse to the back wall of the vagina, called a rectocele, can also cause bowel-emptying problems.

We discuss rectocele more in video 2 about pelvic organ prolapse.

[8] Constipation is when 2 or more of the following apply to you:

- You strain on the toilet.

- You have hard stool.

- You can't empty your bowels completely.

- You have fewer than 3 bowel movements in a week.

- You need to use your fingers to push against your rectum to start emptying.

[9] Almost everyone gets constipated at one time or another.

But straining regularly or long term because you are constipated can lead to problems such as pelvic organ prolapse or a weakened pelvic floor.

[10] It can be challenging to find the solution that works best for you.

Here are the strategies that relieve constipation for most people.

Start by drinking enough water.

For most people this means 6 to 8 glasses of fluid per day.

If you are drinking enough water, then you can start to add more fibre to your diet.

Sit on the toilet in a good position, with support for your feet to get your knees higher than your hips.

Lean a bit forward with your back as straight as possible.

Moving your body also helps to move your bowels.

Try to do daily activity, such as walking or other exercise you enjoy.

Don't wait to have a bowel movement.

When you have an urge, go as soon as you can.

Putting off the urge can delay a bowel movement, and the stool has time to become hard.

Sometimes laxatives are needed.

There are different types of laxatives that are sold at pharmacies.

Some are safe to take regularly, and others should only be taken for occasional constipation.

[11] The Canadian Society of Intestinal Research has information on:

- dietary fibre and how to include more in your diet

- the benefits and risks of fibre supplements

- how medicines affect constipation 

Go to www.badgut.org and search for the word “fibre" to learn more.

Talk to your healthcare provider if you have any questions.

[12] If you are eating more fibre and are still constipated, a laxative —a substance that helps you have a bowel movement—may be right for you.

There are different types of laxatives available in Canada.

Research has found osmotic laxatives, which bring water into the bowel, are better for chronic or long-term constipation than other types of laxatives.

Go to www.badgut.org or MyHealth.Alberta.ca and search for “laxatives" and “chronic constipation" to learn more, and talk to your healthcare provider if you have questions.

[13] The opposite of constipation is anal incontinence, which is when stool or gas comes out by accident.

It can be very challenging to live with, and it has many possible causes.

[14] Anal incontinence is defined as the complaint of the involuntary or accidental loss of feces (stool) or flatus (gas). 

Anal incontinence may not happen every day or every time you move your bowels.

You may notice you have a hard time controlling gas.

And when you need to have a bowel movement, it feels urgent.

Anal incontinence is more common when stool is liquid or soft.

Hemorrhoids are sometimes confused with anal incontinence, because hemorrhoids can make it hard to wash the anal area well, causing stool to smear.

If stool isn't actually coming out, it is not anal incontinence.

[15] If you have anal incontinence with loose stools, try to find out what is upsetting your bowel.

Coffee, tea, pop, chocolate, spicy foods, and alcohol can all irritate your bowel.

Emotions or stress can also affect your bowel.

Everyone is different and has different foods that can trigger symptoms. Write down any foods you think are bothering you, especially foods that make you feel bloated or gassy or send you running to the toilet after eating them.

[16] Once you have your list of foods, pick 1 food from the list, and don't eat it for 5 to 7 days.

Then try eating that food again.

This should give you a good idea if that food bothers you.

It is important to do this only 1 food at a time.

[17] Some foods can help to firm up stool in most people.

These foods include bananas, probiotic yogurt, cheese, white rice, and tapioca.

You can try eating more of these foods to see if they help your symptoms.

Talk to your doctor or a registered dietitian to learn more about what foods might help or trigger your symptoms.

[18] Over-the-counter fibre supplements such as Metamucil and Fibresure can help to absorb extra fluid in your large bowel and firm up loose stool.

If you choose to use these, start with a half a dose and gradually work up to taking a full dose or the dose that works best for you. 

The most common complaint about fibre supplements is bloating. 

It helps to go slow.

With time, your body will get used to the fibre, and you will have less bloating.

The non-prescription medicine loperamide, which you may know as Imodium, may be another option.

It works by slowing down food that moves through your intestines.

Speak to your healthcare provider or pharmacist to see if this medicine is right for you.

[19] If rectocele or other issues linked to pelvic organ prolapse are causing anal incontinence, a pessary may help.

A pessary is a small, removable device, that is inserted into your vagina to help support the area.

This helps you empty your bowels better so that you have less leaking of stool.

This Understanding Pelvic Floor video series has a video about pessaries that you can watch to learn more.

Along with pelvic floor physical therapy and food changes, a pessary can be an alternative to surgery.

[20] There aren't many surgery options for anal incontinence.  

Different surgeries have been tried over the years with different rates of success.

Sometimes, the sphincter (the muscle that opens and closes around the opening of the anus) can be repaired.

But the success rates are less than 50 percent.

Another surgical treatment is injecting (using a needle) bulking agents into the anal area.

This gives tissue more bulk and makes the anal canal less wide.

Bulking agents have been used for over 25 years and have similar results to surgery.

More recently, bulking agents along with anal implants are being tried.

Other options may include a sacral nerve stimulator.

Electrodes placed close to the nerves in your sacrum, a bone near your tailbone, are attached to a battery, similar to a pacemaker battery.

This may be an option if nothing else works.

[21] So what can you do now?

Start by making the changes that only you can make to your lifestyle. 

You can manage your stress, your physical activity, and your food and fluid intake. 

Also try to not to strain on the toilet to help prevent pelvic organ prolapse, stress incontinence, and a weak pelvic floor. 

These changes might be all you need to manage your issues. 

[22] We hope this video has helped you understand how you can help yourself if you are having constipation or anal incontinence.

Watch any of the videos in this series again and make your own personal plan.

If you need more help, talk to your healthcare provider about other treatment options. 

Thank you for watching!​