Constipation

CONSTIPATION

Constipation is a common health issue experienced by up to 33% of people at some time in their life [source].

Pelvic floor muscle dyssynergia causes constipation in at least 50% of cases [source].

Dyssynergia is discoordination of pelvic floor muscles. The pelvic floor muscles become hypertonic or tight and have a difficult time coordinating to release a bowel movement.

Dyssynergia isn’t an open and shut deal because there are multiple muscles and nerves that control anal sphincter function.

There are three types of constipation with the first type being the most common in women.

1. Increased intraabdominal pressure is accompanied with increased in anal sphincter pressure.
2. Difficulty generating adequate pushing force (intrarectal pressure), but has increased anal sphincter contraction.
3. Difficulty generating pushing force and anal sphincter relaxation is incomplete.

Treatment may include:

• Pelvic Floor Muscle Training
• Neuromuscular Reeducation
• Visceral Manipulation
• Biofeedback
• Compensatory Strategies
• Scar Mobilization and Massage
• Electrical Stimulation

Individualized evaluation and care are essential to stop constipation from affecting your life.

You don’t have to live with the misery of constipation!

Citations:

1. Baffy, Harris, Foxx-Orenstein. “Pelvic Floor Dysfunction and Refractory Constipation.” WGO: World Gastroenterology Organisation. Vol. 22, Issue 1 (May 2017).

2. “Treating patients with pelvic floor dysfunction.” Mayo Clinic, Physical Medicine and Rehabilitation. 05/22/2014.

Accidental Bowel Leakage

ACCIDENTAL BOWEL LEAKAGE

Accidental bowel leakage is an embarrassing issue that burdens up to 15% of women [source].

The social consequences of accidental bowel leakage can be devastating. There are many reasons women experience accidental bowel leakage, which can be directly related to pelvic floor function.

Below is a breakdown of accidental bowel leakage issues we rehab at You’re In CONTROL!

1. Anal sphincter injury from a perineal tear during childbirth

Often, accidental bowel leakage begins after childbirth. This type of injury is very common with more than 25% of postpartum women reporting accidental bowel leakage or anal smearing at 6 months postpartum [source]. In severe cases, this issue may require surgery.

2. Nerve Damage that inhibits the anal sphincter muscle from closing

Anal sphincter nerve damage can occur from excessive straining, obstruction, assault, or other neurological impairments.

3. Constipation that causes a dry, hard mass of stool (impacted stool) to block the rectum

The muscles of the rectum and intestines stretch and eventually weaken, allowing watery stool from farther up the digestive tract to move around the impacted stool and leak out. Removal of the mass is recommended to begin therapy.

4. Internal Hemorrhoids make it impossible to close the anal sphincter and bowel matter leaks.

5. Scarring from surgery or radiation decreases the elasticity of the anal sphincter or rectum, making it difficult to adequately hold in bowel matter. 

6. Prolapse of the rectum

Prolapse of the rectum can occur when the rectum drops into the space of the vagina or protrudes out the anus, making anal sphincter function difficult or nearly impossible. In rare cases, the small intestines can prolapse between the space of the vagina and rectum as well. 

Pelvic floor rehabilitation is up to 80% effective in the treatment of accidental bowel leakage [source]. 

An individualized evaluation and rehabilitation plan is your least invasive path to gaining control. Much of our success in rehab is using biofeedback EMG to reeducate clients on using their pelvic floor muscles in coordination with the anal sphincter. If you didn’t notice, there is an intricacy of neuromuscular structure involved that control the anal sphincter.

Treatment may include:

• Pelvic Floor Muscle Training
• Neuromuscular Reeducation
• Bladder Retraining
• Biofeedback
• Compensatory Strategies
• Scar Mobilization and Massage
• Electrical Stimulation

The social and relational burden of accidental bowel leakage can be devastating. 

Each woman’s issue is different, but our goal is to achieve control of bowel function.

Citations:

1. Bharucha, A. E., Dunivan, G., Goode, P. S., Lukacz, E. S., Markland, A. D., Matthews, C. A., Mott, L., Rogers, R. G., Zinsmeister, A. R., Whitehead, W. E., Rao, S. S., & Hamilton, F. A. (2015). “Epidemiology, pathophysiology, and classification of fecal incontinence: state of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop.” The American Journal of Gastroenterology, 110(1), 127–136. DOI: 10.1038/ajg.2014.396

2. Guise, J. M., Morris, C., Osterweil, P., Li, H., Rosenberg, D., & Greenlick, M. (2007). “Incidence of fecal incontinence after childbirth. Obstetrics and gynecology.” 109(2 Pt 1), 281–288. DOI: 10.1097/01.AOG.0000254164.67182.78

3. “Pelvic Rehabilitation Medicine Reviewed” By: Allyson Augusta Shrikhande, Medicine, B. P. R., & Shrikhande, R. B. A. A. (n.d.). Pelvic Floor Muscle Hypertonia. Pelvic Rehabilitation Medicine.

