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The Pelvic Floor And Bowel Function


The pelvic floor is comprised of three layers of muscles that line the pelvic bowl, controlling sexual, urinary, and bowel function. They play an important role in your core strength and stability as well, working with the deep muscles of your abdomen, low back, and the diaphragm (respiration). Under normal conditions, the pelvic floor muscles are always working to hold up our pelvic organs, such as our bladder and rectum. This helps to maintain urinary and fecal continence. They also relax to allow urine and stool to pass. 

Disruption to the pelvic floor muscles or to your GI system can lead to bloating, increased abdominal discomfort, fecal incontinence, or constipation. Dietary factors, the gut microbiodome health, pelvic floor musculature, and bowel habits must also be analyzed to get the whole picture. 

Who Can Develop Fecal Incontinence? 

Fecal incontinence is the involuntary loss of stool and can sometimes occur after a vaginal delivery with perineal tearing. Third and fourth degree tears, especially if extending to the anus, can lead to damage and scarring of skin and pelvic floor musculature and affect function, leading to urinary and fecal incontinence. Individuals who have had surgery and radiation treatment for colorectal and prostate cancer are also at risk to developing fecal incontinence. They may not feel an urge to have a bowel movement and can have poor to no control over their pelvic floor muscles. Aging is another factor, as tissues tend to thin out and pelvic floor muscles weaken as we get older. Those with fecal incontinence can present with fecal soiling on their undergarments or complete loss of stool, necessitating use of incontinence pads or underwear.

What Leads To Constipation? 

On the other end of the spectrum, constipation is the inability to or difficulty having a bowel movement. It is defined as having fewer than three bowel movements a week. Some causes of constipation are poor diet, decreased water intake, side effects of medication or iron supplements, or tight pelvic floor muscles. Pregnant and postpartum women can also experience constipation, as a result of decreased motility of the stomach and colon and and weakened abdominal muscles.

Treatment with Pelvic Floor Physical Therapy

Pelvic floor physical therapy can help by assessing the integrity and strength of your pelvic floor musculature. Damage and scarring to the perineum or pelvis cause the pelvic floor muscles and skin to lose their elasticity and weaken, therefore affecting their ability to properly work. Internal manual treatment can help restore their function. Biofeedback treatment utilizing internal vaginal or rectal sensors can be also assist in training the pelvic floor muscles. Along with physical therapy treatment and exercises, analyzing a bowel or food diary to identify certain triggers, the effect of stool softeners or fiber in your diet, and reviewing good toileting techniques are all very important parts of the overall treatment program. 


Reach me if I can answer any questions on physical therapy, serving you locally in New York City or anywhere online virtually through “telehealth“.

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Pelvic floor disorders impact 1 in 3 women and many are surprised to learn pelvic floor physical therapy doesn’t only deal with the pelvic floor. Because our pelvic floors connect to so many other muscles and joints, it can affect many other parts of the body as well. Hence that hip or lower back pain may actually be due to pelvic floor dysfunction.  The good news—pelvic floor dysfunction is not considered a normal part of aging and can be treated successfully. Subscribe and receive my tips along with insights on the latest advancements on physical therapy including pelvic health.

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