Constipation & Urgency: A Pelvic Floor Therapist's Guide
How can pelvic floor therapy help my bowel issues?
Pelvic floor therapy is increasingly recognized for treating bowel concerns, but understanding its role and finding solutions can be challenging. Support is available for those seeking help -- we are here for you!
Pelvic floor therapy for bowel health can support the following issues:
Constipation
Straining
Hemorrhoids
Fissures
Symptoms of IBS
Fecal smearing (needing to excessively wipe after bowel movements, staining underwear)
Bowel leakage or seepage
Incontrollable loss of gas
Pelvic floor therapy sessions for clients with bowel concerns may look different depending on the person's individual needs but may include internal (vaginal or rectal) and external manual therapies, nervous system down-regulation, exercise and strengthening, mobility, positioning, and habit retraining, as well as additional strategies such as biofeedback and intra-rectal balloon training.
Overall, treatment will help you with improving your awareness of your pelvic floor and ability to control these muscles in the right time for optimal toileting.
How do I know if I'm constipated?
Many new clients, despite not complaining of constipation, often express that they have always felt 'sort of constipated,' indicating a normalization of their condition over time. This sometimes leads to a loss of understanding of what 'normal' bowel movements even are.
Signs of constipation may include:
Increased time between bowel movements
Painful bowel movements
Needing to strain
Incomplete emptying
Issues with hemorrhoids or fissures
Stools that are dry, hard, and/or lumpy
Bowel movements that occur between once every 3 days and 3 times per day can all be considered normal, depending on what your 'normal' typically is. For example, if someone is used to having a bowel movement 1-2 times per day and now all the sudden is going once every 3 days, then that would not be their normal.
Take a look at the Bristol Stool Scale below -- it's almost like a game of Clue for your bowel movements. Hard like rocks? Soft and fluffy? We all want to aim to have stools somewhere around Type 4, smooth like a snake and solid.
What is dyssynergia?
If you have heard the term 'pelvic floor dyssynergia,' it is likely that you may have heard this from your GI doctor or colorectal specialist. Sometimes this is diagnosed after an assessment by your doctor's office called an anorectal manometry. Dyssynergia is a fancy way of saying that your pelvic floor muscles lack the coordination necessary for optimal bowel movements.
Symptoms of pelvic floor dyssynergia may include straining, feelings of incomplete emptying, bloating, stomach pain, or anorectal pain -- in other words, constipation.
The pelvic floor is responsible for contracting or tightening to maintain continence throughout the day but also relaxing in a coordinated fashion when it is time for toileting. In the case where the pelvic floor muscles do not want to relax or release the appropriate amount or in the right time in synchrony with your bowels, this may lead to constipation.
Sometimes, the urge to defecate, or have a bowel movement, is thrown off when there is a coordination issue of the pelvic floor muscles. For example, it may feel like you really have to use the bathroom urgently. However, when you go to the bathroom, it seems there is nothing to defecate.
The opposite can also be true. Some may feel that there is no need to defecate with little to no urge at all, yet they anatomically are indeed ready to pass a bowel movement.
What is outlet constipation?
Another way of saying that your pelvic floor muscles are to blame when it comes to constipation is 'outlet constipation.' Outlet constipation could be occurring because the pelvic floor muscles are overactive with increased tone or because the muscles are uncoordinated. More often than not, both are at play.
Some signs of outlet constipation or this type of pelvic floor dysfunction may include straining, stools that are difficult to pass, pain in the rectum, or needing to use hands to help empty.
How can pelvic floor therapy help with anal fissures?
Believe it or not, pelvic floor therapy can be a huge help in breaking the cycles of anal fissures. Fissures are small, paper-cut like tears in the anal canal that can develop from irritating bowel movements, such as when passing hard stool. Oftentimes, there is a pelvic floor tension and/or coordination component that contributes to someone getting anal fissures.
When there is pain from fissures, there is guarding and more muscle tightness, which makes it even more difficult to relax the muscles for well-coordinated, smooth bowel movements - pun completely intended. When indicated, supporting relaxation of the pelvic floor muscles in conjunction with improving coordination of these muscles can be an excellent way to promote tissue healing and reduce the recurrence of fissures.
How do I make sure I am getting enough fiber and water?
Classic advice like 'Eat your fiber!' and 'Drink your water!' is often oversimplified. However, it is crucial to ensure these factors aren't causing bowel issues. Aim for water intake of half your body weight in ounces, excluding beverages like coffee and wine.
Adults should target 25-30g of fiber daily, but many underestimate their actual intake. Not all fiber types are equal, and a pelvic floor therapist can assist in understanding your needs based on stool consistency and other factors.
Help me get in control of my bowels! Having the opposite problem?
Constipation gets a lot of press, but what about fecal seepage, fecal leakage, or fecal smearing? Fecal smearing involves excessive wiping or stains on underwear, while fecal urgency with leakage refers to difficulty reaching the bathroom after a strong urge.
Fecal seepage is characterized by small stool bits in underwear. These issues stem from pelvic floor muscle dysfunction, which can result from either low or high muscle tone and coordination problems.
Pelvic floor therapists can help identify reasons for your issues, like obstetric anal sphincter injury (OASIS) or more subtle contributors like daily habits affecting muscle function over time. Although fecal leaking can be embarrassing, pelvic floor therapy offers a supportive solution without judgment. There is no TMI with pelvic floor therapy.
What is intra-rectal balloon training?
Intra-rectal balloon training is an evidence-based intervention that can be a part of a more comprehensive treatment plan to get your bowel movements in order.
Using a medical-grade balloon attached to a catheter that is inserted into your rectum, your pelvic floor therapist can slowly inflate or deflate the balloon to improve your sensation, awareness, and muscle function. Expelling can also be addressed with a balloon that is slightly inflated to simulate bowel movements.
While intra-rectal balloon training can sound quite intimidating, your pelvic floor therapist will acquaint you with the equipment and procedure to ensure it is more approachable than it may seem when reading about it.
Not everyone is a candidate for balloon training, so this is something to certainly talk with your pelvic floor therapist about.
What is biofeedback?
Biofeedback is a tool that is often recommended for clients with pelvic floor dysfunction, pelvic floor dyssynergia, and other bowel related concerns. This treatment tool involves using external or internal sensors to read the EMG activity of the pelvic floor and abdominal muscles. There is a computer screen that displays a graph, which will depict the EMG readings in real-time.
Visualizing the activity of the muscles can be helpful if someone is learning to voluntarily 'let go' of their pelvic floor by relaxing the muscles and when teaching how to use the abdominals and pelvic floor in conjunction with one another to optimize bowel movements.
If someone is having more issues with fecal urgency or leakage, this may be a helpful tool to visualize the engagement of the pelvic floor muscles that is necessary to potentially sustain on the way to the bathroom. Either way, this a strategy that is one of many that your pelvic floor therapist may discuss with you.
Biofeedback is not a one-size-fits-all approach. You should never be left alone hooked up to a biofeedback machine for "treatment" and biofeedback should never be your sole treatment intervention for optimal pelvic health.
Let's get started.
If you are unsure where you land on the spectrum of bowel health and pelvic floor issues and would like to see if pelvic floor therapy would be helpful for you, we would love to hear from you!
Send us a web inquiry or give us a call to connect at Bloom Pelvic Therapy.