Did you know that Irritable Bowel Syndrome (IBS) affects 11% of the population? IBS can consist of either 1) IBS-dominant diarrhea, 2) IBS -dominant constipation or 3) some combination of the two. It is diagnosed by recurrent abdominal pain of at least 1 day/week in the last 3 months and at least two of the following 1) related to defecation 2) associated with change in stool frequency 3) associated with change in stool form or appearance. Overall symptoms can include pain related to BMs (bowel movements), sensation of incomplete emptying, whitish mucous in stool, increased symptoms during menses, abdominal pain, changes in bowel movements (diarrhea, constipation or both).
Individuals with IBS may also report urinary frequency or urgency, dyspareunia (pain with intercourse), chronic low back and pelvic pain, fibromyalgia, chronic fatigue syndrome, sleep difficulties, insomnia, TMJ dysfunction. So, you may be asking, what does this have to do with a pelvic floor PT?
First, it is important to make sure you have seen a GI specialist, especially if this has become a chronic problem for you. Second, once cleared by the doctor, it is beneficial to follow up with a properly trained Physical Therapist. Our goal is to both educate and restore pelvic floor health. Now what do I mean by that? First and foremost we want to look at bowel habits, shape and consistency, and whether you have any of the additional symptoms listed above (ie- incontinence, pain with intercourse, etc). What we ultimately are piecing together is discovering where there could be dysfunction at your pelvic floor (the sling of muscles that ultimately support your digestive organs).
What may a typical session entail then? First, there would be a LOT of questions about symptoms; do you strain when you have to have a bowel movement, is it difficult to hold, do you leak feces or gas, do you wipe and there is still additional feces, etc. We also would be touching upon stool consistency and shape based on the Bristol Stool Chart as seen below.
This gives us a way to “grade” your bowel movements. 3-4 is considered “normal” whereas 1,2 may be due to a lack of water and fiber and type 5 may also be due to a lack of fiber. However, if we get into the 6-7 range than you may be consuming a food that your body does not like/high inflammatory food. For a lot of people that may be dairy or gluten but that links to our next homework assignment which is a bowel or bladder diary usually performed for 2-3 days where we are monitoring trends and consistency.
We would also be assessing overall hip/low back/mid back mobility, flexibility through the muscles (including the deep glut muscles), and strength. In some cases, an internal examination is warranted which would be performed vaginally or rectally depending on the answers above. This would allow the Physical Therapist to see whether tone was an issue (a very tight pelvic floor) and therefore was further contributing to difficulty with using the bathroom, or whether the bigger issue is attributed to a lack of strength. An appropriate home exercise program, as well as hands on by the PT, could then be performed to put the patient in the best possible position moving forward. The approach and methods discussed here allow us to treat today’s problem while also setting up the patient for long term success; this is truly the ideal result for everyone we see.