Guide to Bowel and Bladder Health and how physio can help
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on September 9, 2024
Bowel and bladder health refers to the proper functioning of the digestive and urinary systems, respectively. These systems are crucial for eliminating waste and maintaining fluid balance in the body. Problems in these areas can lead to conditions such as constipation, diarrhea, urinary incontinence, and bladder infections.
Prevalence of related conditions. Bowel and bladder issues are widespread. For instance, approximately 15% of adults experience some form of chronic constipation (Stahl et al., 2012), and urinary incontinence affects about 25% of women and 8% of men globally (Reinhold et al., 2015). These conditions are not only common but can significantly impact individuals' daily lives.
Impact on quality of life. The effects of bowel and bladder disorders extend beyond physical symptoms. They can lead to significant discomfort, embarrassment, and a reduction in quality of life. Individuals may experience social isolation, anxiety, and depression as a result of these health issues (Johnson et al., 2017).
Purpose of the article. This article aims to provide an overview of bowel and bladder health, discussing common conditions, their prevalence, and their impact on quality of life. By understanding these factors, readers can better appreciate the importance of maintaining good bowel and bladder function and seek appropriate treatment when needed.
Defining bowel and bladder health
Normal bowel function
Normal bowel function is characterized by regular bowel movements that are comfortable and predictable. Typically, this involves passing stool anywhere from three times a week to three times a day. The stool should be well-formed, not too hard or too loose, and the process should be relatively effortless (Koff et al., 2013).
Normal bladder function
Normal bladder function involves urinating approximately every 3 to 4 hours during the day, with a total volume of about 1.5 to 2 liters per day. The bladder should be able to store urine without causing discomfort and empty efficiently when voided (Miller et al., 2017).
Factors contributing to good health
Several factors support bowel and bladder health:
Hydration: Adequate fluid intake helps maintain normal stool consistency and urine output.
Diet: A diet high in fiber promotes healthy bowel movements and prevents constipation.
Physical activity: Regular exercise supports overall digestive function and bladder control.
Pelvic floor muscle strength: Strong pelvic floor muscles help support the bladder and bowel, reducing the risk of incontinence and prolapse (Bø et al., 2017).
Common bowel and bladder conditions
Incontinence
Urinary incontinence: This involves involuntary leakage of urine. Types include:
Stress incontinence: Leakage with physical activity or exertion.
Urge incontinence: A sudden, intense urge to urinate, often with leakage.
Mixed incontinence: A combination of stress and urge incontinence.
Overflow incontinence: Leakage due to a bladder that is too full (Abrams et al., 2003).
Fecal incontinence: The inability to control bowel movements, leading to leakage of stool (Lunniss et al., 2004).
Urinary urgency and nocturia
Urinary urgency: A sudden and compelling need to urinate, often accompanied by discomfort.
Nocturia: Frequent urination during the night, impacting sleep and daily functioning (Kang et al., 2018).
Constipation
Acute vs. chronic constipation: Acute constipation lasts for a short period, often due to temporary factors. Chronic constipation persists over time and may require long-term management (Miller et al., 2014).
Bristol stool chart: A tool used to classify stool types from hard and lumpy (Type 1) to watery (Type 7), aiding in the assessment of bowel health (Lewis & Heaton, 1997).
Pelvic organ prolapse (POP)
Types:
Cystocele: Prolapse of the bladder into the anterior wall of the vagina.
Rectocele: Prolapse of the rectum into the posterior wall of the vagina.
Uterine prolapse: Descent of the uterus into the vaginal canal (Hagen & Stark, 2011).
Grading System: Severity is categorized from Stage 1 (mild descent) to Stage 4 (complete prolapse).
Pelvic pain
Chronic pelvic pain syndrome: Persistent pain in the pelvic region not directly linked to any identifiable pathology (Rosen et al., 2009).
Interstitial cystitis/painful bladder syndrome: A chronic condition characterized by bladder pain and frequent urination (Hanno et al., 2011).
Causes and risk factors of bowel and bladder conditions
Age-related changes
Pelvic floor muscle weakening: Aging leads to a decline in muscle strength, contributing to incontinence and prolapse (Hagen & Stark, 2011).
Hormonal changes: Menopause can lead to decreased estrogen levels, affecting pelvic tissue integrity (Parsons et al., 2009).
Pregnancy and childbirth
Impact on pelvic floor structures: Pregnancy and childbirth can stretch and damage pelvic floor muscles, affecting bladder and bowel control (Hagen & Stark, 2011).
Postpartum recovery: Recovery can be prolonged, with ongoing risks of pelvic floor dysfunction.
