We all know that stress, diet, fluid intake, and activity can influence our bowels, but what about the pelvic floor muscles?
Pelvic floor physical therapy (also known as PFPT) is a specialized branch of physical therapy that targets the muscles, organs, and joints of the pelvic area. There are many structures in the neighborhood, including the bladder, reproductive organs, and the rectum, and they all interact with each other more than you might think! By addressing dysfunction in the pelvic floor, we can directly impact how effectively our bodies eliminate waste.
Pelvic floor PT is becoming more and more commonly used as a treatment for a variety of bowel issues, including constipation, leakage, pain, and IBS. Read on to learn more!
Understanding the Pelvic Floor
What is the Pelvic Floor?
The pelvic floor refers to a group of muscles at the base of the pelvis that control the bladder, bowel, sexual function, and provide necessary support for the core, hips, and spine. There are over 20 muscles of the pelvic floor and they all play a role in managing in-comings and out-goings of the pelvis (ahem.. pee, poop, and sex).
Connection to Bowel Function
Let’s take a more specific look at how the pelvic floor impacts the bowels. There are three layers of muscle involved in keeping stool in and letting it out. As stool exits the body, it must pass through each of these layers successfully.
First, it meets the puborectalis muscle, which is a horseshoe-shaped muscle that is part of the deepest pelvic floor muscle layer (the levator ani)
After this, it reaches the internal anal sphincter.
Then, the external anal sphincter
Each muscle plays a unique role in regulating bowel movements and making sure you’re always in control. But to keep it simple, when they’re relaxed and open, you’re pooping. When they are engaged and closed, you’re not pooping.
Common Bowel Issues Linked to Pelvic Floor Dysfunction
Constipation
Remember how there are three layers to the bowel control mechanism? That’s a lot of safeguards! It’s almost like our bodies REALLY don’t want us to lose control of our bowels for some reason…
The drawback to this is the fact that there are lots of opportunities for stool to have a hard time coming out. If any of those three muscles isn’t able to relax effectively, the opening will be too small for poop to be able to exit. This may be manageable if your stools are soft, but what if you aren’t drinking enough water or eating enough fiber and your stool is hard?? Well. We’ve got a bit of a problem here, don’t we?
Fecal Incontinence
This one is a bit more straight-forward. If the muscles aren’t ready or strong enough to close the opening, stuff is going to leak out. For some this happens only with strong urge or with coughing/movement, for others it happens randomly or in small amounts throughout the day.
Irritable Bowel Syndrome (IBS) and Pelvic Floor Dysfunction
IBS is a complex (and not fully understood) condition, so there are many factors that contribute to symptoms. The pelvic floor is one of them. Think of it this way: when you’re in pain, anxious, or stressed are you generally going to be tense or relaxed? Muscles in our bodies tend to reflect the overall vibe of our nervous systems. This happens on a global scale (you stub your toe and you find yourself clenching your fists because of the pain), or in a more local way (you bump your elbow and instinctively pull your arm in towards your torso for protection).
Well, what if you chronically have abdominal pain, bloating, “nervous gut”, or unpredictable bowels? This is hardly a relaxing situation, so chances are your abdominals and pelvic floor muscles are not going to be chillin. They’re going to be tense and reactive in an effort to protect this painful area. That muscle tension, in turn, can cause its own issues (like worsened constipation, stronger urgency, the list goes on). It’s an unfortunate cycle.
How Pelvic Floor Physical Therapy Helps
Assessment Process
At your pelvic floor evaluation, you’ll be asked way more questions about your bowels than you probably ever cared to share. We need to know all the details: How often? What time of day? What does it look like? What does it feel like coming out? How does your diet, stress, activity impact it? We’ll also need to know all about your medical and physical history.
Next, we’ll evaluate the pelvic floor muscles themselves. The very best way of doing this is via the rectal canal. I know. Sounds uncomfortable, doesn’t it? However, it truly is the gold standard to knowing exactly what is going on. The exam is performed typically with the patient on their side, and the therapist uses one gloved finger to (very gently) palpate (meaning touch or press) each of the pelvic muscles. Starting more superficial and working deeper, fully evaluating each layer of muscle along the way. Along with palpation, she will ask you to squeeze, relax, and bear down with those muscles to evaluate how much control you have.
A skilled and specialized physical therapist will be able to identify specifically if any of these muscles aren’t doing their part. And even more specifically, they can tell if even part of one of those muscles is dysfunctional (e.g. just one side, front or back, etc).
Biofeedback Techniques
Biofeedback refers to the concept of using external input to better understand what’s going on inside your body. For example, assessing your pulse during exercise is a form of biofeedback. By seeing the number go up or down, you have a better understanding of how your body is responding to your movement. Since the pelvic floor muscles are often challenging to control, we can use biofeedback to help you understand exactly when your muscles are tense, relaxed, or engaged.
Manual Therapy
This refers to hands-on treatment. If there is a muscle in your shoulder that is tense, oftentimes the best way to address it is to massage or apply pressure to the area. The same thing is true with the pelvic floor. A skilled physical therapist can use manual techniques to reduce muscle spasm and improve mobility of stubborn muscles.
Bowel Retraining
Based on how well you coordinate your muscles, your therapist will prescribe specific exercises to address any deficits. For example, if your muscles are overly tense, you’ll practice breathing techniques and stretches to reduce that tension. If they’re weak, your program will be primarily strength-based.
Lifestyle Modifications
Alongside your PT treatments, making an effort to encourage proper bowel function will be key. This includes plenty of water intake, balanced diet, regular physical activity, and stress management.
Who Can Benefit from Pelvic Floor Physical Therapy?
Populations
Some individuals are at a greater risk for bowel and pelvic floor dysfunction, including postpartum individuals, those with IBS, chronic constipation, anxiety, pelvic pain, or abdominal surgeries. However, you don’t necessarily need these things in your history to be a great candidate for PFPT.
Signs You Might Need PFPT
Still unsure? If you’re experiencing any of these, you likely could benefit from pelvic floor PT:
Difficulty emptying bowels
Straining when you poop
Pain before, during, or after bowel movements
Unintentional stool leakage at ANY time
Any bowel concerns that are also associated with bladder symptoms
Conclusion
Pelvic floor PTs are specifically trained to assess, diagnose, and treat muscle dysfunctions in the pelvic floor. Based on your evaluative findings, they can tailor programs to address your body’s specific needs.
If any of the above symptoms sound all-too familiar, pelvic floor PT might be just what you need so that you can get your bowels in order and get on with your life! If you’re still unsure, give us a call and Dr. Bailee will gladly help you determine over the phone if you would benefit from this treatment.
Click below to contact us and book your evaluation today. You’ll be so glad you did!
Written by:
Dual Board-Certified Pelvic Floor Therapist and Owner of Bonneville Pelvic Health
As an expert in pelvic floor rehabilitation, Dr. Bailee Burningham brings extensive experience in treating complex pelvic floor disorders, including bowel dysfunction. She is dedicated to providing compassionate, patient-centered care.
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