Constipation Conversation

If the New York Times is talking about it, then I certainly can as well.  In a recent article in the Well section of the New York Times (“Simple Remedies for Constipation,” February 8, 2016, link to article), Jane Brody discusses causes of constipation, a variety of simple yet effective remedies to treat constipation, and certain false “myths” about constipation.  She shares with the readers a decent amount of personal information – namely, she elaborates upon her personal struggle with disordered bowel movements at various stages of her life, and she shares with the reader the tricks and techniques which helped her along her journey.  I applaud her candidness and appreciate that she divulged what probably was not easy to share in order to benefit the greater public audience.

On that note, I feel inspired by Brody to share my own personal story.  While reading the article, I was especially struck by the following line, “Most of the time, relatively simple treatments prove adequate.” I could not agree more, and I speak from firsthand experience.  Once upon a time, I was a teenage girl who was somewhat of a “germaphobe”.  By that, I mean that I tried to avoid using the public bathrooms at all costs, both for voiding and defecating, and I waited until I returned home from school to use the facilities.  I left for school at approximately 7:30 AM and did not return home until 6:30 PM.  Unbeknownst to me, I was wreaking havoc on my pelvic floor muscles (which I did not even know existed at the time) by “holding it in” all day.  In addition, I strictly limited fluid consumption in order to preclude the necessity of voiding in the public bathrooms.  The decreased fluid resulted in extremely hard and large stools which I was unable to pass frequently and only with tremendous pain.  I recall crying to my mother after one particularly painful experience, “childbirth couldn’t possibly be more painful than what I just experienced.”

At the time, my pediatrician instructed me to take laxatives daily.  Not once in our conversation did he ask me what I was eating or drinking.  Something didn’t sit well with me about being dependent on laxatives as a teenager, and that didn’t seem like a viable plan moving forward.  Wasn’t my body supposed to work like everyone else’s? As far as I was aware, none of my friends required daily laxatives to pass bowel movements.  When I mentioned this to one particular friend, she asked me the million dollar question, “How much water are you drinking?”  She looked aghast when I shrugged and responded, “None.”  My friend kindly explained to me the importance of drinking water, and suggested I attempt drinking 8 cups of water per day.  Desperate as I was, I decided to follow her experiment.  Public bathrooms would simply have to become my friend at best, or tolerable at worst.  Success is the best form of positive reinforcement.  Within several days, I was passing pain-free bowel movements on a regular basis.

I was shocked twofold: 1. How such a simple solution could impact my health so significantly, and 2. How my physician never recommended this solution, and that I would still be taking laxatives had followed my physician orders.  The experience taught me to ask questions.  I say the following with all due respect to physicians and medical care providers:  You know your body best.  If a medication or intervention doesn’t make sense to you, you have every right to delve deeper into the matter and ask about alternatives.

In conclusion, I thank Brody for sharing and for inspiring me to do the same.  If our stories educate others and direct them to proper care, then they are well worth telling.  Furthermore, I thank Brody for discussing how breathing exercises, colon massage, and biofeedback, all which are components of pelvic floor physical therapy, can help individuals suffering with constipation.  My one critique of Brody’s article is that she never mentions pelvic floor physical therapy explicitly.  As I wrote in the comments section of the New York Times article, “As a pelvic floor physical therapist and certified biofeedback clinician at Revitalize Physical Therapy who encounters patients suffering from constipation on a regular basis, I want to emphasize how beneficial physical therapy is in the treatment of bowel dysfunction. Biofeedback is definitely helpful to many, however nothing can substitute for external and internal manual myofascial release and connective tissue mobilization. Trained pelvic floor physical therapists are experts of the musculoskeletal system, and they can assist with releasing tightness or tension in the pelvic floor muscles which may be interfering with proper defecation.”  Perhaps my experience years ago subconsciously inspired my decision to become a pelvic floor physical therapist and to help others experiencing what I endured.  If you or anyone you know stand to benefit from these types of services, please contact me.  I would love to have the opportunity to help you.