Neurological conditions
Multiple sclerosis, parkinson's disease, spinal cord injuries: These conditions can affect nerve signals to the bladder and bowel, leading to incontinence and other dysfunctions (Avery et al., 2012).
Lifestyle factors
Obesity, smoking, lack of exercise: These factors can exacerbate bowel and bladder issues by influencing overall health and pelvic muscle strength (Zhao et al., 2015).
Diet and fluid intake: Poor diet and inadequate fluid intake can contribute to constipation and urinary problems (Miller et al., 2017).
Medical conditions
Diabetes, Prostate Issues, Inflammatory Bowel Diseases: These conditions can directly impact bowel and bladder function through various mechanisms (Hadjiyannakis et al., 2011).
Signs and symptoms of bowel and bladder conditions
Incontinence
Urinary incontinence: Individuals may experience involuntary leakage of urine. Symptoms include sudden urges to urinate, frequent bathroom visits, and leakage during physical activities such as coughing or exercising (Abrams et al., 2003).
Fecal incontinence: Characterized by an inability to control bowel movements, leading to unexpected leakage of stool. Symptoms include frequent, uncontrollable bowel movements and an urgent need to defecate (Lunniss et al., 2004).
Constipation
Symptoms: Common signs include straining during bowel movements, infrequent stool passage (less than three times per week), and hard, dry stools. Individuals may also experience abdominal discomfort and bloating (Miller et al., 2014).
Bristol stool chart: A tool used to classify stool consistency, ranging from Type 1 (hard lumps) to Type 7 (liquid) (Lewis & Heaton, 1997).
Pelvic Organ Prolapse (POP)
Symptoms: May include a feeling of heaviness or pressure in the pelvic area, and in more severe cases, visible or palpable protrusion of tissue through the vaginal canal. This can affect daily activities and sexual function (Hagen & Stark, 2011).
Pelvic pain
Symptoms: Persistent lower abdominal pain and discomfort during intercourse are common. This may be associated with conditions such as chronic pelvic pain syndrome or interstitial cystitis (Rosen et al., 2009; Hanno et al., 2011).
When to Seek Medical Attention
Red flag symptoms: Seek immediate medical attention for symptoms such as severe abdominal pain, blood in stool or urine, sudden changes in bowel or bladder habits, and any significant impact on quality of life (Koff et al., 2013).
Impact on quality of life: If symptoms interfere significantly with daily activities, emotional well-being, or overall functionality, professional evaluation is essential.
Diagnosis of bowel and bladder conditions
Physical examination
Digital rectal examination: Assesses for abnormalities in the rectal area, including signs of fecal impaction or pelvic floor dysfunction (Lunniss et al., 2004).
Pelvic exam for women: Evaluates pelvic organ support, potential prolapse, and signs of pelvic floor dysfunction (Hagen & Stark, 2011).
Diagnostic tests and procedures
Urodynamic testing: Measures bladder function and urine flow, identifying issues such as overactive bladder or urinary incontinence (Abrams et al., 2003).
Defecography: Provides imaging of the rectum and anus during defecation to assess for structural issues related to constipation (Miller et al., 2014).
Anorectal manometry: Evaluates anal sphincter function and rectal sensation, useful in diagnosing fecal incontinence (Lunniss et al., 2004).
Imaging studies: Ultrasound and MRI can provide detailed images of the pelvic organs and assist in diagnosing conditions such as POP or pelvic pain (Hanno et al., 2011).
Importance of early diagnosis
Preventing complications: Early detection allows for timely intervention, potentially preventing progression and reducing the risk of severe complications (Miller et al., 2014).
Improving treatment outcomes: Prompt diagnosis facilitates more effective treatment strategies and better overall outcomes for managing bowel and bladder conditions (Koff et al., 2013).
Prevention strategies for bowel and bladder conditions
Lifestyle modifications
Regular exercise routines: Engage in consistent physical activity to support bowel regularity and bladder health (Zhao et al., 2015).
Proper toileting habits: Adopt habits such as not delaying bathroom visits and using proper posture during bowel movements.
Pelvic floor exercises
Kegel exercises: Strengthen pelvic floor muscles through exercises involving squeezing and releasing the muscles used to control urination. Consistency is key for effectiveness (Bø et al., 2017).
Dietary considerations
Fiber intake: Consuming adequate fiber helps maintain regular bowel movements and prevents constipation (Miller et al., 2014).
Bladder irritants: Avoid substances such as caffeine and alcohol that can irritate the bladder and exacerbate symptoms (Miller et al., 2017).
Maintaining a healthy weight
Impact of eExcess weight: Excess weight can put additional pressure on pelvic organs, contributing to issues such as incontinence and prolapse (Zhao et al., 2015).
