Bowel Dysfunction

A healthy gut can be a difficult thing to achieve long term! We understand that being able to readily and regularly open your bowels with a comfortable motion isn’t something that is easy to maintain. We encourage you to discuss any changes with your GP that you are concerned with and to then discuss with your women’s health physiotherapist to build your ability to maintain healthy bowel function.

We can manage a multitude of conditions including:

  • Constipation
  • Faecal or flatal incontinence (leakage of bowel motion or wind)
  • Haemorrhoids
  • Prolapse of the bowel (rectocele) with use of pessaries
  • Dyssynergic defecation (trouble coordinating the pelvic floor muscles)

These issues can become more common in pregnancy, after a difficult vaginal delivery and alongside endometriosis or other chronic pelvic conditions. We also see that ageing and pelvic surgery can impact on your bowel function.

We can manage your bowel dysfunction with physiotherapy to build your knowledge around the pelvic floor (relaxation, release work then strengthening), lifestyle and diet tips, education re toileting posture and a ‘good morning’ routine. We will work alongside other health professionals as required such as dieticians, colorectal specialists, and your GP. If you have questions about your bowel health feel free to send Caitlin an email or give us a call.


Being blocked up in your bowels can be linked to many different issues but relates to two or more of the following: straining to defecate, hard stools, sensation of lack of complete emptying or less than two bowel motions a week. A women’s health physiotherapist can help guide you if you are getting symptoms of the bowel that are impacting on your bladder health (eg incontinence or prolapse) or back pain. We have advanced training in management of ano-rectal conditions including rectocele (bowel prolapse), haemorrhoids, dyssynergic constipation (difficulty with coordinating pelvic floor muscles) and IBS.

Treatment will likely involve finding the right diet and fluid intake for your level of activity, it can be advice about toileting posture and when to be attempting to empty your bowels (listen to your first urge!). It can involve re-training the muscles of the pelvic floor to allow complete emptying of your bowels and being able to reduce the frequency of straining to do so. We can manage a condition called dyssynergic defecation where the pelvic floor muscles contract instead of relaxing whilst you are trying to open your bowels.

If we think you would benefit from further review from a dietician or medical professional we can guide you as to what your next steps should be.

Faecal and flatal incontinence

Incontinence of the bowel is a difficult condition to deal with and we understand the implications it can have on all aspects of your life. We have advanced training in anorectal conditions that can lead to leakage at your back passage (of both wind and solids) and understand that often it is associated with complex medical conditions like IBS/ulcerative colitis and Chron’s disease. We aim to discuss your bowel habits, figuring out your good days and your bad days and how to restore some regularity to your system. We can retrain the muscles that control your bowel – both learning to strengthen the sphincters and to relax the pelvic floor when it comes time to sit on the toilet. We understand these issues are difficult to discuss and take time and resilience to.


Haemorrhoids are dilated veins in your rectum – both inside and outside the anus. They can cause bright red bleeding, pain with opening your bowels and discomfort in sitting. They are more common in pregnancy (and can pop out during labour) and can be exacerbated by straining to open your bowels. Physiotherapy management is focused on advice regarding bowel dysfunction, developing the right stool type for you (soft sausage with cracks) and giving advice around education about how to manage the discomfort that can be associated with haemorrhoids and associated conditions. We will also guide you on how to build strength in your muscles without straining through your pelvic floor so you can get back to the exercise that you love safely with longevity in mind.

Rectocele (Prolapse of the back wall of the vagina)

Rectoceles, or posterior wall pelvic organ prolapse, can occur alongside other conditions and is more common after vaginal births and is increasingly common with age. Opening your bowels may feel incomplete and you might need to use your hand to help support they area as you try. You may feel a dragging or heaviness at the vagina and see or feel a bulge in this region. Sometimes it seems like it occurs gradually whilst for others it follows a particularly strong coughing fit. The role of first line conservative management includes:

  • Increasing pelvic floor muscle support and strength.
  • Use of advanced pessaries which can be fitted in our clinic.
  • Reducing downward strain and retraining common movements like coughing, bowel opening, exercising.