Patients who participate in pelvic floor physical therapy can present with bowel dysfunction which encompasses a myriad of conditions from constipation to the other end of the spectrum being fecal incontinence (FI). As a fairly new pelvic floor physical therapist having worked at Sullivan PT for 1 year and 3 months, I admit that I struggle with resolving bowel issues. I have learned that there is a fine balance that needs to be figured out with regards to gastrointestinal (GI) function, primarily gut health, as well as the musculoskeletal component including addressing any muscle tension and connective tissue restrictions within the pelvic girdle or addressing pelvic floor muscle weakness. I find that one of the main difficulties I have is setting the right expectations in terms of “healing time” as like with any other systems, each person’s body responds differently to physical therapy. For FI, more often than not, the time frame for symptom improvements tends to be a higher duration due to the time it can take for a muscle to get stronger, physiologically speaking.
Since I have struggled with this condition, I took an opportunity to do some research and found a couple of articles which delved into Irritable Bowel Syndrome (IBS) as well as FI. In the article I found regarding IBS, patients tend to have tense pelvic floor muscles. An effective PT treatment involves providing education and prescribing exercises to address behavioral aspects that contribute to symptoms such as incorrect toilet posture, prolonged time spent in the toilet, and use of inappropriate cues to trigger need to defecate. This information was provided in the article which was called “Treatment of irritable bowel syndrome” written by Chamara Basnayake, MD. On the other hand, the article regarding FI mentioned that sacroiliac joint (SIJ) pain and pelvic ligaments can contribute to fecal leakage due to the effect on the nerve which innervates GI organs. This information was provided in the article which was called “Faecal urgency and pelvic pain: a case study implicating pudendal nerve entrapment” written by Peter Dornan, PT.