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Bowel dysfunction

Anorectal dysfunctions (Bowel Dysfunction) in men are problems associated with an individual’s bowel movements. Some problems may result in men experiencing difficulties passing faeces / stools or in some cases faeces may leak due to an inability to control bowel movements. Also anorectal problems may involve frequently passing wind as a result of decreased bowel control. Anorectal dysfunction in men may be caused by a variety of factors including muscle weakness around the anus, pelvic floor or abdominal weakness and neurological disorder or injury. Additionally anorectal problems may be a result of surgery in this area such as prostate surgery.


Physiotherapy can assist with the following dysfunctions:

  • Constipation
  • Faecal Incontinence
  • Weak Anal Sphincter



Constipation occurs when bowel movements become abnormally infrequent and can affect men of all ages. Constipation is when faeces (stools) become hard, and difficult or painful to pass. This can mean that stools are not passed as often as they normally should i.e. less than three times a week. You may have to strain more than usual and you may be unable to fully empty your bowels. The severity of constipation can vary significantly and constipation can be experienced for a short period of time or symptoms may be experienced more long term.



Constipation can be caused by a variety of reasons. The most common causes of constipation in men include;

  • Insufficient fibre intake
  • Dehydration – not drinking enough fluids
  • Medication
  • Stress / emotions
  • Trauma
  • Neurological diseases injury
  • Prostate enlargement or cancer
  • Prostate surgery or other surgery to the area around the bladder
  • Weakness  in pelvic floor muscles / abdominal muscles.



Constipation in men can cause symptoms such as;

  • Inability to produce regular bowel movements – less than three times a week
  • Difficulty or pain when passing motions
  • Abdominal pain or cramps
  • Feeling of being ‘bloated’ or sick
  • General discomfort
  • Tiredness and reduced energy levels.

If you are suffering from constipation, there are a number of treatment options that aim to reduce any of your current symptoms. You may be offered several medical interventions including medication and diet advice. Additionally, physiotherapy has shown to provide constipation sufferers with significant relief from problems associated with the condition.



Physiotherapy treatment may include:

  • Relaxation of sphincter muscles
  • Strengthening exercises for the pelvic floor muscles and abdominal muscles
  • Electrical stimulation to improve muscle function
  • Positioning
  • Pain control modalities
  • Breathing control and relaxation exercises
  • Education on how to make lifestyle changes that may affect the bowels.


Faecal Incontinence

Faecal incontinence in men is the inability to control bowel movements therefore causing stools (faeces) to leak involuntarily from the rectum (rear passage). Involuntary bowel movements are caused by weakness of the muscles around the anus (rear passage). The anus has internal and external muscles called the sphincter muscles which help control the movement of faeces out of the rectum. Due to the weakness in these muscles, the inability to control wind may also be a problem for those suffering from faecal incontinence. There are two main types of faecal incontinence in men:

  • Faecal urge incontinence: Leakage of stools before you can get to the toilet
  • Faecal urgency: Needing to go to the toilet quickly but minimal leaking of stools.

There are a number of causes for faecal incontinence in men, the main ones include;

  • Muscle imbalance and weakness around the anus
  • Anxiety
  • Neurological conditions
  • Pelvic Floor and Abdominal muscle weakness
  • Medication
  • Trauma
  • Surgery on the prostate surgery or other surgery to areas around the bladder
  • Cancer or enlargement of the prostate.



Symptoms that are usually present in men with faecal incontinence include;

  • Lack of control over bowel movements
  • Involuntary wind
  • Urgency to go to the toilet even when stool (faeces) leakage is minimal
  • Leakage of stools (faeces) in large or small amounts before being able to get to the toilet.

If you are experiencing faecal incontinence, there is a variety of treatment options that may involve either medical or dietary interventions which aim to reduce any of your present symptoms. In addition, Physiotherapy is a very effective method that will help significantly reduce symptoms that are associated with faecal incontinence.



Physiotherapy treatment may include:

  • Strengthening of sphincter and pelvic floor muscles
  • Advice about lifestyle and diet changes
  • Bladder charts
  • Biofeedback (to retrain your muscles)
  • Positioning
  • Advice on moving and handling techniques
  • Cardiovascular activity
  • Controlled breathing and relaxation exercises.


Weak Anal Sphincter

What is a weak anal sphincter?

A weak anal sphincter refers to weakness in either or both of the two rings of muscle located in the anus. A weak anal sphincter can result in being unable to control bowel movements and may result in faecal incontinence.



There are two sphincter muscles which wrap around the anus: an internal and an external sphincter. The inner ring or internal sphincter is an involuntary muscle, which is closed at all times except when opening the bowels. The outer ring or external sphincter is a voluntary muscle, which can be tightened up voluntarily to close strongly if you have urgency to open your bowels. Damage or weakness to either of these muscles can lead to faecal leakage or incontinence.

Weak anal sphincters in men can be caused by:

  • Injury to the sphincter muscle (for example due to rectal surgery)
  • Straining, constipation, or general wear and tear
  • Damage to the nerves innervating the muscle.



Symptoms of a weak anal sphincter can include:

  • Leakage following opening your bowels
  • Leakage during exercise
  • Small quantity of stool being passed when passing wind
  • Leakage following coughing/sneezing.



Physiotherapy exercises can help strengthen the external sphincter muscle so it provides more support, this may also help squeeze the internal sphincter muscle to help stop leakage. Biofeedback techniques can also be used to increase the strength of the external sphincter muscle.

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