Monday Medical: Physical therapy for bowel issues
For Steamboat Pilot & Today
While bowel issues may not be fun to talk about, they are important to address. And some can be resolved through a surprising treatment: physical therapy.
“These issues can be embarrassing for people, and they definitely affect someone’s quality of life,” said Sara Peterson, a physical therapist with UCHealth SportsMed Clinic in Steamboat Springs. “But physical therapy can help.”
Common bowel issues
Constipation and fecal incontinence are two issues that may benefit from physical therapy.
Constipation takes place when the colon absorbs too much water or when muscle contraction through the bowels is slow, causing hard, dry stools that are difficult to pass. Diet, medications and underlying colorectal conditions, such as irritable bowel syndrome, can all cause constipation. Other contributors can include conditions such as multiple sclerosis and Parkinson’s disease and issues with hormones, nerves or muscles in the colon.
Fecal incontinence, or the unwanted loss of stool, liquid or gas, is often a result of a weakness in the pelvic floor muscles. That weakening may occur as people age and lose muscle mass, or may be a result of diet, certain medications, cancer or tissue changes that occur after surgery or radiation.
An initial exam
One of Peterson’s first questions when a patient comes in for treatment is what the consistency of their stool is.
“Even if someone has a healthy pelvic floor, if they’re having liquid stool, they’re probably going to have some issues being able to maintain continence,” Peterson said. “Usually with some basic recommendations on healthy fluid intake and the importance of fiber, we can normalize stool. Letting them know what’s considered normal is really important, so we can establish goals, and they can know what to expect for outcomes.”
Peterson next conducts a pelvic floor exam, which may include an external and internal exam. “Everything is explained, and consent is obtained with every part of the exam,” Peterson said. “It’s all done to the patient’s comfort level.”
Through an exam, Peterson can learn a lot about what’s happening in the pelvic floor, honing in on muscle strength and coordination, whether muscles are underactive or overactive and whether trigger points exist. Because the pelvic floor doesn’t exist in a vacuum, it’s also important to examine the abdomen, hips, pelvis and diaphragm.
Peterson develops an individualized exercise program for the patient that involves strengthening or relaxing specific muscles.
She often uses biofeedback, in which the patient is connected to electrical sensors that help them visualize a muscle contraction.
“It’s a nice visual for patients,” Peterson said. “They may see that there’s muscle activity happening when they tighten, but that it then takes 10 seconds to relax when it should only take one second.”
Electrical stimulation can aid in muscle contraction until the muscle is strong enough for the patient to engage on their own.
And manual therapy can help release muscles and mobilize joints.
The power of knowledge
Patient education is an important part of the therapy and covers topics, such as how to maintain good posture and practice good toileting habits.
“A lot of people don’t really know how to go to the bathroom,” Peterson said. “They may think it’s normal to sit on the toilet for 30 minutes, but that’s not normal — you shouldn’t sit there and strain.”
A position similar to a squat, in which the knees are higher than the hips, is actually ideal for encouraging a bowel movement, as it allows material to move through the bowels more easily. Breath control is also key.
With physical therapy and education, people often experience positive changes.
“With some small adjustments, people can see some pretty profound effects,” Peterson said. “They improve their quality of life and are able to go out in public and do what they want to do.”
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