As a pelvic floor therapists, we really understand, just how difficult “pooping” or having a bowel movement can be! It may embarrass people to talk about it, but bowel problems really impact people’s lives. “Pooping” or having a bowel movement is a super basic human activity–so when it’s not working the way it should, it’s awful. It involves a very complicated process with the interaction of many nerves, muscles, and the brain.
There are multiple reasons why constipation occurs, however, one condition is Dyssynergic Defecation.
Several factors can cause chronic constipation. Dyssynergic Defecation causes an estimated one-third or more of chronic constipation.
Dyssynergic Defecation is a condition in which there is a problem with the way certain nerves and muscles function in the pelvic floor. The pelvic floor is a group of muscles located at the lower part of the abdomen, between the hip bones, that supports pelvic organs such as the rectum, uterus, and urinary bladder. One of its most important functions is to help us to have normal and easy bowel movements.
Working together, nerves and muscles help maintain continence until we decide to have a bowel movement. The pelvic floor muscles together with anal opening muscles must all relax in a coordinated way to have a normal bowel movement. Failure of this to happen can lead to problems of constipation.
In terms that we all understand, when your colon is contracting to push fecal material out, and you are sitting on the toilet ready to empty your bowels, the muscles should relax and open to allow this to occur. Sometimes, this relationship does not work properly, and your body thinks you are pushing and relaxing the sphincter muscles, but instead, the muscles are contracting and closing the sphincter.
What are the signs and symptoms?
Symptoms may include:
Excessive straining to have a bowel movement
Feeling of incomplete emptying after a bowel movement
Frequent hard to pass stools
Frequent use of the finger to either help pull stool out of the rectum, or using a finger to press inside the vagina to help empty)
What can you do about it?
The great news is that men and women of all ages with a Dyssynergic defecation pattern can respond very well to physical therapy! Pelvic physical therapists are specialists that can work with your primary care physician or a gastroenterologist to develop various tools to cope with chronic constipation.
1. Teaching Proper Toileting Techniques – Typically individuals do not think about having a bowel movement. However, pelvic floor therapists will teach proper sitting positions and techniques to teach people how to relax the pelvic floor when having a bowel movement. (Check out the Squatty Potty!).
2. Surface EMG Biofeedback training to improve muscle coordination – Biofeedback training uses surface electrodes placed at the anal sphincter muscles and the abdominal muscles to identify the type of pattern a person uses to expel a bowel movement. Once we identify the pattern you currently use, we can work together to improve the pattern so that your sphincter muscles relax when you generate abdominal pressure to empty your bowels.
3. Teaching your pelvic floor muscles to relax and to be coordinated – For people with Dyssynergic defecation patterns, teaching patients how to relax the pelvic floor when having a bowel movement is extremely important! Treatment focuses on learning to relax the muscles and may include manual therapy)to help reduce the tenderness and improve the fascial mobility of the muscles.
4. Dietary Changes – Dietary fiber is the part of plants that can digested. There are 2 kinds of dietary fiber: insoluble and soluble. Insoluble fiber adds bulk to keep foods moving through the digestive system. Soluble fiber holds water, which softens the stool for easy bowel movements. Fiber is an important part of your diet, even though it passes through your body undigested and has no nutritional value. A high fiber diet can: promote regular bowel movements
If you are having problems with constipation talk to your GI physician and consider physical therapy. Aquacare Physical Therapy has pelvic floor therapists that can help you get on the right track with constipation!