Bowel Issues

  • Constipation can vary from infrequent stools, hard to pass stools, or hard small stools. Patients may also recount a feeling they have to use the bathroom, but they can’t fully empty or get the stool out.   There are many reasons, some of which can be helped by physical therapy.  One reason may be a non-relaxing anal outlet or pelvic floor.  Another scenario is pelvic floor dyssynergy,  a confused pelvic floor that tightens when it should be relaxing during bowel movements.  Usually this condition develops after a period of painful bowel movements from fissures, hemorrhoids, or perineal tears with birth.  However, we sometimes find in in individuals without any precursors.  We have been specially trained at Mayo Clinic to learn the program for constipation outlet problems that was only available at Mayo Clinic and John Hopkins, before we brought it to Indianapolis.  We use systematic muscle retraining techniques, in progressive positions of the body, biofeedback, and finally we progress to training with passing different volumes of mini balloons with air or water, to learn to keep the anal outlet relaxed with passing bowels.  Additionally, we address the non relaxing musculature with manual therapy to help it lengthen and function better.  Finally, we address the restricted fascia in the abdomen with manual therapy. If patients still have abdominal or rectal pain with bowel movements, this is usually treatable pain.
  • In other situations, abdominal surgeries or endometriosis has left the bowels unable to have the motility and mobility they once did.  This can cause slowed motility.   Visceral work can often help that as well.
  • Bowel leakage:    Fecal incontinence or smearing (bowel leakage) is an under-reported problem that can often be helped by strengthening anal outlet musculature.
  • Patients often report smears of discoloration in their undergarments, losing their bowels during the day, finding feces on the toilet paper every time you urinate and wipe (without having had a bowel movement) or an inability to stop themselves from passing gas, even in embarrassing situations.  Sometimes there is a history of birth trauma or radiation treatment locally.
  • These embarrassing problem are treatable with time and attention.  Increasing sensory awareness via modalities helps in training to sense feces or gas more easily.  Additionally, tweaking some sphincter relaxing foods in your diet can help.   Reducing local scar improves muscle function and contractility.  Estim and nerve retraining help to regain control of the sphincter to form a better defense.  Often a combination of techniques may eliminate the problem altogether, if the patient can commit to working on the program.