General Bio
Jo is a specialist pelvic health physiotherapist who helps men and women both online and in her clinic in Newcastle upon Tyne. She is passionate about raising awareness and breaking stigma around taboo pelvic topics such as bowel health, sexual function and pelvic pain. After working in both private and NHS settings in London and Newcastle, she has gained a wealth of experience in treating all types of pelvic floor dysfunction with a holistic and client centred approach. She believes no symptom is too big or too small to get help, and that pelvic health rehabilitation is a journey best enjoyed as a multidisciplinary team with the client front and centre.
Jo, your approach to helping your clients in your practice seems to be very patient centred and goal orientated. How do you feel this approach impacts outcomes?
Taking a holistic approach allows you to understand your clients experience of their symptoms, rather than just the symptoms themselves. Knowing which symptoms are most bothersome to them (even if they seem insignificant to you) and understanding how that affects their daily life is key to setting achievable and realistic goals that your client will be motivated to work towards. Working this way creates a dynamic relationship between you and the client where you support them in their rehabilitation journey, rather than you giving them a set of things to do. This improves outcomes massively, as clients are motivated and feel in the driver’s seat of their own care.
In your practice you see people with many different concerns and ailments, how do you know when low volume irrigation might be a beneficial addition to their treatment plan.
Often clients come to see me with multiple pelvic health symptoms such as pelvic pain, urinary leaking, constipation and difficulties with sex and intimacy. For many pelvic health conditions, improving bowel health can cause significant improvement in other pelvic health areas and so is often a great place to start. A thorough subjective assessment and analysis of a bowel and food diary is key to establishing the key drivers for their bowel dysfunction, and completing an in depth biomechanical, pelvic floor and anorectal assessment can help to identify anatomical and physiological causes for dysfunction.
Conservative management is vital, and treatment will always begin with optimisation of their fibre and fluid intake, gastrocolic reflexes, and defecation dynamics. Lifestyle advice and education about gastrointestinal anatomy often makes a huge difference to symptoms, but for many low volume irrigations is an obvious next step for remaining symptoms due to its ease of application, safety and efficacy.
In your experience is low volume irrigation good for one type of patient, or a specific condition or have you seen success with a broader range of patients and conditions within your practice?
Low volume irrigation can be a great tool for many of the clients I see in clinic with all sorts of pelvic floor and visceral dysfunction. For clients with dyssernergic defecation with or without tenesmus, low volume irrigation can give them confidence that they have completely emptied so they can get off the toilet and get on with their life. For those with a trapping rectocele or postnatal laxity leading to incomplete emptying and post defecation soiling, the anatomy of their fascial defect can affect the efficacy of perineal or vaginal splinting, and so irrigation can help to wash out the pocket. Injuries to the anal sphincter during childbirth can lead to symptoms of bowel urgency, incontinence and post defecation soiling which can be supported with irrigation.
Hormonal changes around the menopause can cause constipation and pelvic floor changes which respond really well to using irrigation to get their bowel back into a regular routine. For many older clients who have been reliant on laxative medication which causes them to yoyo between hard and loose stool, irrigation allows a dosable treatment option which can give them reliability of stool consistency. Clients with neurological conditions such as multiple sclerosis can respond really well to irrigation, and the benefit of Qufora systems is that as their physical dexterity reduces and their bowel changes with their condition they can move onto different systems such as the mini go flex, all the way to the higher volume systems. And for those men and women who have had bowel issues their whole life but never tried irrigation, it is often a key tool in helping them to establish a new and reliable bowel routine.
How do you perceive the role of rectal irrigation in supporting other therapeutic modalities within a holistic approach to patient care?
Supporting bowel health within physiotherapy is all about finding the primary driver for the problem. For those clients who are struggling with straining and difficulty initiating a bowel movement, low volume irrigation can cause a stronger sense of urge and rectal propulsion which can stimulate emptying alongside optimising defecation dynamics and positions for emptying. For those with a paradoxical contraction of the levator ani or anismus during defecation, irrigation can improve sensation of rectal fullness whilst retraining the pelvic floor to relax during emptying. For those who have a greater tone pelvic floor, irrigation can be used to improve bowel habits whilst other down training strategies such as breathwork and stretches have time to work. Similarly, if the pelvic floor or anal sphincter complex needs strengthening to reduce incontinence or post defecation soiling, irrigation can provide the client confidence during this process. For many, irrigation does not treat the primary driver, but allows an opportunity to break the cycle of evacuatory disorders or obstructed defecation to allow the client to relearn how to empty their bowel effectively, whilst simultaneously establishing a new bowel routine over a twelve-week period.
When considering holistic care, our aim is to improve quality of life and irrigation can do this by providing reliability of bowel habits leading to less fear of leaking, less fear of urgency, and improved comfort of bowel emptying.
What would you say to healthcare professionals who think rectal irrigation may be of help to some of their patients, but are maybe less familiar with it? Are there any resources you would recommend they start with?
Rectal irrigation can be intimidating at first as it is important to understand contraindications to be able to recommend it safely. However, it can be such a lifechanging treatment modality that anyone working in bowel health will find great satisfaction in helping clients with irrigation.
In my practice I have found keys to confidence with irrigation is being able to cover the basics first including giving out lifestyle advice regarding fluid intake, dietary changes, optimisation of defecation dynamics and improving gut transit with morning routines and abdominal massage. It is also key to feel really comfortable and familiar with doing anorectal examinations so that you can understand if there are physical problems such as anismus, paradoxial contraction of the levator ani, reduced rectal sensation or hypersensitivity, and any anal sphincter complex issues such as defects of scarring. That way you can feel confident knowing that irrigation is a safe and appropriate next step.
Using the decision guide to rule out your contraindications and precautions helps ensure safe prescribing and can help guide you regarding the best form of irrigation for your client. Get support from your local Qufora key account manager – as they can support you with basic training, understanding the set up, providing sample packs and can even see clients with you at the beginning until you feel confident. There are also brilliant resources from Qufora which you can send to your clients to support them on their irrigation journey. Often starting with low volume irrigation can help to build your confidence with irrigation for the less complex clients as it is associated with less risks and is easier to teach.
Remember, although some clients use rectal irrigation as a long-term management strategy for their bowel dysfunction, most clients within physiotherapy will use it for a period of time to allow treatment of the primary driver of their problem, and then will no longer need it once a new bowel routine is established and maintained.
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