An Incredible Introduction

Meeting Adam for the Very First Time
Meeting Adam for the Very First Time

For the first time ever, I recently experienced something wonderful and poignant which I would like to share with you.  Several weeks ago, I met an adorable baby named Adam*.  Adam is the first baby I have met who was born in part due to my services as a pelvic floor physical therapist.  When I first met Adam’s parents, Sarah* and Jonathan*, they had been married for approximately one year without ever having consummated their marriage.  Despite multiple attempts, Jonathan and Sarah were not able to participate in intercourse due to Sarah’s pelvic floor muscle tightness which resulted in sexual dysfunction.  They tried various approaches, such as acupuncture and relaxation approaches, however nothing succeeded at reducing Sarah’s pain.  Even though Sarah knew that this was not her fault, she could not help but feel embarrassed and shameful about her symptoms.  She began to wonder if she would ever be able to participate in intercourse with her spouse, and this led her to question whether or not she would be able to have children.  The couple decided to raise the issue with Sarah’s doctor, for the potential benefit outweighed the discomfort and awkwardness associated with the conversation.

Fortunately, Sarah’s gynecologist was familiar with the benefits of pelvic floor physical therapy, and she quickly realized that Sarah was describing musculoskeletal related pelvic floor dysfunction.  Sarah left the office that day with a prescription in hand for pelvic floor physical therapy.

I am grateful that I was granted the wonderful opportunity to guide Sarah along her healing journey.  I initiated a downtraining program for Sarah in order to help stretch and relax her tight pelvic floor muscles.  Her downtraining program included external and internal manual therapy, myofascial release, trigger point work, pudendal nerve glides, diaphragmatic breathing exercises, and hip and low back stretches.  In addition, I taught Sarah how to use both dilators and the Therawand, tools which enabled her to perform vaginal desensitization training at home between sessions.

Sarah responded well to pelvic floor physical therapy.  I remember the day several months into therapy when she excitedly arrived at her session and shared the wonderful news that she and Jonathan successfully consummated their marriage.  Sarah continued her therapy for several more months, and she informed me that she and Jonathan had begun family planning conversations.  She was at a point in her therapy where she was independent in a thorough home exercise program, and she had all the tools at her disposal to maintain a healthy pelvic floor.  Sarah was discharged from physical therapy, and we have remained in touch since then.

Do you know how you remember very specific details about monumental, life changing moments?  Well, fast-forward to December 2014, and please picture this scene: I was about to embark upon a vacation, and I was standing in line at the JFK airport check in catching up on last minute emails and text messages.  I had not heard from Sarah in several weeks, and I noticed that I had received a message from her.  I opened the message which informed me that she and Jonathan were expecting a baby.  My eyes welled with tears of joy and happiness, and to this day I still feel chills when I think about that moment.  I was overjoyed, but I was all alone at the airport with no one to share the moment!  (For half a second, I debated giving a hug to the woman who checked in my luggage; I used my better judgement and decided against that.)  After the many months of hard work, dedication, and commitment, Sarah and Jonathan had finally arrived at their ultimate goal.  What an honor and privilege it was to be God’s messenger in that process and to be the conduit through which this incredible couple’s dream would shortly come true.

Fortunately for me, I often meet wonderful people through my work.  I am constantly inspired by my patient’s and their significant others.  Sarah and Jonathan are the paradigmatic example of such a couple.  Jonathan was incredibly supportive throughout the therapy, and his loving patience facilitated Sarah’s journey.  According to Sarah, “Riva’s excellent and compassionate care helped my husband and I be able to have physical intimacy in our marriage that was previously impossible.  Her work with me also enabled us to have our sweet son.  We are so grateful!”  After Adam was born, Sarah and I met for coffee so that I could meet their precious little miracle.  It was a moving and emotional experience for me, and it reminded me how blessed I am to be a pelvic floor physical therapist who has the opportunity to help people with such intimate and personal aspects of their lives.  I hope to have the opportunity to continue doing so for many years to come.

*Names and minor details have been changed out of respect to involved parties