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More of the 5 Step Plan: Step 4Managing your Bowels Well.

26 March, 2014

Remember this series of blogs relates to a talk I did for the public a few weeks ago and Part 4 of the 5 Step Plan is all about bowels.

Bowels Bring Down Prolapse (and cause failure of operations): WHY?

  • Never taught correctly as a child how to defaecate
  • Bad habits- stool wrong consistency, always strains or leans back to defaecate (can be equivalent of having a little baby every day!); dyssynergia – a lack of coordination between the external anal sphincter and one of the pelvic floor muscles (pubo-rectalis) so the anus tightens instead of releasing the stool.
  • Birth Damage: Weak pelvic floor muscles (nerve damage); Levator Avulsion leading to ballooning of vaginal hiatus during defaecation-resistance from PF to enable effective defaecation lost
  • Too much mobility of the perineal body (between the vagina and the anus)-lack of support, short perineal body.

Good management of bowels is all about maths (angles) and physics (correct displacement of forces)

ano-rectal angle  (1)   anorectal angle2 (2)

Defaecation Dynamics

  • Respond to first urge, don’t defer.
  • Use correct posture
  • Relax your tummy.
  • Gently further bulge your abdominal wall.
  • This action opens and relaxes the anal sphincter.
Defaecation Position

Defaecation Position (3)

So to help manage your prolapse well, get your bowels in order!

1. Women’s Health: A Textbook for Physiotherapists. 1998 Sapsford R, Bullock-Saxton J, Markwell S. London; Sydney : WB Saunders.

2. GastroenterolHepatol (N Y). 2008 November; 4(11): 807–817. PMCID: PMC3104390 Management of Fecal Incontinence Adil E. Bharucha, MBBS,

3. Pelvic Floor Essentials: Sue Croft 2012


One Comment
  1. Reblogged this on The Life Of Von and commented:
    A blog with all the answers to the questions you were too shy to ask!

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