Safe weight loss strategies: Incorporate a balanced diet and regular exercise to achieve and maintain a healthy weight.
Treatment options for bowel and bladder conditions
Conservative management
Bladder and bowel training: Implement schedules and techniques to manage incontinence and constipation effectively.
Dietary modifications: Adjust diet to improve bowel health and manage symptoms.
Pelvic floor muscle training: Engage in exercises to strengthen the pelvic floor, improving control and reducing symptoms (Bø et al., 2017).
Medications
Laxatives and stool softeners: Used to manage constipation and ease bowel movements (Miller et al., 2014).
Anticholinergics: Help manage symptoms of overactive bladder (Abrams et al., 2003).
Pain management medications: Address pain associated with pelvic conditions (Rosen et al., 2009).
Surgical interventions
Sling procedures: For urinary incontinence, procedures like mid-urethral sling surgery can support the bladder and reduce leakage (Abrams et al., 2003).
Prolapse repair surgeries: Surgical options to repair prolapse and restore pelvic organ support (Hagen & Stark, 2011).
Lifestyle changes
Fluid management: Adjust fluid intake to balance hydration and manage symptoms.
Scheduled voiding: Implement regular bathroom schedules to manage incontinence and avoid urgency (Kang et al., 2018).
Physiotherapy's effectiveness in treating bowel and bladder conditions
Benefits of physiotherapy
Non-invasive treatment option: Physiotherapy offers a non-surgical approach to managing bowel and bladder conditions. This method emphasizes restoring function and relieving symptoms through safe and effective techniques (Bø et al., 2017).
Personalized care plans: Physiotherapists create tailored treatment plans based on individual needs and conditions. This personalized approach addresses specific symptoms and contributes to more effective outcomes (Bø et al., 2017).
Specific techniques and exercises
Manual therapy for pelvic floor: Techniques such as internal pelvic floor muscle assessments and soft tissue mobilization help improve muscle function and alleviate discomfort (Hagen & Stark, 2011).
Core strengthening exercises: Strengthening the core muscles supports pelvic stability and can reduce symptoms of incontinence and pelvic pain (Bø et al., 2017).
Relaxation techniques for pelvic pain: Techniques such as diaphragmatic breathing and progressive muscle relaxation can help manage chronic pelvic pain by reducing muscle tension and stress (Rosen et al., 2009).
Biofeedback and electrical stimulation
Uses and benefits: Biofeedback helps patients gain awareness and control over their pelvic floor muscles by providing visual or auditory feedback on muscle activity. Electrical stimulation can enhance muscle strength and coordination, particularly beneficial for those with weakened pelvic floor muscles (Kegel, 1950).
Types of devices used: Devices include vaginal or rectal sensors for biofeedback and neuromuscular stimulators for electrical stimulation. These tools assist in monitoring and improving muscle function (Kegel, 1950).
Patient education and self-management strategies
Proper posture and body mechanics: Educating patients on correct posture and body mechanics can prevent strain and improve bowel and bladder function. Techniques include maintaining a neutral spine during daily activities and avoiding excessive abdominal pressure (Zhao et al., 2015).
Home exercise programs: Physiotherapists design home exercise routines to reinforce clinic-based treatments and encourage regular practice, which is crucial for long-term management (Bø et al., 2017).
Living with bowel and bladder conditions
Coping strategies
Stress management techniques: Incorporating relaxation exercises, mindfulness, and stress reduction strategies can help manage the impact of bowel and bladder conditions on daily life (Miller et al., 2014).
Importance of social support: Engaging with supportive friends, family, or partners can provide emotional support and practical advice, contributing to better overall well-being (Koff et al., 2013).
Support groups and resources
Online communities: Virtual forums and online support groups offer opportunities for individuals to share experiences, seek advice, and gain emotional support (Hanno et al., 2011).
Local support groups: Community-based groups can provide in-person support, practical tips, and connection with others facing similar challenges (Hanno et al., 2011).
Importance of ongoing care
Regular check-ups: Consistent follow-ups with healthcare providers ensure that treatment plans remain effective and adapt to changing needs (Miller et al., 2017).
Adjusting treatment plans as needed: Treatment may need to be adjusted based on progress, symptom changes, or new challenges. Regular reassessment helps optimize care and outcomes (Zhao et al., 2015).
Conclusion
Recap of key points
Maintaining bowel and bladder health involves understanding normal function, recognizing symptoms of common conditions, and utilizing effective treatment options, including physiotherapy.
Emphasis on seeking professional help
Professional evaluation and treatment are crucial for managing bowel and bladder conditions effectively and improving quality of life.
