Female Health SA


Digestive System Anatomy



The Intestinal tract is basically a tube that extends from the mouth to the anus. An absorptive layer of epithelial cells that are involved in absorbing nutrients and water lines the inside of the intestinal tract.


The small intestines absorb the nutrients and change the liquid to stool.


At the ascending colon the stool becomes more solid by allowing water absorption. It also acts as a reservoir where the mixing function takes place.


At the transverse and descending colon peristaltic movement happens and the solid faecal matter is pushed to the sigmoid colon, which acts as a reservoir.


The rectum acts as a reservoir and a pump to propel the stool during defecation.


At the anus there is sensory mucosa that is necessary to distinguish between solid, gas and liquid. If it is the appropriated time and place the anus will allow defecation.


All of these movements in the intestinal tract are under involuntary control except the external anal sphincter that can voluntary contract or eccentrically relax to allow or defer defecation.


The anal sphincters are the muscles that close off the lower end of the bowel. These two muscles wrap in an inner (Internal Anal Sphincter) and outer (External Anal Sphincter) circle around the anal outlet.

The Puborectalis (Levator Ani ) muscle is continuously tensioned and acts to pull the lower part of the rectum forward, closing off the exit angle. When defecation is planned the muscle relaxes and the anorectal angle widens. Any damage to this muscle or its innervation will disrupt this sequence.



The consistency and shape of your stool is a good guide to how fast or slow your bowel is rather than the number of times that you go to the toilet.



Bowel Conditions



CONSTIPATION

If the stool is so hard that you frequently have to strain, you are constipated. It can be either be due to:

  1. Slow transit of faecal matter through the bowel
  2. Blockage of the bowel outlet, so called obstructed defecation where the rectum is full of stool and the desire to defecate is registered in the brain but there is an inability to physically expel the rectal contents.
  3. The transit of the stool through the colon may be at normal speed but when the stool reaches the rectum there is failure to progress. Typically the patient is called to stool at least daily but only small amounts of stool are passed with a sense of incomplete evacuation. Failure to evacuate the rectum is commonly due to a mechanical blockage of the anal outlet. It can be due to :
    • Dyssynergic defecation: paradoxical contraction or inadequate relaxation of the pelvic floor during defecation.
    • Inadequate defaecatory propulsion: Inadequate propulsive forces during attempted defecation.
    • Change of normal anatomy of the anorectal area: The muscles and connective tissue supporting the rectum can become weakened and unsupported, because of:
      • prolapse
      • hemorrhoids
      • descending perineum


Preventing constipation simultaneously prevents straining the pelvic floor muscles and can limit injury.

  • Basic constipation prevention includes: eating fresh fruits, vegetables, legumes and whole grains — thus lots of fiber (30g per day); avoiding processed foods, including white flour and white sugar.
  • Ensuring adequate water intake (30 ml/kg daily)
  • Getting regular exercise.
  • Correct toilet positioning
  • Diaphragmatic breathing
  • If those methods are not enough, magnesium glycinate taken at night before bed can help as well.


IRRITABLE BOWEL SYNDROME


Mucus (slime) passing along with the stool is normal in some people but is more common in people with an irritable bowel. Patients complain about abdominal pain and bowel difficulties, bloating, altered stool and dietary restrictions.


FAECAL INCONTINENCE


Faecal incontinence is a distressing condition, both physically and emotionally. Until recently, surgical treatment had little to offer.

  • Faecal incontinence is the the loss of control of wind or faeces with or without noticing. Faecal continence is sustained when anal pressure exceeds rectal pressure. Anal pressure is maintained and controlled by a complex interaction of muscles (particularly puborectalis, internal and external anal sphincters), fascia, ligaments and nerves. Increased intra-abdominal pressure causes increased rectal pressure and if the pressure rise is sufficient to overcome anal pressure then faecal incontinence results. The most common reasons for the function of the relevant muscles to be compromised are obstetric injury (e.g. anal sphincter tears, perineum tears), surgical trauma, anal operations and neurological conditions.
  • Patients with faecal urgency can feel the urge to evacuate but cannot retain the faeces. Urgency is due to a low rectal capacity or an inflamed rectal mucosa.
  • Soiling is due to seepage of stool through the anal sphincter and can be due to anal sphincter damage or faecal obstruction in the rectum.


Treatment:

  • Physiotherapy
  • Education
  • Neuromodulation


Proctalgia Fugax



Severe, episodic pain in the regions of the rectum and anus. It can be caused by spasm of levator ani muscle, particularly in the pubococcygeus part.


Treatment:​

  • Physiotherapy:
    • Down training of the pelvic floor muscle
    • Trigger point release
    • Pelvic girdle alignment
    • Connective tissue mobilisation
  • Diaphragmatic breathing
  • Vaginal dilators
  • Correct toilet position
  • Managing your bowel consistency
  • Correct sitting posture


Tailbone Pain / Coccydynia



Pain and tenderness at the tip of the tailbone between the buttocks. It can be caused by an injury e.g. during a fall, prolonged sitting on a hard or narrow surface, degenerative joint changes or vaginal childbirth, but may occur seemingly spontaneously.


There are many causes of tailbone pain which can mimic coccydynia, including sciatica, infection, pilonidal cysts and fractured bone.


Defecation and sex also might become painful.





Suite 13, Netcare Pretoria East Hospital
Cnr Garsfontein Road & Netcare Ave
Pretoria East


Antoinette Jansen van Vuuren