Hi Pelvic Care family,
This month we’ll be talking about colorectal health. Check out the list of colorectal issues we commonly treat below.
Colorectal issues that can be addressed in pelvic floor physical therapy include but are not limited to: constipation; pelvic floor dysfunction associated with IBS, ulcerative colitis, chronic heartburn, or other GI concerns; fecal incontinence and fecal smearing; chronic hemmorhoids; issues with bowel movements caused by perineal tearing during childbirth (OASIS); anal fissures; and rectocele/posterior vaginal prolapse.
Do you have any of these issues? Do you have a colorectal issue we didn’t mention and you’re wondering if pelvic floor PT could help? If so, shoot us a text (4052409575) or PM us @pelviccare. We’d love to help.
We treat constipation more than anything else in that previous list. There is nothing better than receiving a client’s text after treatment, saying “I just had the best poop of my life!” (And not to brag but–we get this a lot!) There are several different forms of constipation, and it is a pelvic floor PTs job to discern the mechanism of the constipation so we can get you better as quickly as possible. Some folks are constipated because their pelvic floor is so tense, their anus can’t open and stretch sufficiently to let the poop come out. These people need manual therapy and stretches to relax the posterior pelvic floor. Others have dyssynergic defecation: the muscular coordination required to produce a bowel movement isn’t happening for them. These folks often need help learning how to use their abs and diaphragm to produce downward pressure while relaxing their anus. If you have dyssynergic defecation, this can feel a lot like rubbing your tummy and patting your head–nearly impossible! Tools like balloon training, which we’ll talk more about here in a bit, help give our PT clients with dyssynergic defecation direct experience coordinating effective bowel movements. Other clients have slow transit constipation, which means that fecal matter isn’t moving at the normal pace through their GI tract, resulting in hardened and hard to pass stools. These people (and really all our constipation clients) see good results with abdominal massage to increase GI motility, nutrition review and advice, training in having a “bowel routine” to stimulate the call to stool, customized exercises including cardiovascular training and yoga twists, and biofeedback including balloon training.
What is a bowel routine? So glad you asked! A bowel routine is a way of habitually setting the stage for a bowel movement to happen. If you have constipation, wake up a little early to give yourself time for your bowel routine. If you’re not an early riser–just make time for this stuff later in the day. Drink a warm cup of coffee (or water, or tea). Eat a fiber-rich breakfast, and take your supplements/constipation meds (Miralax, magnesium/Calm powder, etc.) Get some movement in. Take your dogs for a brisk walk, or roll around in bed and do some yoga stretches and twists. Give yourself a tummy rub. (Don’t know how? Don’t worry, we’ll teach you!) Then, go sit on the toilet. Don’t forget to use your squatty potty! Make the bathroom your spa, your me time. Take your time. Sit upright, and take some deep breaths. Feel the breath moving through your back ribs, widening your sits bones and opening your anus each time you inhale. If nothing is happening, try some perianal acupressure–press gently with a finger around (or inside) your anus to stimulate a BM. These are just a few ideas for a bowel routine. What works for a given person, may be different than for another.
Balloon training is our new favorite tool for helping clients with colorectal problems. A medical balloon is inserted ano-rectally and gently inflated to produce rectal distention, simulating the presence of fecal matter in the rectum. When the rectum senses pressure (even if it’s actually just coming from a balloon), it thinks “I need to poop!” This comes in handy, because it allows us to use these medical balloons to treat a wide variety of defecatory dysfunctions. Individuals with fecal incontinence and fecal urgency often have hypersensitive rectums. We use balloon training to help these people reach a higher pressure threshold before they have the urge to poop. People with constipation often have hyposensitive rectums. We use the same intervention for these folks, with a few modifications, to train them to identify the urge to poop sooner. And folks with dyssynergic defecation can practice expelling the balloon, with a physical therapist’s coaching–which then translates to improved coordination on the toilet.
There are a million other colorectal issues we’d love to discuss with you here–this is just the tip of the iceberg. Here are some ideas we have for future colorectal foci–we’d love your feedback on what would be most helpful to discuss in coming months:
What does internal anorectal manual therapy look like?
What are signs of rectocele/posterior vaginal wall prolapse and how is it treated?
What are OASIS injuries and how are they treated (postpartum moms with posterior pelvic floor pain and/or fecal incontinence due to perineal tearing)
Insoluble vs. soluble fiber, how much fiber is ideal, how to correctly increase one’s fiber intake, and other issues surrounding dietary management of IBS, ulcerative colitis, constipation
The science of defecation (how our gut works, from mouth to anus, and how a BM is coordinated neuromuscularly)
