The pelvic floor is the area between the pubic bone in the front and the tail bone at the back. It is richly meshed with several small muscles, nerves, and other soft tissues. These structures form a sling that supports the abdominal and pelvic organs primarily the bladder, uterus and bowel. These muscles also encircle the openings of the bladder (urethra), bowel (rectum) and uterus (vagina) – they provide closure as appropriate for these openings and enhance sexual activity. The muscles of the pelvic floor are the primary target for physical therapy treatment.
Patients who come to physical therapy with bowel dysfunctions fall into two broad categories:
- Patients with pelvic floor muscle tension – with symptoms of constipation or tension myalgias of the muscles with symptoms of rectal pain
- Patients with pelvic floor muscle weakness – with symptoms of leakage of flatus (gas) and feces
Bowel function can be influenced by several factors. Once your physician has done a medical work up and physical therapy is recommended, the therapy targets the muscles surrounding the anal canal.
Tension Myalgias of the Anal/Rectal Muscles:
The muscles of the pelvic floor, particularly those surrounding the anal canal are shortened and cannot relax, stretch or work in a coordinated manner with the lower abdominal muscles to allow for normal bowel movement. Also scars and fascial tightness may contribute to the pain. Bowel movement requires the puborectalis muscle to relax and “open the gate” so that the bowel can be emptied. If this muscle is not able to relax, patients may experience constipation. (There are other causes for constipation also).
The goal of physical therapy is to restore the normal contract/relax/stretch sequence of the pelvic floor muscles to minimize pain and allow for a comfortable bowel movement
Muscle Weakness of the Anal/Rectal Muscles - Incontinence
Pelvic floor muscles provide closure when appropriate and relax when we need to empty our bowels or bladder. When the muscles are weak, they cannot provide closure you have leakage.
Physical therapy will help you identify and strengthen these muscles to minimize leakage and fecal “urgency”.
Physical therapy treatment includes one or more of the following:
The assessment is detailed and primarily directed towards determining the degree of weakness, tension and coordination of the anal/rectal muscles and lower abdominal muscles.
We do ask you a detailed history of your symptoms and toileting habits, your fluid intake, some dietary questions and exercise history are also included.
- Manually applied Quick stretch to the muscles will jump start a weak muscle or gentle stretching and release techniques will relax the muscles
- Correct misalignments of the joints in the pelvis and/or spine: tail bone, sacroiliac (joint mobilization). These misalignments may be perpetuating or contributing inefficient muscle effort
- Gentle movements to mobilize stiff or tense bowel or rectum and related structures (visceral mobilization)
Pelvic floor BIOFEEDBACK or surface EMG:
Biofeedback involves the insertion of a small probe into the vagina or rectum that “records” muscle activity and translates these signals onto a computer screen so that patients can “see” their muscle contraction, tension and relaxation. The ability to view muscle activity helps patients to see the results of their efforts as muscles strengthen or relax.
For muscle re-education
Electrical stimulation at certain frequencies may be applied directly into the rectum to enhance muscle action. The stimulation recruits muscle fibers to contract at the same time that you are also making the effort to contract. At lower frequencies, electrical stimulation calms the bladder and lessens symptoms of urgency. Patients are given resources on how to order “home units” if necessary.
Exercise: to Ensure Accuracy and Specificity
All muscles should have the ability to contract, relax, stretch and act in coordination with other muscles. Physical therapy is directed towards helping your pelvic floor muscles achieve all these as necessary
Depending on the strength and endurance of the pelvic floor and lower abdominal muscles, a tailored exercise program is designed to ensure that exercises are done accurately. Hints and tips help to minimize the use of the buttocks and inner thigh muscles. The number of repetitions, the position in which you do the exercises and how often and how many and how to coordinate with the lower abdominal muscles – all make a difference to the effectiveness of the exercise. If the muscle is too tense, the focus of exercises is to facilitate relaxation of the muscle.
Exercises are made more challenging as you progress.
The therapist will suggest modifications to your diet, fluid intake, exercise to help stimulate the bowels, bowel massage to do at home, ideal toileting positions, and suggestions for relaxation will be discussed.
You will need a prescription from your physician and physical therapy services are reimbursed by most insurance companies.
Physical therapists are health care professionals who assess and manage patients who have medical problems or other health related conditions that limit their ability to move and perform their daily activities comfortably. Your Physical therapist will take a detailed health history, examine you and develop a personal plan of care.
Treatment techniques are used to promote movement, reduce pain, restore function, and prevent disability. Your Physical therapists will work with you to enhance health by developing fitness- and wellness-oriented programs for healthier and more active lifestyles tailored your ability.
For more information or to schedule an appointment call 713-799-6193