Irritable Bowel Syndrome (IBS)

IRRITABLE BOWEL SYNDROME

Irritable bowel syndrome (IBS) is a silent epidemic suffered by up to 20% of women [source].

The cluster of symptoms from IBS can, but not always, include abdominal pain and cramping, as well as diarrhea or constipation. 

Women with irritable bowel syndrome experience increased intra-abdominal pressure, or bloating, which leads to compromised visceral mobility. The bloating produced by IBS causes mesenteric, abdominal muscle, or pelvic floor trigger pain. Orthopedic rib, shoulder, and/or back pain is frequently secondary pain symptoms of IBS, which is caused by pressure of the intestines, liver, or stomach on the joints in the skeletal system.

While irritable bowel syndrome is a chronic gastrointestinal disorder, it frequently presents with pelvic floor dyssernergia, or discoordination, which can significantly contribute to symptoms [source]. 

Women who experience loose stool with irritable bowel syndrome unknowingly tighten the pelvic floor chronically to avoid leakage. This can lead to pelvic muscle tension and discoordination that makes it difficult and painful to hold. 

Women who experience constipation and straining may also interfere with healthy muscle activity by creating prolonged stress on the supporting tissues in the pelvis and pelvic floor. 

Paradoxical puborectalis syndrome,  the failure of the puborectalis muscle to relax when one is attempting to have a bowel movement, is one example of pelvic floor dyssynergia that is prevalent in women with irritable bowel syndrome.

Irritable bowel syndrome has shown to be responsive to therapeutic intervention to decrease pain and increase gestational mobility. In therapy, we work to decrease pain, bloating, and promote normal bowel movements.

Treatment may include:

• Pelvic Floor Muscle Training
• Neuromuscular Reeducation
• Bowel Retraining
• EMG Biofeedback
• Compensatory strategies
• Behavioral Intervention
• Electrical Stimulation
• Dietary Adaptive Techniques

Irritable bowel syndrome significantly effects quality of life. Achieving control is possible using a holistic approach to treatment.

Citations:

1. Saito, Y. (2002). “The epidemiology of irritable bowel syndrome in North America: a systematic review.” The American Journal of Gastroenterology, 97(8), 1910–1915. DOI: http://dx.doi.org/10.1016/S0002-9270(02)04270-3

2. Prott, G., Shim, L., Hansen, R., Kellow, J., & Malcolm, A. (2010). “Relationships between pelvic floor symptoms and function in irritable bowel syndrome.” Neurogastroenterology and Motility: The Official Journal of the European Gastrointestinal Motility Society, 22(7), 764–769. DOI: 10.1111/j.1365-2982.2010.01503.x

Gastroesophageal Reflux Disease (GERD)

GASTROESOPHAGEAL REFLUX DISEASE (GERD)

It is estimated 14.1% of women (and 9.5% of men) suffer from GERD [source].

Acid reflux or GERD may be caused by a hiatal hernia, which gastroenterologists diagnose by an endoscopy. Hiatal hernia often moves the esophagus higher into the chest, pulling stomach acid contents into the esophagus where it does not belong. 

Unfortunately, the lower esophageal sphincter cannot close properly with a piece of the stomach wedged through the enlarged hiatal hole. As stomach acid refluxes back up into the esophagus, the person may experience heartburn, esophageal spasms, inflammation, or sometimes ulcers. 

GERD is both a chemical and mechanical dysfunction.

Poor posture may also alter the position of the stomach, causing the hernia to squash the neighboring vagus nerve which regulates digestion. Since this cranial nerve stimulates the release of hydrochloric acid (via proton pumps), this may cause over or under secretion of hydrochloric acid and stomach enzymes. 

It may also reflexively relax the pyloric sphincter at the bottom of the stomach, causing leakage of vital digestive juices. The lack of hydrochloric acid can lead to poor digestion and toxicity, which may contribute to food allergies, anemia, constipation, and immune and glandular system weaknesses. 

Manual therapy techniques combined with diaphragmatic exercises and postural training stretch the diaphragm and guide the stomach lower from the diaphragm into its normal position to alleviate symptoms.

Treatment may include:

• Neuromuscular Reeducation
• Manual Techniques
• EMG Biofeedback
• Compensatory Strategies
• Electrical Stimulation
• Dietary Adaptive Techniques

We work closely with your healthcare provider to rehabilitate the mechanical dysfunctions of GERD so you can Take CONTROL!

Citation:

Kim, Y. S., Kim, N., & Kim, G. H. (2016). “Sex and Gender Differences in Gastroesophageal Reflux Disease.” Journal of Neurogastroenterology and Motility, 22(4), 575–588. DOI: 10.5056/jnm16138

Small Intestinal Bacterial Overgrowth (SIBO)

SMALL INSTESTINE BACTERIAL OVERGROWTH (SIBO)

SIBO is often caused by the impedance of forward motion in the digestive track.

Small intestinal bacterial overgrowth (SIBO) is defined as excessive bacteria in the small intestine. Patients with SIBO vary in presentation, from being only mildly symptomatic to suffering from chronic diarrhea, pain, weight loss, and intestinal malabsorption. 

