Constipation may be a possible sign of pelvic floor disorder. The Department of Colorectal Surgery at Singapore General Surgery (SGH) tells more.
Constipation may be a possible symptom of pelvic floor disorder
For more than 10 years, secretary Ms K took laxatives every day for her constipation. Even then, she only managed to move her bowels with great difficulty on many days.
The 51-year-old sought treatment from various clinics and hospitals for her chronic problem, but was always offered laxatives and fibre drinks that made her feel more bloated and uncomfortable.
“The problem became so bad that even when I ate light meals, my tummy would become bloated and painful to the touch,” said Ms K.
In April 2012, she saw
Dr Mark Wong, Senior Consultant,
Department of Colorectal Surgery and Director,
Pelvic Floor Disorders Service,
Singapore General Hospital (SGH), a member of the
SingHealth group. Dr Wong put her through a series of tests, which revealed that she was suffering from a form of pelvic floor disorder, where the muscles involved in bowel movement weren’t coordinating the way they should.
Constipation caused by pelvic floor disorder: not your usual constipation
The pelvic floor consists of muscles that form a sling-like structure. This structure, together with connecting tissues, holds up or supports the organs above the pelvis, such as the rectum, bladder and womb.
During a bowel movement, the pelvic floor muscles relax while the muscles of the abdomen contract to push faeces out of the rectum – the lowest portion of the large intestine. This process is an automatic, coordinated effort between different muscles. But, sometimes, the contractions don’t coordinate well, meaning the pelvic floor muscles are contracting when they should be relaxing, leading to difficult bowel movement.
“The passing of stools is a complex interplay of relaxing and contracting the muscles at appropriate times. In some people, this interplay is disrupted or just mixed up and, like an electric circuit, needs to be rewired,” said Dr Wong.
This malfunction can be due to a weakness or deficiency of the pelvic floor and can occur in patients as young as in their late teens. However, such causes of constipation are more often picked up only when patients are much older.
“Probably everyone has suffered from constipation at some point in life. Constipation is so common that, after a while, people come to accept it as a part of their lives. They stop bothering to investigate (the problem) further,” said Dr Wong.
One reason, said Dr Wong, is a lack of awareness that a constipation problem that is due to a malfunction of the pelvic floor can be treated. “Sometimes, the entire colon contracts poorly for some reason or other, or there is obstructed defecation – meaning the patient is contracting normally, but must strain at the end as if there is blockage,” said Dr Wong.
“Our message to doctors is that if you’ve tried everything for your patients, are at your wits' end and find that you’re going nowhere (in addressing the problem), please send them to us,” said Dr Wong.
See next page for the
causes of constipation and exercises to relieve it.