OCEAN: 
Watch out! Poop on the move!
The first thought that probably comes to people’s minds when they think of physical therapy includes rehabilitation after an injury or a surgery. People regard physical therapists as experts in movement. Physical therapists focus on how joints and muscles work and interact to produce function that translates into ease and pain free mobility with activities like walking, running, sports play, etc. However, judging by the title of this article, you probably know that is not the main topic of this PASSAGE.
Physical therapists can also assist with another form of mobility – the passage of stool – the mobility of stool to pass through the abdominal cavity, through the small intestines into the large intestines, through the sigmoid colon, and out through the rectal opening, passing through various valves and sphincters to exit through an opening surrounded by pelvic floor muscles. Our stool travels a lengthy distance on a daily basis to reach its end destination – which we hope is the toilet! For the most part this system is designed to work pretty well and in our favor. Our stool starts as liquid in the small intestines, and then enters the large intestines where fluid is drawn out, and our stool forms into a more solid form. Our body frequently “samples” if we have to go to the bathroom by our poop entering our rectum – and our sensors assessing if we can wait or have to go to the bathroom right away. If we have time to go, we need our pelvic floor muscles to relax as we sit on the toilet or if we have to wait, we need our pelvic floor muscles to contract and prevent us from going until a later time.
Despite this system having lots of checks and balances in place, most of us know that this system at times can be quite flawed with urgency to poop, accidents with not being able to hold our poop in when needed, or on the opposite end of the spectrum – constipation – having days between bowel movements and sometimes being accompanied by abdominal pain. Pain can even be present with the physical act of having a bowel movement – during and after. The latter may occur when stool takes awhile to pass and more fluid has drained out and our poop hardens.
Most people think of going to their gastrointestinal medical doctor, going to their primary doctor or sometimes even ignoring bowel issues. The last one should never be the answer as there are a variety of ways to address these symptoms. And medication doesn’t always have to be the answer, especially when a medical doctor says there is nothing systematically wrong and maybe just add more fiber into your diet.
Have you ever thought of going to a pelvic health physical therapist to address these issues? Physical therapists, again, work directly with movement and as you can tell our bowels go through this passage with lots of movement (we hope) to reach our end result. Physical therapists who work specifically with the pelvic floor have an in-depth understanding of how our abdominal health and pelvic health interlay. Pelvic physical therapists treat bowel symptoms as we work daily on the mobility of urine and fecal matter.
Poor abdominal mobility, which can be accompanied by symptoms including bloating, hardness, gas, constipation or abdominal pain, can indicate impaired bowel passage. This means things are getting slowed down in our intestinal tract causing discomfort. Physical therapists can provide specific stretches, breathing exercises, or therapeutic exercises to assist with the mobility. Soft tissue work may be performed as well which is similar to a massage.
Second, our muscles need to have good strength, sensation and coordination to relax and allow bowels to pass when needed or to contract and prevent us from pooping. Strengthening can easily be implemented with specific exercises to our pelvic floor to help with urgency or incontinence. Coordination involves controlling the movement of our pelvic floor muscles to relax, bulge or contract depending on what we want to accomplish – but sometimes this can become impaired just like any other muscle in our body that may need some retraining. Biofeedback is an excellent tool to assist with this as it allows you to pair a visual representation for what you are feeling.
Another facet physical therapists will address is posture. Posture while going to the bathroom is just as vital as the posture everyone talks about in regards to when we are standing or sitting during the day. There is a proper way to sit to go the bathroom to make sure our abdomen and pelvic floor muscles don’t have any kinks or tension in them that may be preventing us from doing our business. It’s all about the flow!
It’s very important to go to a gastroenterologists to discuss any potential red flag causes that are preventing you from pooping daily without straining or having uncontrollable bowels, however, if you have been told to take medication or to just live with it as there is nothing seriously wrong – physical therapy focused on pelvic health should be what you consider next. A thorough assessment of the mobility of your abdomen, hips, breathing patterns, and pelvic floor can address problems that are causing bowel issues. This article has mentioned just a few tactics we work on to address symptoms and diagnoses included, but no limited to, constipation, irritable bowel syndrome, fecal incontinence, fecal urgency, and dyssynergia.
Curious about who can benefit from this – everyone. Constipation and straining as a child for bowel movements increases chances of having pelvic pain as an adult. By addressing this sooner than later, even as young as 5 years of age, can improve function and outcomes in the long run. So even if you are 65 and have already had two colonoscopies or starting kindergarten, bowel health is important and is a true quality of life component.
