Bathroom Troubles? Pelvic Floor Physical Therapy May Help

If you have trouble going to the bathroom — if you have to struggle or push to have a bowel movement — you may think this is normal. That’s what AdventHealth physical therapist Heidi Ramsdell, DPT, WCS, says many of her patients tell her.

“The majority of the time, people don’t think it’s a problem because they’ve had it for so long that’s normal for them,” she says. “A lot of people think everyone’s struggling and pushing hard to have a bowel movement.”

But learning to live with constipation doesn’t change its consequences. Just like straining your back can lead to pain, straining to go to the bathroom can cause hemorrhoids (swollen veins in the rectum that cause pain and bleeding) and similar conditions.

The muscle that we used to go to the bathroom are called the “pelvic floor.” These muscles are hidden from view, but they have critical functions. When they’re strained or weak, they can cause constipation or incontinence, which means a lack of control over going to the bathroom.

One AdventHealth patient, named David, opened up about his struggles with debilitating pelvic floor pain.

“It was just so severe and so constant that it took everything that I had to be able to get to work every day and so when I got home I didn’t want to do anything,” he said.

Straining is far from the only cause of these problems. Injury, surgery and childbirth can all change our ability to control these muscles. (New mothers can take this quiz to see if pelvic floor services can help them feel at home in their own body again.)

These are topics that few of us want to discuss, so we may avoid taking action. But treating these problems early with physical therapy can help people regain control over their lives and avoid long-term problems.

Ramsdell, a pelvic floor physical therapist, said the trust she builds with patients helps them open up, leading to progress and higher-quality lives. First, a few basic questions: What’s the pelvic floor, and what does it do?

What is the Pelvic Floor?

These are the muscles in the base of your pelvis that create its bowl shape. The pelvic floor wraps and supports the bladder and colon. In men, it also supports the prostate and in women, the uterus.

The pelvic floor is wider in women, who tend to have more pelvic floor problems as a result.

People often don’t think about what’s going on in the bottom of their pelvis as muscle activity, Ramsdell says. But these muscles can be strained or weakened just like any other muscle.

That’s a theme in treatment of pelvic floor disorders. It’s easy to connect an aching back to a pulled muscle, but harder to connect problems with using the bathroom to muscles we can’t see.

But these muscles, too, need a balance of flexibility and strength.

“We treat them just like a muscle strain or a tight muscle in the neck, shoulder or back,” she Ramsdell says. “That means stretching, strengthening and activating them to get them to do what you want them to do.”

Often, the goal is to relax.

Are You Constipated?

The formal definition of constipation is having fewer than three bowel movements per week. But Ramsdell thinks that doesn’t captures everyone who has trouble using the bathroom. Look for the following as signs there may be a problem:

• Spending a lot of time on the toilet (more than 10 minutes at a time)
• Straining or pushing to have a bowel movement
• Passing stool in small, hard pellets or large, uncomfortable masses
• Feeling pain or seeing bleeding during a bowel movement
• Thinking often about the next bowel movement or regularly taking supplements to make it happen

“We should all be able to sit on a toilet, relax and eliminate without having to push or make an effort,” Ramsdell says. “It should be smooth, comfortable and easy.”

Someone who is pushing and straining to go often doesn’t know it.

“You think you’re relaxing but you’re clenching,” she says.

Other common causes of constipation include:

• Eating too much processed food
• Giving birth
• Undergoing surgery
• Eating a low-fiber diet

People with constipation often hesitate to eat more fiber, Ramsdell says, falsely believing that it will bulk their feces and make it harder to go. That’s partly true — fiber does add bulk — but it also absorbs water, leading to softer stools.

The Incontinence Connection

It might seem like having trouble using the bathroom doesn’t have much in common with being unable to control when you go. But constipation and incontinence often have a common cause: The inability to relax and control the muscles of the pelvic floor.

“Especially with women, urinary incontinence and constipation go hand in hand,” Ramsdell says.Urinary incontinence may start small.

“Often, people tell me they don’t have incontinence because they only leak a few drops, but that’s the beginning of a problem,” Ramsdell says. Seeing a physical therapist when the problem is small can prevent it from getting worse.

It can be harder to get people to open up about fecal incontinence. Long-term constipation can sometimes damage the nerves in the colon that sense when the rectum is full or empty.

“They think they’re done, they wipe and a little more slips out,” Ramsdell says. Here, too, strengthening the pelvic floor can help, but the first step is seeking help.

“By the time people come here, they’ve gotten brave enough to talk to somebody about it,” she says.

No matter your pelvic floor problem, physical therapists have plenty of tools to help.

Tools to Regain Control

Physical therapists like Ramsdell have plenty of techniques to help their patients strengthen the muscles of their pelvic floor. They include:

• Biofeedback: The use of sensors and video to see how a person’s pelvic floor muscles are reacting as they attempt to contract or relax them.
• Posture: Changing how you sit on a toilet can make a big difference.
• Diet: What you eat can make constipation or incontinence worse or better.
• Relaxation: Meditation and other techniques can help you relax your pelvic floor muscles.
• Exercise: Pilates, ball exercises and Kegels (the tightening and relaxation of pelvic floor muscles) can help men and women regain muscle control.
• Electrical stimulation: Because of injury, childbirth or another reason, some people have trouble contracting their pelvic floor muscles. Small devices can send electric current to contract these muscles.

Though many people wait for years or even decades before seeking help, it’s possible to go directly to a physical therapist.

David, the patient who struggled with pelvic floor pain, underwent three surgeries and years of pain without getting an answer. In 2018, he started rehab at AdventHealth Sports Med and Rehab. His physical therapist was different than the doctors he’d seen before.

“Finally, somebody who would listen and break that cycle of pain through therapy was the key,” he said. “For the most part, I’m pain free now with the course that I’m on.”

It changed his whole family’s life.

“I’m thankful for them,” his wife said of his AdventHealth team, “because I have my husband back.”

A person struggling to use the bathroom or control their bladder or bowel is dealing with emotional stresses as well as physical ones. AdventHealth Sports Med and Rehab physical therapists put in the time to build a rapport to help patients talk openly about what they’re experiencing. Together, you’ll create a plan to put your body, mind and spirit at ease.

To learn about the pelvic health services most convenient to you, visit our website.