Most people are unaware that pelvic floor therapy can be very effective in the treatment of bowel disorders. Bowel dysfunction can occur due to many medical reasons, however physical therapists can evaluate and treat the musculoskeletal components of bowel dysfunction. Musculoskeletal dysfunctions leading to bowel disorders can be treated with physical therapy as outlined below.
Bowel Disorders include:
• Fecal Incontinence
• Bowel Frequency, Urgency, Retention, and/or Incomplete Emptying
• Rectal Prolapse
• Abdominal Bloating• Anal/Rectal and/or Abdominal Pain, Pressure, or Spasm
While there can be many medical reasons for bowel disorders, physical therapists can evaluate and treat the musculoskeletal components of bowel dysfunction. Musculoskeletal dysfunctions caused by IBS, constipation, and the other bowel disorders can be treated with physical therapy through releasing myofascial trigger points in the abdomen, back, gluteal, and pelvic floor, and re-education of these muscle groups.
Constipation is a common disorder that primary care physicians and gastroenterologists diagnose on a regular basis. There are many causes, but when constipation is due to “pelvic floor dyssynergia”, which are restricted pelvic floor muscles around the anal region that contract instead of relax during attempted bowel movements. A licensed physical therapist, trained in pelvic floor dysfunction can reverse constipation and help you resume normal bowel function.
The pelvic floor is a group of muscles at the base of the pelvis that help control sexual, urinary and bowel function. These muscles, namely the puborectalis, levator ani and coccyxgeus must relax and contract properly to maintain urinary and fecal continence, sexual function and proper voiding habits. When the pelvic floor muscles fail to relax and contract properly, this can be referred to as “pelvic floor dyssynergia”. The inability to relax and contract the pelvic floor muscles correctly can lead to symptoms of constipation, straining with bowel movements, and feelings of incomplete evacuation.
Diarrhea is defined as a condition in which feces are discharged from the bowels frequently and in a liquid form. Leakage from diarrhea can occur due to weak pelvic floor muscles, due to its soft consistency.
Irritable Bowel Syndrome (IBS):
Signs and symptoms of IBS may include abdominal pain or discomfort, bloating, gas, frequent bowel movements, diarrhea, and/or constipation. As one of the most common disorder of the gastrointestinal system. IBS may result from tightening, weakening, and/or incoordination of the pelvic floor and abdominal musculature.
Fecal incontinence is the inability to control bowel movements, causing stool to leak unexpectedly. Precursor symptoms include soiling, fecal urgency, and flatulence (gas loss). The amount of stool will vary as sometimes only a small quantity will be lost or the complete bowel movement may be lost,
Fecal Incontinence can occur due to the following:
• Muscle damage. Injury to the rings of muscle at the end of the rectum (anal sphincter) may make it difficult to hold stool back properly. This kind of damage can occur during childbirth, especially if you have an episiotomy or forceps are used during delivery.
• Nerve damage. Injury to the nerves that sense stool in the rectum or those that control the anal sphincter can lead to fecal incontinence. The nerve damage can be caused by childbirth, constant straining during bowel movements, spinal cord injury or stroke. Some diseases, such as diabetes and multiple sclerosis, also can affect these nerves and cause damage that leads to fecal incontinence.
• Loss of storage capacity in the rectum. Normally, the rectum stretches to accommodate stool. If your rectum is scarred or your rectal walls have stiffened from surgery, radiation treatment or inflammatory bowel disease, the rectum can’t stretch as much as it needs to, and excess stool can leak out.
Hemorrhoids are painful, swollen, and inflamed veins around the anus and rectum. They occur usually due to straining with bowel movements with pregnancy, or chronic constipation. Hemorrhoids can be external (skin around the anus) or internal (inside the anal canal). If the muscles or tissues in the rectum and anal canal are restricted or in spasm, blood flow to the hemorrhoid is restricted. This decreased circulation can make healing more difficult. Physical therapy can help increase tissue mobility and reduce muscle spasms in the affected area.
A rectocele is the protrusion of rectal tissue in the posterior vaginal wall. It may occur with childbirth, chronic constipation, chronic coughing, heavy lifting, estrogen deficiency, abdominal weakness and/or obesity. Symptoms may include constipation and/or pelvic pain, fecal and/or urinary incontinence. A rectocele may be prevented through correct body mechanics with lifting, avoidance of straining, controlling and treating constipation, weight control, core stabilization exercises and kegels. A rectocele can be successfully managed through pelvic floor
Some of the physical therapy treatments for bowel disorders include external and internal rectal myofascial release techniques trigger point release techniques, biofeedback therapy to help down train tight muscles and/or up train weak muscles, instruction to correct bowel techniques to prevent straining, instruction in home exercise program to stretch and strengthen pelvic floor, hip and gluteal muscles.
Manual therapy is needed to reduce the tension, adhesions, and knots in muscles that cause them to become dysfunctional.
Biofeedback therapy helps retrains your pelvic floor muscle’s ability to contract and relax within their full range of motion. It is a treatment which requires either insertion of a rectal sensor (sensor is the size and length of a pinky) or external sensors to measure pelvic floor muscle tension through electromyography (EMG). The EMG activity is visually displayed on the biofeedback unit so you can see what your muscles are doing and learn to better control these muscles with verbal and tactile cueing from the physical therapist. Identifying the internal sensations associated with the relaxation and how to maintain the ability for your pelvic floor muscles to be at a relaxed state throughout the day is taught as well.
Specific stretching and strengthening exercises are taught for the pelvic floor; the abdomen and pelvic girdle (the gluteal, hamstring and adductor musculature). Manual therapy such as soft tissue mobilization and trigger point release are administered to tight and restricted tissue both to the lower abdominal region and pelvic floor musculature to help increase blood flow, decrease restrictions and promote healing. Education regarding normal bowel function and identification of problematic toileting habits is also an important step to recovery. By complying with a pelvic floor physical therapist’s recommendations, you can be well on your way to pain free and stress free bowel function.