Male Bowel Dysfunction

Explanation of common symptoms/ problems

Problems related to difficult bowel movements or having bowel incontinence are relatively common. They can affect people of all ages, both men and women, and may have a considerable impact on your everyday life.

Normal bowel movements range from going three times a day to three times a week. 

Common problems include :

• Constipation
• difficulty emptying well or wiping clean;
• urgency resulting in a rush to the toilet and perhaps a bowel accident;
• soiling in your underwear that you weren’t aware of or felt any warning about
• excessive wind that is difficult to control.

These issues may arise as a result of:

• certain medications
• other illnesses, operations or injuries
• changes in hormones
• neurological issues
•  infection
•  inflammation
• history of trauma
• chronic constipation
• a combination of factors which allows these symptoms to build up.

Often, we are slow to seek advice or help due to embarrassment or fear but there are plenty of treatment options available.

Self help / Advice

If you notice changes in your bowel function you should go to see your GP. You may benefit from medications, require some further tests or they may refer you to see a specialist doctor (gastroenterologist). There may be a lot of variability in how often you go and the consistency of the bowel motion (stool or poo) but the following tips may be useful in most cases:

• Eat little and often, and try not to miss breakfast! Try to have something every 2-3 hours to keep your gut regular, avoiding very long gaps between meals. Three meals and three snacks are ideal, making sure that these snacks are nutritious. Avoid snacking on processed foods, cakes, biscuits, crisps or foods high in fat and/or sugar.
• Fibre is important for a healthy bowel and forming a good stool consistency. Some foods contain fibres that soften your stool while other foods contain fibre that gives your stool bulk/substance. The goal is to eat a balanced amount of each to achieve a stool that is smooth, formed and easy to move!
• If your stools are hard, dry and sometimes difficult to pass eating food such as kiwis, pears, plums, dried fruit, prune juice and green vegetables may help.
• If your stools are loose, soft or mushy then foods such as wholegrains, spelt bread, milled linseed/flaxseed or psyllium husk supplements may help by adding bulk to the stool if you trial including them in your diet.
• Gradually increase fibres over 3-5 days to reduce risk of stomach discomfort or excess wind.

• Fibre needs fluid to be effective regardless of your stool type. Make sure you are getting in at least 1.5 – 2 litres daily, the majority of which should ideally be water.
• These are basic dietary suggestions. For more specific individual advice speak to a Registered Dietician, possibly via referral from your GP.

• Try to never ignore the urge to move your bowels or put it off for very long. Going regularly can often prevent accidents later on.
• We often feel the urge to go shortly after eating or exercise. Be aware of these urges and don’t ignore them where possible.
• Sit well on the toilet, relax and do not hover! If possible put a small footstool or step under your feet to lift the feet/knees. 
• Relax, lean forward, keep your tummy soft, breath normally and do not strain.
• It’s important to take your time to allow for good emptying without straining, regardless of the consistency of your bowel motion. Even soft stools can be difficult to empty well if you rush or strain.
  
• Daily exercise helps to promote regular bowel activity and benefits your overall health.  Aim for 30 minutes of exercise at least 5 days of the week. Walking is a simple way to get moving but do try to find something you enjoy. Jogging, swimming, cycling, pilates or yoga are all good options too. Taking time to exercise is also good for your mental health, can aid in stress management or can just give you some time to yourself. 
• Regular mindfulness practice has been shown to be beneficial in gut health. Maybe try some meditation, mindfulness apps or online relaxation videos. As little as 10 minutes each day has been shown to have benefits for physical and mental health.

Where to go to next

• POGP booklet: Improving your Bowel Function
• https://www.bbuk.org.uk/adults/adults-resources/
• https://www.bladderandbowel.org/bowel/
• https://www.ageuk.org.uk/globalassets/age-uk/documents/information-guides/ageukig15_bladder_bowel.inf.pdf

What to expect from physiotherapy

The specialist pelvic health physiotherapist will ask in detail about your symptoms, and what treatments or strategies you may have tried already.

They may ask you to fill in a diary to look at your bowel motions, and possibly what you are eating & drinking also.

Many bowel problems have one thing in common, and that is pelvic floor muscles or anal sphincter muscles that are not performing well. For some it is weakness resulting in poor control but for others it may be poor co-ordination resulting in difficulty emptying. Your specialist pelvic health physiotherapist may ask if you are happy to be examined to assess these muscles and prescribe a specific pelvic floor muscle rehabilitation programme. This is useful as not everybody will benefit from the same exercises.