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RUOK Day and Faecal Incontinence following a 3rd or 4th degree tear.

14 September, 2019

The 12th September is RUOK ? Day. A day which Gary Larkin began in 2009 after his own father died by suicide. Soon after his father’s death, Gary himself started to have suicidal thoughts. As an advertising executive, he used his marketing skills and high-profile contacts to create a national day of awareness to encourage people to have a conversation with their family and/or friends if they are suffering with depression or anxiety and are having suicidal ideation. This day has become much more visible and since its inception has been responsible for helping people to have those difficult conversations, seek help and for sure has saved lives.

Many things can be the cause of depression and anxiety. In my world of pelvic floor dysfunction, there can be many women (and men) who are profoundly affected by dysfunction such as constant pelvic pain, prolapse, urinary and faecal incontinence and for men erectile dysfunction. Because of the personal nature of pelvic floor dysfunction it can really add to the anxiety because these areas are so private and even seeking help from professionals can seem so damn embarrassing!

Except it needn’t be, because pelvic health physios are so used to the problems you are experiencing that they are definitely in their comfort zone even if you are way out of it – and they will put you at ease and be reassuring and calming as you are telling your story.

So what prompted this blog?

Today one of my pelvic health colleagues sent me this meme.

This came at a time when I had been lamenting the loss of my Qantas travel card. (See the full story of this at the end of this blog) Now I was pretty down about this, but when I saw this meme, it reminded me that the issues that women have to endure such as faecal incontinence (FI), with the added anxiety of not knowing when the FI may occur, make my silly issue with my card pale into insignificance.

Faecal incontinence can follow the life-changing event of a traumatic vaginal delivery with a 3rd or 4th degree tear which can change a once athletic care-free young woman into a housebound, worried mother who spends the first twelve months not only caring for a new baby but also wondering ‘what the hell just happened?’ So much around pregnancy and childbirth is cloaked in ‘rose-coloured glasses’ imagery, so that when the unexpected catastrophe happens – it is completely out of left field for the woman (and her partner).

Once the immediate six week recovery period has passed, where the treatment following a 3rd or 4th degree tear consists of adequate pain relief, stool modification to keep the stool soft and easy to pass and Sitz baths for good healing, it is important that women are routinely referred for pelvic health physiotherapy assessment to see what the state of the anal sphincter is like.

At that initial appointment with your pelvic health physio, there will be extensive education about good bowel habits including defaecation dynamics (the correct way to pass a motion, to get more complete evacuation of the stool), the role of the internal and external sphincter –  some that the internal is comprised of smooth muscle and the external sphincter is striated muscle and this is the one that can be strengthened with specific strengthening exercises and enhanced with electrical stimulation.

A type of E-stim machine to help regain strength in the external anal sphincter

Your pelvic health physiotherapist will instruct you how to use the machine and it is something that you can purchase and use in the privacy of your own home on a regular basis. This may not only improve your strength, but also your sensory awareness which is important when treating faecal incontinence.

Manipulation of the stool is one of the key factors though when managing faecal incontinence. Using different products to give better bulk to your stool is useful (such as a bulking agent like Normafibe or Benefibre), Imodium to help slow the bowel motility or even a codeine based product depending on the situation.

This is just some of the strategies that your physio will help you with for any faecal incontinence you may be suffering. Don’t suffer in silence – see a Pelvic Health physiotherapist and getting help for these physical problems will also help any anxiety or depression about your changed physical condition following childbirth that you may experience. The physiotherapist can also advise you about the name of a psychologist who can be helpful with any anxiety or depression.

Also always remember to ask your friends, relatives and neighbours: RUOK?

You never know when you may start a conversation which will significantly help the mental health of someone.

Now about the Qantas Travel Card story: 

You can completely not worry about reading this part because it is, in the scheme of this serious topic, completely not a worry, but it is there for those to read who may use a debit type card overseas.

I have had a difficult relationship with this card this holiday because very early on, I foolishly (unaware of the catastrophic consequences of this action) gave the number to the car hire company for the ‘pending‘ payment for the rental and the security in case we had an accident. Except ‘pending’ with a travel card actually means the money disappears never to be seen again- so 1200euros for the deposit and 396 euros for the car hire later- my Qantas travel card was reduced to almost zero and that was at the beginning of the holiday.

About 25 phone calls and 10 days later, the pending status of my travel card had reverted back to its correct amount and suddenly I felt elated again. You’d think after that nightmarish experience I would treasure that card? But only a few days later, half way up a mountain in Zermatt, after purchasing a hot chocolate -the new substitute for the (hideous) coffee over here- I managed to leave it there and only discovered it was missing as we had to leave on a train for Geneva, so I was forced to cancel the card and again was rendered euro-less with weeks of the holiday to go.

I thought it important to alert you to this fact – you probably already know but if not it will stop you making the same mistake I did.

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