Having Bowel Troubles? When to See a Pelvic Floor Physical Therapist

Dr. Hannah Lattanzio, PT, DPT 

August serves as an awareness month for many gastrointestinal diseases and conditions - so we wanted to dedicate this month's blog post to all things bowel dysfunction. 

Do you find yourself straining to poop? Have abdominal pain and bloating without a known cause? How about having to wipe excessively until the toilet paper is clean? If this sounds like you, keep reading below! 

Your Gastrointestinal System and Pelvic Floor 

You probably know that your gastrointestinal (GI) system is a complex network of organs that assist with many functions including digestion, absorption of nutrients and waste removal. While many people are familiar with the various organs involved in digestion, most are not aware that your pelvic floor muscles play a role as well (it’s true!). 

Many individuals are unsure of what constitutes normal bowel habits and functions, so below includes a list of symptoms (though not an exhaustive list). If any of these describe your trips to the bathroom, it might be a good sign to visit a pelvic floor physical therapist! Feeling unsure? Feel free to book a discovery call with us to see if you are a good fit. 

Symptoms of pelvic floor and bowel dysfunction can include:

• Excessive wiping after defecation 

• Straining to empty bowels 

• Fecal or flatulence (passing gas) incontinence 

• Abdominal bloating and/or pain 

• Fecal frequency and/or urgency 

• Changes in the width of your stool (becoming more narrow or pencil-like)

Healthy bowel habits:

• Healthy bowel frequency can be 3 times a week up to 3 times a day, what is important is the consistency of bowel movements and little deviation from your baseline. 

• No straining, pain or bleeding with bowel movements

• Using a squatty potty or similar device that brings knees higher than hips while sitting on the toilet for easier elimination 

And surprisingly upper GI symptoms including acid reflux, excessive burping, and GERD can also be symptoms of bowel dysfunction! 

Constipation 

Constipation is defined as decreased frequency of bowel movements and/or difficulty eliminating stool (such as pain or straining). Constipation can be primary or secondary. Primary constipation arises from the colon itself or has no clear cause. Secondary constipation occurs due to lifestyle factors or as a symptom of an illness. 

Primary constipation types: 

• Normal transit: consistency of stool is normal and digestion moves at a healthy pace however the individual still feels constipated and can experience abdominal bloating and/or pain. 

• Slow transit: stool takes longer to pass through the colon resulting in less frequent bowel movements. 

• Outlet constipation: results from pelvic floor dysfunction (muscles may be too tense or “tight”). 

Constipation can be caused by medications, diet, dehydration (check out our blog post for more info on adequate fluid intake), surgery, childbirth, hormonal changes, or pelvic floor dysfunction. 

Diarrhea 

Another symptom of pelvic floor and bowel dysfunction can be diarrhea or loose stools. Similar to constipation, diarrhea is typically multifactorial and a pelvic floor physical therapist can help! 

Typically seen in patients with IBS, Chron’s disease, Ulcerative Colitis or similar conditions, diarrhea can be influenced by pelvic floor muscle function and coordination. 

Other Bowel-Related Conditions and Symptoms 

Other bowel conditions and symptoms include but are not limited to:

• Fecal smearing (having to wipe excessively)

• Neurogenic bowel, dyssynergia, or paradoxical pelvic floor 

• SIBO, MCAS, or EDS 

• IBS or IBD 

• Consistent laxative use and/or excessive antibiotic use

• Strong bowel urgency 

• Hemorrhoids, fistulas, or fissures 

If these sound familiar to you, consider seeing a pelvic floor physical therapist for symptom relief. 

How Pelvic Floor Physical Therapy Can Help 

As we previously mentioned, your pelvic floor muscles play a large role in your bowel function and symptoms. That is why a pelvic floor physical therapist, who is uniquely qualified to assess and treat your pelvic floor muscles, should be an integral part of your healthcare team. It is worth mentioning that bowel-related symptoms can be multifactorial in nature and your pelvic floor therapist can work closely with GI physicians, nutritionists, and other specialists to provide the best treatment plan for you.  

As pelvic floor therapists, we use many tools to treat bowel dysfunction including:

• Biofeedback/pelvic floor muscle training: this can involve specific biofeedback devices or manual feedback from your therapist (one gloved and lubricated finger inserted into the vagina and/or rectum) to train your pelvic floor muscles how to effectively contract and relax for optimal function 

• Myofascial work and abdominal massage: soft tissue and/or scar restrictions throughout your abdominals, pelvis and legs can contribute to bowel dysfunction, and your pelvic floor physical therapist can use various manual techniques to reduce restrictions and promote healthy tissue function

• Education: diet, fluid intake, different products and devices, urge strategies, bowel scheduling, etc. 

• Diaphragmatic breathing and other exercises