CONSTIPATION
If the stool is so hard that you frequently have to strain, you are constipated. It can be either be due to:
1. Slow transit of faecal matter through the bowel
2. Blockage of the bowel outlet, so called obstructed defecation where the rectum is full of stool and the desire to defecate is registered in the brain but there is an inability to physically expel the rectal contents.
3. The transit of the stool through the colon may be at normal speed but when the stool reaches the rectum there is failure to progress. Typically the patient is called to stool at least daily but only small amounts of stool are passed with a sense of incomplete evacuation. Failure to evacuate the rectum is commonly due to a mechanical blockage of the anal outlet. It can be due to :
o Dyssynergic defecation: paradoxical contraction or inadequate relaxation of the pelvic floor during defecation.
o Inadequate defaecatory propulsion: Inadequate propulsive forces during attempted defecation.
o Change of normal anatomy of the anorectal area: The muscles and connective tissue supporting the rectum can become weakened and unsupported, because of:
prolapse
hemorrhoids
descending perineum
Preventing constipation simultaneously prevents straining the pelvic floor muscles and can limit injury.
o Basic constipation prevention includes: eating fresh fruits, vegetables, legumes and whole grains — thus lots of fiber (30g per day); avoiding processed foods, including white flour and white sugar.
o Ensuring adequate water intake (30 ml/kg daily)
o Getting regular exercise.
o Correct toilet positioning
o Diaphragmatic breathing
o If those methods are not enough, magnesium glycinate taken at night before bed can help as well.
IRRITABLE BOWEL SYNDROME
Mucus (slime) passing along with the stool is normal in some people but is more common in people with an irritable bowel. Patients complain about abdominal pain and bowel difficulties, bloating, altered stool and dietary restrictions.
FAECAL INCONTINENCE
Faecal incontinence is a distressing condition, both physically and emotionally. Until recently, surgical treatment had little to offer Faecal incontinence is a distressing condition, both physically and emotionally. Until recently, surgical treatment had little to offer Faecal incontinence is a distressing condition, both physically and emotionally. Until recently, surgical treatment had little to offer Faecal incontinence is a distressing condition for women, both physically and emotionally.
o Patients with faecal urgency can feel the urge to evacuate but cannot retain the faeces. Urgency is due to a low rectal capacity or an inflamed rectal mucosa.
o Soiling is due to seepage of stool through the anal sphincter and can be due to anal sphincter damage or faecal obstruction in the rectum.
o Faecal incontinence is the the loss of control of wind or faeces with or without noticing. Faecal continence is sustained when anal pressure exceeds rectal pressure. Anal pressure is maintained and controlled by a complex interaction of muscles (particularly puborectalis, internal and external anal sphincters), fascia, ligaments and nerves. Increased intra-abdominal pressure causes increased rectal pressure and if the pressure rise is sufficient to overcome anal pressure then faecal incontinence results. The most common reasons for the function of the relevant muscles to be compromised are obstetric injury (e.g. anal sphincter tears, perineum tears), surgical trauma, anal operations and neurological conditions.
Treatment:
o Physiotherapy
o Education
o Neuromodulation
