- bowel frequency, urgency, retention, and/or incomplete emptying
- rectal and/or abdominal pain, pressure, or spasm
- difficulty with initiation; and/or incontinence
Definitions of Bowel Conditions
The following information relates to various bowel disorders. While there can be many medical reasons for bowel disorders, physical therapists can evaluate and treat the musculoskeletal components of bowel dysfunction, which is defined below. Musculoskeletal dysfunctions caused by IBS, constipation, and the other bowel disorders can be treated with physical therapy through releasing myofascial trigger points in the abdomen, back, gluteals, and pelvic floor, and re-education of these muscle groups.
- Delayed or abnormal colonic transport, constipation may result from tight and/or weakened pelvic floor and abdominal musculature or due to incoordination of these muscles. Constipation as a result of muscle dysfunction can be managed conservatively with physical therapy. Treatment consists of bowel stimulation through abdominal massage and trigger point release. In the female population, the use of oral contraceptive pills at puberty affects colon motility adversely and may lead to problems with constipation.
- The passage of an increased amount of feces. Chronic diarrhea (lasts more than three weeks) is a symptom of irritable bowel syndrome, Crohn's disease, or ulcerative colitis. Diarrhea can be caused by some medications such as digoxin, laxatives, antacids, certain antimicrobial agents, thiazide diuretics, and alcohol. Leakage from weak pelvic floor muscles commonly is seen with diarrhea, due to its soft consistency.
- Inflammatory Bowel Disease (IBD):
- This group includes Crohn's disease and ulcerative colitis. Crohn's disease is an inflammation of the digestive tract (anywhere from mouth to anus). It can affect all layers of the intestine and most commonly affects the small intestine (ileum). Ulcerative colitis is an inflammation of the top layer of the lining of the large intestine (colon and rectum). The inflammation can result in ulcers in the top layer. Signs and symptoms of both may include abdominal pain, diarrhea, rectal bleeding, weight loss, fever, arthritis, and skin problems. These diseases can result in tightening of the surrounding musculature, due to irritated tissue and/or from 'holding' or gripping the muscles.
- Irritable Bowel Syndrome (IBS):
- Signs and symptoms of IBS may include abdominal pain or discomfort, bloating, gas, and such changes in bowel pattern as more frequent bowel movements, diarrhea, and/or constipation. Most common disorder of the gastrointestinal system. IBS may result from tightening, weakening, and/or incoordination of the pelvic floor and abdominal musculature.
- Fecal Incontinence:
- Unexpected leakage of stool from the rectum. This can be due to pelvic floor muscle weakness.
- Hemorrhoid Pain:
- Painful, swollen, and inflamed veins around the anus and rectum. They occur usually due to straining with bowel movements. They can be seen with pregnancy, chronic constipation, and/or diarrhea. Hemorrhoids can be external (skin around the anus) or internal (inside the anal canal). If the muscles or tissues in the rectum and anal canal are restricted or in spasm, blood flow to the hemorrhoid is restricted. This decreased circulation can make healing more difficult. Physical therapy can help increase tissue mobility and reduce muscle spasms in the affected area.
- Rectal Prolapse:
- Weak pelvic floor musculature or chronic straining can produce a feeling of "falling out" or fullness. Men may suffer a prolapse of the rectum into the posterior pelvic floor wall. The herniation of rectal tissue may occur with chronic constipation, chronic coughing, heavy lifting, and/or obesity. Symptoms may include constipation and/or pelvic pain. A rectal prolapse may be prevented through correct body mechanics with lifting, avoidance of straining, controlling and treating constipation, weight control, and kegels. A rectal prolapse can be managed with pelvic floor physical therapy, pessary (for women), or surgery (in severe cases).
- Anal Fissure:
- A tear in the skin of the anal canal, commonly caused by overstretching of the tissue. This is typically due to tight pelvic floor musculature and hard stool.