Most of you know that physical therapists treat musculoskeletal problems like back pain and sprained ankles. Some of you may even have heard that physical therapists treat urinary incontinence. But did you know that physical therapists can treat constipation and fecal incontinence? With specialized training, yes, we can. We have two certified specialists in pelvic rehabilitation in our A.Fox Physical Therapy offices. Most of our day is spent talking about bowel and bladder disorders and the role of the pelvic floor muscles.

Think about it this way:

The pelvic floor muscles are muscles just like any other and THEN SOME. They are muscles under our voluntary control, and additionally, they are under the control of our autonomic nervous system. For example, when the bladder gets full, there is a feedback loop to and from the brain that tells the bladder to contract and release urine. As the bladder contracts, the urethral sphincter and the pelvic floor muscles relax. For bowel, when stool comes down through the rectum, the pressure in the rectum sends the message to the brain to tell the anal sphincter and pelvic floor muscles to relax. (Actually, there is a lot more to the sphincter thing than this, but for the sake of brevity, We won’t go into it here). But what if you are shopping, and you are all the way back in produce section at Costco, and the bathroom is in the front of the store past check out? Or you are on the golf course? Or stuck in Denver traffic? Then we tell our brain to tell those muscles to squeeze and hold. The sphincters close and the muscles shorten and tighten. Otherwise, there is a whole lot of socially unacceptable unpleasantness that happens. Embarrassing!

Not only do these muscles have to be strong, they also must let go and elongate. If they do not, this is a whole other issue. The problem then is constipation or urinary symptoms such as hesitancy to start the stream and the feeling of incomplete emptying. Over time, the muscles become uncoordinated and instead of relaxing to allow emptying, they do the opposite and tighten. This can lead to straining, and straining can lead to the organs being pushed or prolapsed.

Admittedly, all of us may have a bit of urinary leakage when sneezing, or we may pass unwanted gas in Pilates class. All of us experience occasional constipation with pressure and bloating. So, when is this a problem? There is a questionnaire called the Pelvic Floor Distress Inventory, PFDI. Google it! Feel free to look over the questions and then decide for yourself. Urinary or bowel dysfunction that affects your quality of life, limits your social engagements, or interferes with participation in activities for health is a worth having addressed, especially if you are an active older adult.

What can a physical therapist do? As a specialist, we can assess your muscles (yes those!) for strength, flexibility, coordination, just like an ortho PT checks your hamstrings. Then we can design a program specific for you that may include exercise, manual therapy, behavioral adjustments such as dietary and fluid recommendations. Other modalities such as biofeedback and electrical stimulation can be helpful. If you would like to know more, please call, and we would be more than happy to have this conversation with you. We are not shy! And you should not be either!

Dr. Veda McIntire, DPT, PRPC Herman and Wallace
Dr. Amanda Sejna, DPT, PMA-CPT, CAPP-OB certified APTA