The bowel is the lower part of the digestive system (a hollow tube) that goes from the stomach to the back passage (anus). After processing food it empties solid waste from the body. The bowel is divided into the small intestine where food is digested and nutrients are absorbed. The large bowel absorbs water from the digested food and forms stools.

The anal sphincters and the puborectalis muscle control continence. The internal anal sphincter controls about 80% of involuntary resting muscle tone and the external anal sphincter controls 15-20% of muscle tone. The puborectalis and external anal sphincter work together to close the anal canal e.g. when you don’t want to pass wind. Occasionally during birth forceps, tears, or extension of an episiotomy may damage the sphincters.

The rectum is located above the sphincters and stores the stool until you decide to defecate. Scarring from diseases such as Crohns disease and Ulcerative colitis can affect the rectums ability to hold the stool, causing leaking.

What is normal emptying?

Bowel emptying is normal if you

  • Have regular bowel movements
  • Empty without straining and using laxatives
  • Don’t have ongoing constipation or diarrhoea

When disease and food intolerances have been ruled out, changes in bowel emptying are commonly due to changes in diet or lifestyle (not eating your veges, less fluids and travelling). Straining to empty the bowel can damage nerves supplying the pelvic floor muscles and cause prolapse of the bowel into the back vaginal wall or down through the rectum.

What affects how the bowel works?

  • What you drink and eat
    Drink plenty of plain fluids to prevent dehydration and eat fiber rich food (vegetables, fruit and whole grains) to keep the stool soft and easy to pass.
  • Daily exercise
    Exercise tightens the muscles in the abdomen, pelvis and gut and helps move the stool through the intestines. Strong PFMs support the bowel and reinforce sphincter closure.
  • Toilet habits
    Slumping on the toilet and straining, tightens muscles around the abdomen and anus. Place feet on a stool, lean forward, breathe deeply and initially relax the stomach muscles and anal sphincter to encourage smoother emptying. Some cultures still squat for bowel emptying – this position is ideal as the colon is lengthened to promote fuller emptying.
  • Medication, illness and surgery
    Many painkillers slow down the passage of the stool causing constipation. Some medications and nerve damage from surgery may result in diarrhoea. Inflammatory bowel disease, irritable bowel, piles (haemorrhoids) and infections result in altered bowel emptying.

Visit your Doctor to uncover the cause of bowel changes and if needed, a dietician for suitable dietary advice. A women’s health physiotherapist will advise how to use your abdominal and pelvic muscles to empty more smoothly. Biofeedback is also used to help relax excessively tight muscles for easier emptying.