by Sue Croft Physiotherapist
Updated version of blog first published Mar 26, 2014 at SueCroftPhysiotherapist.com.au
Bowel health plays a crucial role in pelvic floor function and prolapse management. Step 4 of the 5 Step Plan focuses on understanding how your bowel habits, toilet posture, and defaecation technique can either protect or strain the pelvic floor.
Why bowel management matters for prolapse
Many women are surprised to learn how strongly the bowel and pelvic floor are connected.
Poor bowel management can increase downward pressure on the pelvic organs, leading to prolapse or even causing failure of prolapse surgery.
- Inadequate toilet training as a child – many people were never taught the correct way to defecate
- Bad habits - stool of the wrong consistency, habitual straining , or leaning back to defecate (can be equivalent of having a little baby every day!)
- Dyssynergia – poor coordination between the external anal sphincter and one of the pelvic floor muscles (pubo-rectalis), so the anus tightens instead of relaxing and releasing the stool.
- Birth-related pelvic floor damage – weakened pelvic floor muscles, nerve injury/damage, or levator avulsion can cause the vaginal walls to balloon during bowel emptying
- Perineal weakness – too much mobility or a short perineal body reduces support between the vagina and anus.
All these factors increase pressure, strain, and risk of worsening prolapse.
The physics of bowel health
Good management of bowels is about angles and forces – so, a bit of maths and physics(1)(2). The position of your pelvis and the relaxation of your muscles make a huge difference in how easily you can empty your bowels.
Defaecation Dynamics: How to empty your bowels without straining
- Respond to first urge – don’t defer or delay bowel movements.
- Use correct toilet posture – sit with your knees higher than your hips (use a footstool if needed), lean forward slightly, and rest your elbows on your knees.
- Relax your tummy – take slow, deep breaths.
- Gently bulge your abdominal wall – this helps open and relax the anal sphincter naturally.
- Never strain! – forcing the stool out increases pelvic floor pressure and risks worsening prolapse.
These simple strategies can make a major difference in preventing constipation, bowel dysfunction, and pelvic organ prolapse.
How to keep your bowels healthy
A healthy bowel routine supports every other aspect of prolapse care.
- Maintain a fibre-rich diet and good hydration.
- Move regularly to stimulate bowel motility.
- Allow time and privacy for unhurried toileting.
- Seek help from a women’s health physiotherapist if you notice difficulty, pain, or incomplete emptying.
In summary
Healthy bowel habits and pelvic floor-friendly defecation techniques are key to managing prolapse and preventing it from worsening. Learning how to empty your bowels without straining protects surgical outcomes, supports your pelvic floor, and restores confidence in daily life.
So, to manage your prolapse well, you need to get your bowels in order!
References
- Sapsford, R., Bullock-Saxton, J., & Markwell, S. (1998). Women’s health: A textbook for physiotherapists. W.B. Saunders.
- Bharucha AE. Management of fecal incontinence. Gastroenterol Hepatol (NY). (2008), Nov;4(11):807-17. PMID: 21960903; PMCID: PMC3104390.
- Croft, S. (2012). Pelvic Floor Essentials.
