Pelvic floor physical therapy is an evidenced based, effective, and conservative form of treatment for bowel related disorders. Bowel disorders include constipation, bowel frequency, bowel urgency, bowel retention, rectal pain and/or pressure, fecal incontinence, difficulty initiating bowel movements, incomplete emptying of the rectum, decreased colonic activity, and abdominal pain. These types of disorders are often accompanied by pelvic floor musculoskeletal issues. They may also be associated with hypersensitization, also referred to as upregulation, of the central nervous system.
Physical therapy for bowel dysfunction often includes manual therapy to stretch tight internal pelvic floor muscles. Releasing tightness or tension in the pelvic floor muscles, particularly the puborectalis muscle, can help improve ease of defecation. The pelvic floor muscles are rarely tight in isolation, and it is common for individuals with tight pelvic floor muscles to also exhibit tight hip, gluteal, and/or abdominal muscles. When this is the case, pelvic floor physical therapy also addresses the other tight musculature in order to restore normal resting tone to both the pelvic floor muscles and surrounding local muscles.
In addition, pelvic floor physical therapy involves relaxation training and diaphragmatic breathing. It also consists of education on proper foods and fluids, including education of proper fiber intake and water consumption. Furthermore, proper toileting postures and techniques are addressed to ensure that the patient is able to maintain a relaxed pelvic floor and avoid straining. It may also include colon massage to improve and promote intestinal transit.
Very often, people are unaware of when and where they store stress in their bodies. Sometimes, people store stress in the top half of their core, in the neck and shoulders. Other times, people store stress and tension in the lower half of their core, namely in their pelvic floor muscles. People are often unaware when this occurs, especially because the pelvic floor muscles are obscure internal muscles that are usually overlooked until they scream for our attention by producing pain or uncomfortable symptoms. Pain and discomfort is the body’s way of saying, “Please give me attention and take care of me the same way you would take care of your neck.” In order to address pelvic floor muscle tightness, it is first necessary to teach patients how to connect with and create awareness of their pelvic floor muscles.
One way to promote a stronger mind-body awareness for is with biofeedback. Biofeedback is a helpful tool often used by physical therapists to help patients learn how to properly connect with their pelvic floor muscles and assist with neuromuscular re-education. Biofeedback, or surface EMG, involves placing electrodes on the skin overlying the pelvic floor muscles to detect the electrical activity generated by the muscles. It is hard to teach a person how to turn “off” a muscle that is “on” if that person isn’t even aware that it is “on” to begin with. Biofeedback can be used to help bridge that gap.
If you or someone you know stands to benefit from pelvic floor physical therapy for bowel dysfunction, feel free to contact us at Revitalize Physical Therapy. It would be our pleasure to answer your questions and to help in any way possible.