Constipation is a common disorder primary care physicians and gastroenterologists from a Hospital for Special Surgery diagnose on a regular basis. There are many causes, but when constipation is due to “pelvic floor dyssynergia”, which are restricted pelvic floor muscles around the anal region that contract instead of relax during attempted bowel movements, a licensed physical therapist, trained in pelvic floor dysfunction can reverse constipation and help you resume normal bowel function.
The pelvic floor is a group of muscles at the base of the pelvis that help control sexual, urinary and bowel function. These muscles, namely the puborectalis, levator ani and coccyxgeus must relax and contract properly to maintain urinary and fecal continence, sexual function and proper voiding habits. When the pelvic floor muscles fail to relax and contract properly, this can be referred to as “pelvic floor dyssynergia”. The inability to relax and contract the pelvic floor muscles correctly can lead to symptoms of constipation, straining with bowel movements, and feelings of incomplete evacuation.
Some of the physical therapy treatments for constipation include external and internal rectal myofascial release techniques, trigger point release techniques, biofeedback therapy to help down train tight muscles and/or up train weak muscles, instruction to correct bowel techniques to prevent straining, instruction in home exercise program to stretch and strengthen pelvic floor, hip and gluteal muscles.
Manual therapy is needed to reduce the tension, adhesions, and knots in muscles that cause them to become dysfunctional. This treatment is always with a patient’s permission, may be uncomfortable, but overall a very successful approach to rehabilitate faulty pelvic muscles patterns that resulted in constipation.
Biofeedback therapy helps retrains your pelvic floor muscle’s ability to contract and relax within their full range of motion. It is a treatment which requires insertion of a rectal sensor (sensor is the size and length of a pinky) to measure pelvic floor muscle tension through electromyography (EMG). The EMG activity is visually displayed on the biofeedback unit so you can see what your muscles are doing and learn to better control these muscles with verbal and tactile cueing from the physical therapist. Identifying the internal sensations associated with the relaxation and how to maintain the ability for your pelvic floor muscles to be at a relaxed state throughout the day is taught as well.
Specific stretching and strengthening exercises are taught for the pelvic floor; the abdomen and pelvic girdle (the gluteal, hamstring and adductor musculature). Manual therapy such as soft tissue mobilization and trigger point release are administered to tight and restricted tissue both to the lower abdominal region and pelvic floor musculature to help increase blood flow, decrease restrictions and promote healing. Education regarding normal bowel function and identification of problematic toileting habits is also an important step to recovery.
By complying with a pelvic floor physical therapist’s recommendations, you can be well on your way to pain free and stress free bowel function – no more constipation!