Bowel Dysfunction

The pelvic floor muscles play a crucial role in supporting the rectum and regulating bowel movements, both voluntarily and involuntarily. Normally, these muscles prevent unintentional leakage of gas and stool, while also allowing controlled relaxation for stool evacuation. The anal sphincter, a complex neuromuscular structure, can distinguish between air, liquid, and stool, triggering automatic responses from the pelvic floor muscles. Gastrointestinal distress, unfortunately common in the United States, can have a significant impact on these muscles, often worsening gastrointestinal symptoms. Dysfunction in this system can cause considerable discomfort. However, pelvic floor physical therapy, alongside a comprehensive interdisciplinary treatment plan, can provide substantial relief.

Key facts

• Up to 28% of people experience constipation

• Gastrointestinal distress affects over 25% of Americans

• As many as 40% of postpartum women report anal incontinence and fecal urgency

• Women are three times more likely to suffer from constipation than men, especially after age 65

• Irritable Bowel Syndrome (IBS) impacts up to 30% of the population

• Small Intestinal Bacterial Overgrowth (SIBO) is found in 38% of people

• Chronic constipation is a major cause of pelvic pain and pudendal neuralgia

• Constipation can worsen bladder and pelvic pain symptoms

• Normal bowel movement frequency ranges from three times a day to three times a week; less than three per week is abnormal

Symptoms

• Exerting effort to pass stool

• Constipation

• Using an excessive amount of toilet paper

• Leaking or incontinence of stool or gas

• Development of hemorrhoids and fissures

• Pain experienced before, during, or after bowel movements

• Anal or rectal discomfort, burning, or itching

Causes

• Constipation caused by medications such as opiates, mood stabilizers, and oral contraceptives

• Dysfunction in the pelvic floor muscles, including dyssynergia, tightness, or weakness

• Nerve damage in the periphery resulting from childbirth, chronic straining, or surgical injuries

• Effects on the body from gastrointestinal issues like IBS, SIBO, Crohn’s disease, and ulcerative colitis

How we can help

The health of pelvic floor muscles is deeply connected to gastrointestinal function and bowel health. When experiencing gastrointestinal symptoms or bowel movement difficulties, an evaluation by a pelvic floor physical therapist is often necessary. Bowel issues can arise from pelvic floor muscles being either too tight or too weak, or from a lack of coordination in these muscles. Traditional advice such as doing kegel exercises might actually worsen symptoms if the pelvic muscles are overly tight, highlighting the importance of specialized pelvic floor therapy. This therapy may involve initially lengthening the muscles before strengthening them.

What to expect

At your initial appointment, we will start by taking your medical history, followed by a comprehensive musculoskeletal examination of your pelvic area. This will include assessing your posture, joint alignment, any muscle restrictions or trigger points, the health of your connective tissue, and muscular strength. An internal examination is often part of this process, but it's entirely optional and will only be conducted if you feel completely comfortable with it. This exam is much more relaxed and comfortable compared to a typical ob/gyn visit, and it provides essential information about your pelvic muscle tone, strength, and coordination. If impairments are found during the exam, the physical therapist can treat the problems with manual therapy techniques resulting in pain relief and improved function. Following the exam, we'll discuss our findings with you and outline a personalized treatment plan aimed at achieving the best results. Most patients start feeling better after their first session and see significant improvement by their third visit.