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While APD is defined as functional incoordination of the diaphragm and the abdominal wall, APD is often seen in conjunction with pelvic floor muscle dyssynergia. This type of dyssynergia happens when the pelvic floor muscles (the sling of muscles involved with bladder, bowel, and sexual function) are not coordinating properly. They too may be contracting when they should be relaxing and the patient may have difficulty going to the bathroom and may experience constipation and/or abdominal and pelvic pain. Our pelvic floor physical therapists are able to assess and treat any possible pelvic floor
dysfunction during your course of treatment.

Excessive abdominal distension and chronic bloating with or without constipation can also be caused by non-musculoskeletal issues. If you choose to seek physical therapy services before seeing an MD or specialist, your physical therapist can help refer you to the appropriate provider at your initial visit. We will collaborate with the appropriate medical providers to determine a systemic cause of pain. Our Doctors of Physical Therapy are also available for remote consultations to assist on your journey to find relief!

APD/Pelvic Floor physical therapy works just like going to physical therapy for your back injury! Your physical therapist will perform a thorough assessment to see if there are any musculoskeletal dysfunction and or lack of neuromuscular control of the abdominals, pelvic floor, and back muscles. They will then provide a personalized treatment plan to
help decrease your pain and abdominal distension!

Your physical therapist will guide you with take-home tools to continue muscle lengthening and strengthening at home as with any physical therapy, to keep working towards goals every day even when you are not at PT.  

Treatment May Include:

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Lifestyle and posture modifications

Manual therapy to diaphragm, thoracic cage and abdominal viscera

Core strengthening

Taping techniques

Self diaphragm release techniques​

Self abdominal massage to encourage peristalsis (involuntary intestinal movement) 

Global relaxation strategies to encourage general muscle release​

Breathing techniques 

Biofeedback:  offers a visual representation as to what one’s muscles are doing followed by retraining for proper coordination. 

Patient education on proper toileting habits, and strategies to avoid muscle clenching throughout the day and straining while going to the bathroom

Referral to dietician and GI as appropriate

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Additional Resources

APD Blog

Abdominophrenic Dyssynergia and Pelvic Floor Dysfunction:  A Case Study by Guest Blogger:  Patient Jordan C.

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More on APD

Abdomino-phrenic dyssynergia in patients with abdominal bloating and distension (NIH National Library of Medicine)

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Bloat and Distension

Bloating and Abdominal Distension: Old Misconceptions and Current Knowledge

(NIH National Library of Medicince)

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Abdomino-Phrenic Dyssynergia

Do you suffer from chronic abdominal distension and feel like your abdominal area is filled with rocks? Are you unhappy with the appearance of your abdominal area due to constant bloating? Do you feel like everything you eat or drink causes distension? This may be because of musculoskeletal dysfunction and postural imbalances or a diagnosis called Abdomino-phrenic dyssynergia.

Abdomino-phrenic dyssynergia (“APD”) is a functional GI disorder that occurs because of an abnormal brain-gut reflex. Typically, the diaphragm muscles should relax when the gut senses fullness due to food, liquids, or gas, allowing expansion. However, with APD, the diaphragm contracts, and the abdominal muscles relax instead. The outcome insignificant bloating, distention, and discomfort and the feeling that “I always look like I am pregnant”. Luckily, if you are diagnosed with APD or Abdominal Distension, physical therapy can help relieve your discomfort and help you regain control and strength of your abdominal area

What in the world is Abdominophrenic Dyssynergia?

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