As many as 50% of people with chronic constipation have pelvic floor dysfunction. This dysfunction is commonly diagnosed as “pelvic floor dyssynergia,” which is a fancy way of saying the pelvic floor muscles are not coordinating correctly to have a bowel movement. When the muscles aren’t coordinated correctly, there is disruption in the signals our body requires to recognize stool is present and then to pass that stool.
Normally, as waste is collected in the rectum the pelvic floor muscles are contracted to avoid incontinence, or not let stool slip out. When the rectum becomes full enough, a stretch reflex lets the brain and body know it’s time to find the restroom. As we sit on the toilet, the pelvic floor muscles relax and, with a little help from simple posturing techniques and gentle intraabdominal pressure increase, we can pass stool.
When pelvic floor dyssynergia is present, we do not see the pelvic floor muscles relax. Therefore, it becomes nearly impossible to pass stool and this can lead to a cascade of events contributing to constipation. The tight muscles contribute to little or no stool passing, causing waste to accumulate in the rectum and disrupt the stretch signal. Further, straining for a bowel movement can cause pain and eventual avoidance behavior, or result in trauma to the tissue such as fissures and hemorrhoids. If the cycle continues, chronic constipation results.
Research favors conservative treatment such as pelvic floor physical therapy versus medication or surgery for constipation caused by pelvic floor dyssynergia. At Mend, our pelvic floor physical therapists can help diagnose and treat pelvic floor dyssynergia. We utilize techniques such as biofeedback, manual therapy, coordination training, and education on diet, posture, and bowel mechanics to restore coordination and improve bowel health. Click here to improve your bowel health today!