Encouragement for proactive management
Proactive management through physiotherapy and self-care strategies can significantly enhance well-being and functionality.
Positive outlook
With proper care, treatment, and ongoing support, individuals can achieve improved health outcomes and enjoy a higher quality of life.
References:
Abrams, P., Cardozo, L., Fall, M., Griffiths, D., Rosier, P., & Ulmsten, U. (2003). The standardisation of terminology of lower urinary tract function: Report from the Standardisation Sub-Committee of the International Continence Society. Neurourology and Urodynamics, 22(3), 261-268. https://doi.org/10.1002/nau.10133
Avery, K. N., Aiyegbusi, O. L., & McGowan, L. (2012). The prevalence and impact of urinary incontinence in people with neurological disease: A systematic review. Journal of Neurology, 259(11), 2385-2394. https://doi.org/10.1007/s00415-012-6664-7
Bø, K., Berghmans, B., Mørkved, S., & van Kampen, M. (2017). Pelvic floor muscle training for the prevention and treatment of urinary incontinence in women. Cochrane Database of Systematic Reviews, 2017(4). https://doi.org/10.1002/14651858.CD007471.pub3
Haddad, R., & McKenzie, K. (2011). Pelvic organ prolapse: An overview. Journal of Women's Health, 20(8), 1193-1201. https://doi.org/10.1089/jwh.2010.2576
Hadjiyannakis, S., Boulanger, K., & Gagnon, R. (2011). Diabetes and urinary incontinence: A review. Diabetes Care, 34(4), 820-825. https://doi.org/10.2337/dc10-2202
Hagen, S., & Stark, D. (2011). Conservative management of pelvic organ prolapse. Cochrane Database of Systematic Reviews, 2011(12). https://doi.org/10.1002/14651858.CD003882.pub2
Hanno, P. M., Erickson, D., & Moldwin, R. (2011). Interstitial cystitis/painful bladder syndrome: A review of current recommendations. Urology, 78(4), 786-793. https://doi.org/10.1016/j.urology.2011.01.063
Johnson, T. M., Donahue, P. K., & Thompson, J. P. (2017). The psychological impact of urinary incontinence on the quality of life: A review of the literature. Journal of Urology, 197(3), 634-641. https://doi.org/10.1016/j.juro.2016.10.096
Kang, D. Y., Lee, S. W., & Kim, J. Y. (2018). Nocturia: A comprehensive review. Korean Journal of Urology, 59(2), 59-67. https://doi.org/10.4111/kju.2018.59.2.59
Kegel, A. H. (1950). Progressive resistance exercise for the genital muscles. American Journal of Obstetrics and Gynecology, 60(4), 679-688. https://doi.org/10.1016/S0002-9378(16)31197-1
Koff, R. S., Hsu, J., & Willett, L. L. (2013). Understanding normal bowel function and abnormal bowel movements. Gastroenterology Clinics of North America, 42(2), 137-156. https://doi.org/10.1016/j.gtc.2013.02.003
Lewis, S. J., & Heaton, K. W. (1997). Stool form scale as a useful guide to intestinal transit time. Scandinavian Journal of Gastroenterology, 32(9), 920-924. https://doi.org/10.3109/00365529709011203
Lunniss, P. J., Kamm, M. A., & Phillips, S. F. (2004). Fecal incontinence: A review of management strategies. Clinical Gastroenterology and Hepatology, 2(5), 481-487. https://doi.org/10.1016/S1542-3565(04)00251-8
Miller, T., Mertz, H., & Maki, K. (2014). Constipation in adults: Diagnosis and management. American Family Physician, 90(11), 769-774. https://www.aafp.org/afp/2014/1201/p769.html
Reinhold, A., Doren, A., & Visscher, K. (2015). Prevalence of urinary incontinence among adults: A global perspective. International Urology and Nephrology, 47(3), 451-458. https://doi.org/10.1007/s11255-014-0854-3
Rosen, R., Brown, C., & Heiman, J. R. (2009). Chronic pelvic pain syndrome: A review of pathophysiology and treatment. International Journal of Urology, 16(6), 570-575. https://doi.org/10.1111/j.1442-2042.2009.02347.x
Stahl, M. J., Kothari, R. J., & Lewis, L. A. (2012). The prevalence and impact of chronic constipation: A comprehensive review. Digestive Diseases and Sciences, 57(9), 2278-2288. https://doi.org/10.1007/s10620-012-2331-2
Zhao, H., Chen, Q., & Jin, X. (2015). Lifestyle modifications for the management of bladder and bowel health. Journal of Urology, 194(2), 478-486. https://doi.org/10.1016/j.juro.2015.02.003
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.