A technique where physiological actions (e.g., muscle contraction/relaxation) are monitored in real-time and displayedor ‘fed back’ to the patient. This technique aims to improve the individual’s awareness of their physiological movements (e.g., muscle contraction), which in turn improves control (e.g., coordination of the anal sphincter, abdominal muscles, pelvic floor muscles, and breathing) Electromyography (EMG) sensors can be placed on the skin covering the anal sphincter to measure contractions, which can then be feedback to the patient on a display.

Involves establishing a regular, predictable pattern of bowel emptying. Emptying the bowels at a regular frequency and at the same time of day can make it easier to deal with bowel symptoms. People with constipation-predominant IBS, for example, may miss bodily cues that the bowel is ready to empty.

The muscles of the pelvic floor allow us to control the bowel and bladder. Inability to use these muscles properly can result in an inability to ‘hold in’ a bowel motion or urine, as well as difficulty emptying the bowel properly.

Involves a physiotherapist assessment of the individual’s defaecation. Proper defaecation involves the coordination of several muscles, including the diaphragm, pelvic floor, and anal sphincter. Incorrect or inefficient bowel emptying (e.g., straining) can be corrected using exercises and biofeedback.

Involves placing a small, expandable balloon into the rectum. As the balloon expands, it simulates the feeling of needing to have a bowel motion. The participant is taught to notice the sensation and to contract the pelvic floor and anal sphincter to ‘hold on’. This activity allows the person to develop confidence in controlling their bowel motions in a controlled setting –without the risk of having an ‘accident’. This technique can also be used to retrain the participant in proper bowel evacuation techniques.

Relaxation techniques can be used to reduce issues of bowel movement urgency and constipation. The symptoms of IBS can cause worry and anxiety, which in turn can create physical tension as the muscles in the body contract. This contraction can increase tension in the rectal canal and exacerbate the sense of urgency. Similarly, an inability to relax properly can make it difficult to coordinate the muscles of the pelvic floor and sphincter, making it difficult to pass stool.

Some people with IBS may rely on laxatives, enemas, or suppositories to have a proper bowel motion. These products can effectively empty the bowel but don’t necessarily reduce other symptoms such as pain or bloating. Reducing use of these products reduces the cost and treatment burden on patients, and avoids issues where a product is needed (i.e., to empty the bowel) but is not readily available (e.g., run out and not near a pharmacy).

Many people hold beliefs about bowel habits that are not true. For example, “we need to have a bowel motion once per day” when in actual fact anything from 3 times per day to 3 times per week is considered ‘normal’. Misplaced expectations regarding bowel habits can cause undue stress. Ideally, a physiotherapy based approach to bowel training will involve education about what is considered ‘normal’ and the factors that can influence changes in our bowel habits.