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Physiotherapy and IBS

People with IBS may have problems managing associated symptoms such as bowel urgency, loss of bowel control (incontinence) or difficulty emptying their bowels. Muscles are involved in the bowel processes of “holding on” and “emptying”.

Physiotherapists with additional training in the management of incontinence and pelvic floor muscle dysfunction are able to help people learn ways to use these muscles to improve their control over bowel function. They are also able to help with bladder control problems.

A typical training period is over 6 months. Learning new tasks takes time and practice. The majority of patients can benefit.

“Biofeedback” is one of the terms commonly used for this treatment but biofeedback is just one component of a bowel retraining program.

Other important elements of a treatment program may include:

  • Education

    Education

    Many people do not have an understanding of gut function and may have developed certain beliefs about it that are not based on fact:

    • “We should empty our bowels every day” (actual normal frequency varies from x 3 per day to x 3 per week)
    • “Not producing enough waste” (this depends on many factors and is very variable form person to person)
    • “Constipation causes toxins to build up” (no evidence for this)
    • “Food goes straight through” (food can take anywhere from 24 to 72 hours to pass through the digestive system)

    Before commencing a bowel retraining program it is important to have a good idea about normal bowel function and all the different things that can influence it for better or worse. It is also essential to have an understanding of the training program and the importance of following it every day.

  • Bowel habit training

    Bowel habit training

    When bowel habits become erratic, symptoms can be harder to manage because they will be very unpredictable. Bowel habit training is a way of getting the bowel to empty at a predictable time of day - establishing a regular bowel pattern, suited to your bowel’s own rhythm.

    The bowel is very ‘trainable” – like the bladder – the more you go, the more you need to go – the less you go, the less you need to go. People with IBS may spend too long in the toilet or try too many times to go to the toilet. Sometimes people are so busy and distracted that they miss the signals their body gives them that it is time to go to the toilet.

    The physiotherapist would work out an appropriate routine to stimulate bowel actions at a predictable and convenient time.

  • Defaecation retraining

    Defaecation retraining

    This involves learning how to use your body correctly for effective bowel emptying – without straining. A physiotherapist assesses general posture and toileting posture and makes suggestions for change.

    Other things to be assessed are the muscles of the diaphragm (breathing muscle), abdomen (stomach muscles – “abs”), pelvic floor and anal sphincter muscles (the opening and shutting muscles). All these muscles are involved in emptying the bowel. Various exercises are taught and practised at home. Biofeedback may be used to help in the learning process (see Biofeedback).

  • Biofeedback

    Biofeedback

    Biofeedback is a system for learning a new action by getting information about how well that action is being performed. This information can be “fed back” to you by various methods. For example, the physiotherapist can tell you immediately when you are doing an exercise correctly or incorrectly. The physiotherapist may be observing and/or feeling the muscle action.

  • Rectal balloon training

    Rectal balloon training

    This is a very specific method for learning about separate bowel functions. A small rectal balloon is placed into the back passage and inflated in the rectum with some air or water. This can be used for learning to:

    • recognise rectal sensation, “ the feeling of needing to go” - as the balloon expands
    • squeeze the pelvic floor and anal sphincter muscles closed as soon as this rectal sensation is felt
    • squeeze the pelvic floor and anal sphincter muscles repeatedly until an urge passes – this helps build confidence in the ability to “hang on” – the balloon can be gradually inflated further to make the urge stronger and control more challenging.
    • coordinate the muscles of bowel emptying, without straining, by practising expelling the balloon in a controlled way

    EMG or Pressure Biofeedback:

    A small probe is placed in the anal passage and is connected to a biofeedback unit which has a screen that can be seen by the patient. This is used to help learn muscle contraction (tightening) or muscle relaxation and can be used as part of a muscle training program. As the patient watches the screen they can see whether the muscle is tightening, holding or letting go.

  • Pelvic floor muscle retraining

    Pelvic floor muscle retraining

    The pelvic floor muscles are responsible for both bladder and bowel control. Many people have difficulty learning how to use these muscles well because they are inside us and we can’t see them working. This is one reason why biofeedback is used to assist learning.

    Healthy pelvic floor muscles need to be able contract strongly, hold for long periods of time but be able to relax completely for passing urine and emptying the bowel.

    People with IBS may have pelvic floor muscles which are “underworking” (weak) while others may have pelvic floor muscles which are overworking (‘spasming’). Either can contribute to disturbance in bowel function.

    A physiotherapist with special training will assess your muscles and devise an appropriate individualised training program.

  • Electrotherapy

    Electrotherapy

    Physiotherapists are trained to use special electronic devices which can be used to stimulate muscle activity. These devices may also be used for treating chronic pain.

  • Relaxation

    Relaxation

    People with IBS can become very anxious about their symptoms. When we become anxious, muscles tend to tighten up and our breathing pattern changes. The effect of these reactions may actually make the symptoms even worse. For example if the problem is urgency, tensing up the whole body and “panicking” will increase pressure on the rectum and increase bowel activity, making urgency greater.

    If the problem is constipation or difficulty emptying, getting tense and anxious will make it harder for the abdominal, pelvic floor and anal sphincter muscles to work properly so that the bowels open. The feeling of wanting to go is there but it is very difficult to go.

    The physiotherapist can teach you both general and specific relaxation techniques, relaxed breathing/diaphragmatic breathing and other “calming” strategies.

  • Ceasing or reducing use of laxatives/enemas/suppositories

    Ceasing or reducing use of laxatives/enemas/suppositories

    If a person with IBS has come to rely on laxatives, enemas or suppositories to empty their bowels, an important aim of a bowel retraining program is to help them cease the use of these. While these products may lead to bowel emptying they often do not relieve the symptoms of bloating or abdominal pain and in fact may make these symptoms worse.




MORE LINKS

If you are interested in other gastrointestinal-focused information and intervention websites developed and hosted at
Swinburne University of Technology,
please go to:

IBDclinic.org.au for individuals with Inflammatory Bowel Disease

Gastroparesisclinic.org for individuals with Gastroparesis

DISCLAIMER

This website and its content is not intended or recommended as a substitute for medical advice, diagnosis or treatment. Always seek advice of your own physician or other qualified health care professional regarding any medical questions or conditions.

© 2014 Swinburne University of Technology | CRICOS number 00111D