Scar tissue from abdominal surgery can cause adhesions similar to “kink in hose.” The obstruction allows for food to ferment and create the bacterial overgrowth of the microbiome.

Another root cause of SIBO is malfunctioning of the ileocecal valve and/or pyloric sphincter, prohibiting normal function.

Manual therapy techniques combined with therapeutic abdominal exercises can release adhesions, easing kinks or malfunctions and facilitate proper digestive movement.

Treatment may include:

• Neuromuscular Reeducation
• Bowel Retraining
• EMG Biofeedback
• Compensatory Strategies
• Manual Therapy
• Electrical Stimulation
• Dietary Adaptive Techniques

Initially thought to occur in only a small number of patients, it is now apparent that SIBO is more prevalent than previously thought. 

Achieving control with SIBO is possible using a holistic approach to treatment.

Chronic Bloating (Abdomino-Phrenic Dyssynergia)

CHRONIC BLOATING

A little bit of bloating is normal after eating but it shouldn’t impair your quality of life (or make you look pregnant).

Chronic bloating, or abdominal distension, may occur with IBS or SIBO. 

It may also be caused by a condition called “abdomino-phrenic dyssynergia” (APD). APD is described as the failure of the abdominal wall muscle to contract and the diaphragm to relax after a meal. Instead, the anterior abdominal wall relaxes and the diaphragm contracts and this redistributes gas, which can lead to the sensation of bloating and visible belly distention.

APD occurs when a diaphragmatic reflex mistakenly sends a signal to press the stomach down when eating instead of the signal to move the diaphragm up to allow the stomach to expand when eating.

Learning to actively regulate abdominal pressure with diaphragmatic exercise combined with biofeedback methods and lymphatic drainage can alleviate abdominal distension.

Click image to open a larger version.

Treatment may include:

• Neuromuscular Reeducation
• Bowel Retraining
• EMG Biofeedback
• Compensatory Strategies
• Manual Therapy
• Electrical Stimulation
• Dietary Adaptive Techniques

Achieving control of chronic bloating is possible using our holistic approach to treatment.

Chronic Abdominal Pain

CHRONIC ABDOMINAL PAIN

It is especially important to see a physician prior to receiving therapy for abdominal pain to rule out other pathologies.

There are many causes of chronic abdominal pain, and patients often have gone through extensive medical testing without a definitive diagnosis determined.

The GI system has a profound influence on the body’s pain response via intricate connections with the nervous system in the fascial attachments. Abdominal pain can be produced when these fascial attachments do not move with the body.

Abdominal pain can also be produced by the enteric nervous system. The enteric nervous system (ENS) is large, complex, and uniquely able to orchestrate gastrointestinal behavior independently of the central nervous system (CNS). ENS dysfunction is often linked to digestive disorders and pain. 

The brain receives a constant stream of interoceptive input from the GI tract, via the ENS, and integrates this information with other interoceptive information from the body with contextual information from the environment. It then sends an integrated response back to various target cells within the GI tract. 

In patients with functional abdominal pain syndromes, conscious perception of interoceptive information from the GI tract, or recall of interoceptive memories of such input, can occur in the form of constant or recurrent discomfort or pain.

Each patient with abdominal pain is different and requires an individualized evaluation and treatment plan.

Treatment options used may include:

• Neuromuscular Reeducation
• Bowel Retraining
• EMG Biofeedback
• Compensatory Strategies
• Manual Therapy
• Electrical Stimulation
• Dietary Adaptive Techniques

It is especially important to see a physician prior to receiving therapy for abdominal pain, so they may rule out other pathologies. 

Achieving control of abdominal pain is possible.

Tailbone Pain: Coccydynia

COCCYDYNIA: TAILBONE (COCCYX) PAIN

The position of the coccyx will affect everything that attaches to it!

Tail bone pain, often referred to as coccyx dysfunction or coccydynia, is often a side effect of constipation. Chronic pressure from an overstretched rectum can injure the muscles and position of the tailbone.

The coccyx also provides support to important organs such as the rectum and anus. 

When coccyx pain is left untreated, it causes chronic low back and pelvic pain that is difficult to resolve with traditional physical therapy because the muscles are best accessed via the pelvic floor. 

A key symptom of coccyx dysfunction is pain and intolerance of sitting. There are many structures that attach onto the small surface area on the coccyx.

The position of the coccyx will affect everything that attaches to it, which is why women’s health therapists are uniquely qualified to treat coccydynia. In fact, medical research cites therapy to be 90% effective in treating coccydynia [source].

Therapeutic treatment modalities can include:

• Manual Techniques
• Joint Mobilization
• Pelvic Floor Muscle Training
• Biofeedback
• Transcutaneous Electrical Nerve Stimulation
• Cryotherapy/Thermotherapy

Tail bone pain is best treated in the postpartum period, but can be addressed years and even decades following delivery. 

The goal for each patient with tailbone pain is to be pain free.

Citation:

Lirette, L. S., Chaiban, G., Tolba, R., & Eissa, H. (2014). “Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain.” The Ochsner Journal, 14(1), 84–87.