As many as 50 percent of people with chronic constipation have pelvic floor dysfunction (PFD) — impaired relaxation and coordination of pelvic floor and abdominal muscles during evacuation. Straining, hard or thin stools, and a feeling of incomplete elimination are common signs and symptoms. But because slow transit constipation and functional constipation can overlap with PFD, some patients may also present with other signs and symptoms, such as a long time between bowel movements and abdominal pain.
By definition, postpartum pelvic floor dysfunction only affects women who have given birth, though pregnancy rather than birth or birth method is thought to be the cause. A study of 184 first-time mothers who delivered by Caesarean section and 100 who delivered vaginally found that there was no significant difference in the prevalence of symptoms 10 months following delivery, suggesting that pregnancy is the cause of incontinence for many women irrespective of their mode of delivery. The study also suggested that the changes which occur to the properties of collagen and other connective tissues during pregnancy may affect pelvic floor function.
Pelvic floor dysfunction may include any of a group of clinical conditions that includes urinary incontinence, fecal incontinence, pelvic organ prolapse, sensory and emptying abnormalities of the lower urinary tract, defecatory dysfunction, sexual dysfunction and several chronic pain syndromes, including vulvodynia in women and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men. The three most common and definable conditions encountered clinically are urinary incontinence, anal incontinence and pelvic organ prolapse.
During the internal exam, your physical therapist will place a gloved finger into your vagina or rectum to assess the tone, strength, and irritability of your pelvic floor muscles and tissues. Internal exams and internal treatment are invaluable tools that are taught to pelvic floor physical therapists. It can tell us if there are trigger points (painful spots, with a referral pattern or local); muscle/tissue shortening; nerve irritation and/or bony malalignment that could be causing your pain directly or inhibiting the full function of your pelvic floor muscles. We can also determine if your pelvic floor has good coordination during the exam. A pelvic floor without good coordination, may not open and close appropriately for activities such as going to the bathroom, supporting our pelvis and trunk, sexual activity, and keeping us continent.
Pain can emerge because of lifestyle factors and underlying medical problems. Sitting all day can affect the nerves in your saddle, which may translate into a burning pain in your vulva, explains Rhonda K. Kotarinos, DPT, a specialist in pelvic floor dysfunction in the Chicago area. The discomfort of chronic vaginal infections or holding urine all day long can also lead someone to “walk around with their pelvic floor clinched to their ears. It can make your pelvic floor very angry,” she says.
I have been on this earth almost eighty years, no meds, and have not had these symptoms–yet. I had 5 pregnancies, and one episiotomy birthing one large baby, no hysterectomy. I am not overweight nor do I have a flat butt. Here are some things I’ve done over the years and now am wondering if it may have helped. I don’t know if this was developing core muscles, but when I was a kid, and through most of my life, when I went to bed I would hold my stomach in until I went to sleep. Odd, I know, but I have never had back problems. A strong stomach keeps your back strong. I garden, and have always done squats, still can, although lately I squat without thinking about it and notice it’s less easy to get back up. By doing most things my self I get plenty of exercise and I walk daily. Exercise and diet helps constipation problems. I think as we get older we don’t empty our bladder fully. If you have to lean forward, to the sides, or back or bounce a little, do it. And, true confession, I have a tiny extra bathroom where I can place my feet on the wall–works great for a Squatty Potty. Lastly, keep having orgasms.
The “pelvic floor” refers to a group of muscles that attach to the front, back, and sides of the pelvic bone and sacrum (the large fused bone at the bottom of your spine, just above the tailbone). Like a sling or hammock, these muscles support the organs in the pelvis, including the bladder, uterus or prostate, and rectum. They also wrap around your urethra, rectum, and vagina (in women).
^ Vesentini, Giovana; El Dib, Regina; Righesso, Leonardo Augusto Rachele; Piculo, Fernanda; Marini, Gabriela; Ferraz, Guilherme Augusto Rago; Calderon, Iracema de Mattos Paranhos; Barbosa, Angélica Mércia Pascon; Rudge, Marilza Vieira Cunha (2019). "Pelvic floor and abdominal muscle cocontraction in women with and without pelvic floor dysfunction: a systematic review and meta-analysis". Clinics. 74: e1319. doi:10.6061/clinics/2019/e1319. ISSN 1807-5932. PMC 6862713. PMID 31778432.
Mechanistically, the causes of pelvic floor dysfunction are two-fold: widening of the pelvic floor hiatus and descent of pelvic floor below the pubococcygeal line, with specific organ prolapse graded relative to the hiatus. Associations include obesity, menopause, pregnancy and childbirth. Some women may be more likely to developing pelvic floor dysfunction because of an inherited deficiency in their collagen type. Some women may have congenitally weak connective tissue and fascia and are therefore at risk of stress urinary incontinence and pelvic organ prolapse.
Once patients with pelvic floor constipation have these basic tools, they can begin retraining the pelvic floor muscles with biofeedback. Based on the principle of operant conditioning, biofeedback provides auditory and visual feedback to help retrain the pelvic floor and relax the anal sphincter. Biofeedback training is the treatment of choice for medically refractory pelvic floor constipation, with some studies showing improvement in more than 70 percent of patients. Patients also learn to identify internal sensations associated with relaxation and long-term skills and exercises for use at home.
Pelvic floor dysfunction is a common condition where you’re unable to correctly relax and coordinate the muscles in your pelvic floor to urinate or to have a bowel movement. If you’re a woman, you may also feel pain during sex, and if you’re a man you may have problems having or keeping an erection (erectile dysfunction or ED). Your pelvic floor is a group of muscles found in the floor (the base) of your pelvis (the bottom of your torso).
As you can now see, there is so much out there that can be done for people suffering with pelvic floor dysfunction. This blog is by no means extensive, and there are even more options you and your physical therapist can explore to help manage your pain or other pelvic issues. Pelvic floor dysfunction requires a multidisciplinary approach for most of our patients. Hopefully, this blog helped to paint a picture of what you will experience with a pelvic floor physical therapist. We advise that you seek out an expert and experienced pelvic floor physical therapist in order to help better your life and improve your function.
Physical therapists (PTs) are experts in movement and function, which sounds like a pretty broad topic to be an expert in, and it is. After physical therapists graduate PT school (now-a-days at the doctoral level), they find their niche and specialize. You can find PTs working with high-level athletes, children, infants, people who are recovering from injuries, people with neurological conditions and many other types of clients.