Bladder and bowel dysfunction are also known as concerns with urinating or defecating. This frequently occurs due to nerve or muscle abnormality, as these structures regulate the flow of urine and the discharge of stool. Often females may feel an unwanted need to urine or pass stool without being able to control the urge. It can be so distressing and embarrassing that females tend to not seek help from healthcare workers and suffer in silence. The female urogenital tract comprises of many organs which are vital in reproduction and the formation and release of urine which consist of the kidneys, ureters, bladder, urethra, and organs of reproduction such as the uterus, ovaries, fallopian tubes and vagina.
The normal function of the bladder encompasses two phases: filling and emptying. For a typical micturition cycle to happen the urinary bladder and the urethral sphincter must work hand in hand as a synchronized unit to stock and void urine. The bladder acts as a low-pressure container during urinary storage whereas the urinary sphincter sustains a high resistance to urination whereby keeping the bladder outlet shut.
During the removal of urine, the bladder shortens to permit urine while the urinary sphincter releases slowly to let unhindered urinary flow and bladder voiding. The last stop in the movement of food through the digestive tract is called bowel movement. This is made of what is left after the digestive system which consists of stomach, small intestine, and colon have finished absorbing nutrients and fluids from the intake of what was consumed. Faeces or stool in the body is gotten rid of via the rectum and anus. Stool arrives to the rectum from the colon. Two major muscles that the stool needs to pass in order to exit the body are the internal sphincter muscle and the external sphincter muscle. The internal sphincter muscle which is automatic meaning it routinely relaxes and opens at the top of the anal canal to let stool pass through. After the stool reaches the upper anal canal, sensitive nerve cells are activated hence causing people with normal nerve sensation to have the urge to have a bowel movement. In contrary, the external sphincter muscle is voluntary therefore you have control over this muscle. This muscle helps in storing the stool in the rectum until someone is prepared to have a bowel movement. Squeezing the external sphincter muscle pushes the stool out of the anal canal allowing relaxation of the rectum thereby making the urge to have a bowel movement to disappear until the following colon contraction hits the rectum. Bladder dysfunction and bowel dysfunction are issues related to urinating and passing stools. Urinary or fecal incontinence is a result of unwanted passage of urine or stool. Urinary incontinence defined by Abrams et al is the involuntary loss of urine that is accurately evident and is a social or hygienic problem. Incontinence of urine may be further divided into three main groups: storage, voiding and postmicturition symptoms. Bowel dysfunction falls into two key groupings: struggle in emptying faecal material and an inability to store faecal material steadfastly prior to removal at publically suitable times and places. There are certain nerves in the body that controls the muscles necessary for bladder and bowel function and signals them when to contract and relax so urine and faeces can be removed whenever you want them to. This occurs as nerves in the spinal cord direct messages from the brain to the bladder and sphincter muscles to control the flow of urine. Muscles in the rectum and anus aid with regulation of bowel movements and sphincter muscles control or discharge stool. A wide variety of circumstances affect the nerves and muscles that control the bladder and bowel, causing dysfunction and incontinence. Urinary incontinence may be due to difficulty controlling sphincter muscles, overactive bladder and urine retention. Bowel incontinence results from vaginal childbirth, rectal prolapse, constipation, diarrhea, damage to the nervous system prior to injury/disease and hemorrhoids. Voiding difficulty is a general term describing conditions where there is reduced coordination concerning the bladder muscle and the urethra. As a result there is partial relaxation or over activity of the pelvic floor muscles in voiding. Voiding dysfunction is categorized as either underactivity of the bladder (detrusor) or outflow (urethra).Difficulty arises when the nerve supply to the detrusor is reduced so it does not contract or does so very weakly and detrusor is stretched by amount of urine due to urethra being blocked, that it cannot contract efficiently resulting in chronic urinary retention. Sooner or later the stress in the bladder increases and overpowers the urethra end pressure, and urine is passed in small quantities as a drop or spurt with movement or effort till the pressure in the bladder and the urethral closure pressure equalizes. This leads to a substantial capacity of remaining urine, and the pressure soon builds up overtime. The condition can ascend from neurological impairment disturbing the pelvic innervation as in diabetic neuropathy, urinary tract infections, complications of surgery, detrusor atonia or cauda equine syndrome. Research shows that twenty percent of women over the age of forty have some form of incontinence. Therefore evaluation of bladder or bowel dysfunction must be executed by a healthcare expert such as physiotherapist in order to establish a precise diagnosis so that an action or executive plan can be applied. When a patient is referred with any indications of urinary/faecal incontinence, history taking is a vital form of assessment prior to physical examination. It is essential that the physiotherapist shapes a good relationship with patients in order to achieve their confidence so they will be able to relate the utmost stressful symptoms. Some assessments done for urinary and fecal incontinence are quality of life questionnaire, urinalysis, pad test, paper towel test, visual analogue scale, anorectal manometry, concentric needle EMG, and endoanal ultrasonography. Due to the nature of the problem and symptoms experienced, a health care provider will assist in developing a strategy of action which includes changing your diet, exercises such as kegel exercises, medications, and bladder/bowel retraining and in rare cases, surgery. Physiotherapists in a few UK centres were frequently involved in the treatment of urinary/faecal incontinence in the 1940s and 1950s. They used defaecation technique, anal sphincter exercise, biofeedback, massage for constipation, neuromuscular stimulation, rectal sensitivity training, anal plugs and skin care and body odours for the management of bowel dysfunction. For urinary incontinence physiotherapists assist by teaching pelvic floor muscle (PFM) contractions, biofeedback, interferential therapy, electrical stimulation, vaginal cones, bladder retraining, timed and prompted voiding and functional activity. Physiotherapists are able to achieve specific goals with these treatments thus creating just a little more strength or range of movement to enable a patient in being independent.