While there can be many medical reasons for bowel disorders, physical therapists at Zion Physical Therapy are able to evaluate and treat the musculoskeletal components of bowel dysfunction. Physical therapy can be successful in identifying and treating musculoskeletal dysfunctions such as tightness or weakness in the abdomen, low back or pelvic floor musculature caused by IBS, constipation, and other bowel disorders. Treatments such as myofascial release, biofeedback, trigger point release in the abdomen, back, gluteals, and pelvic floor, and neuromuscular re-education of these muscle groups can be very successful in minimizing and/or eliminating symptoms.
Your physical therapist will coordinate care with your gastroenterologist and dietician or nutritionist to address all aspects of bowel dysfunction.
Dyssynergia: failure of pelvic floor muscles to relax, sometimes with a paradoxical contraction of the pelvic floor muscles with defecation.
Bowel frequency, bowel urgency, bowel retention, and/or incomplete emptying
Constipation: May result from tight and/or weakened pelvic floor and abdominal musculature or due to incoordination of these muscles called “dyssynergia”
Rectal pain, low back pain, hip pain, stomach pain and/or abdominal pain
Rectal pressure or rectal spasm
Fecal incontinence: can be due to pelvic floor muscle weakness
Coccyx pain or a feeling of fullness in the rectum
Irritable bowel syndrome (IBS)
Levator ani syndrome
Anal fissure: A tear in the skin of the anal canal, commonly caused by overstretching of the tissue sometimes due to tight pelvic floor musculature and hard stool.
Treatments for bowel dysfunction include but are not limited to:
External and internal manual therapy if necessary
Patient education regarding pathology potential dietician consulting
Biofeedback for relaxation and/or strengthening training
Strategies to complete elimination
Trigger point release
Modalities as needed
Sexual Symptoms/Diagnoses In Women:
Dysparunia: Pain with initial penetration, deep penetration, thrusting. May be due to lack of lubrication, superficial vaginal scarring, vaginal adhesions, skin irritation, or levator ani muscle tenderness.
Levator Ani Syndrome: pain, pressure, or ache in the vagina, sacrum, coccyx, and/or rectum caused by abnormal tension in the levator ani muscles.
Vulvodynia: Vulvar discomfort characterized by burning, irritation, rawness, and inability to have penetration without pain.
Vaginismus: Inability to penetrate the vagina to due muscle spasm
Pubic Bone Pain
Sexual Symptoms Diagnosis in Men:
Inability to achieve or maintain an erection
Pain with ejaculation
Physical Therapy Treatments Include:
Manual therapy to pelvic floor muscles, hip, abdominal, low back muscle
Internal manual therapy if needed
Trigger point release
Coordination with OB/GYN and/or other health professionals
Pre-natal Physical Therapy
The pregnancy term is divided into three trimesters and ranges between 37-40 weeks. Many physical changes occur as early as the first trimester. For example, postural changes occur to accommodate the growing fetus/uterus, ligaments become more lax, hormone levels change (specifically Relaxin), the abdominal wall weakens, and the posterior core muscles or hip muscles may tighten. These changes can all contribute to the symptoms listed below. Most physical symptoms experienced during pregnancy can be treated with physical therapy.
Pubic symphysis pain: May require an SI belt recommendation
Diastasis Recti: A separation that can occur of the rectus abdominus muscle away from midline. >2 cm separation is considered significant.
Pain in hips, pelvis
Lower back pain, SI joint pain and/or upper back pain
Trouble transitioning positions from sit to stand, lying down to sitting up, rolling in bed
Shortness of breath due to inability of diaphragm to descend all the way.
Postural evaluation and correction
Body mechanics evaluation and correction
Deep tissue massage
Physical Therapy Treatment Includes:
There can be many causes for urinary dysfunction. Once your doctor rules out any serious conditions with diagnostic testing, the physical therapists at Zion Physical Therapy focus on identifying and treating the musculoskeletal components (ie bone, joint, muscle, connective tissue and nerve) of your condition. In most of the bladder conditions listed, weakness and/or restrictions in the muscle tissue can occur, which can lead to irritation and trigger points (hyperactive areas of tight and shortened tissue). Physical therapy can help by identifying the areas of weakness and of decreased tissue flexibility, and by increasing awareness and strength of the muscles of the pelvic floor.
Urinary dysfunctions can include but are not limited to:
Urinary stress incontinence: Urine loss with activities that increase intra-abdominal pressure such as coughing, laughing, sneezing or exercising
Urinary urge incontinence: Urine loss due to a strong sudden urge to urinate.
Mixed incontinence: Combination of stress and urge incontinence
Pain in the urethra, bladder, low back, and/or pelvis.
Difficulty with initiating urination
Urinary frequency: Greater than 1 trip to the bathroom every 2-4 hours
Urinary urgency, hesitancy, retention and/or incomplete emptying
Nocturia- nighttime urinary frequency: More than 1 trip to the bathroom per night
Weak urine stream and/or a stream that stops and starts
Burning sensation with urination (urinary tract infection symptoms)
Functional incontinence: Incontinence that happens with activities of daily living, ie lifting, squatting, walking etc.
Treatments for urinary dysfunction include but are not limited to:
Manual therapy both external and internal if necessary
Biofeedback to promote relaxation or strengthening
Releasing abdominal/visceral restrictions
Re-educating the muscles to contract at appropriate times
Trigger point release
Patient education regarding bladder irritants
Modalities (ie. Heat, ice packs, Electrical stimulation or US) if necessary
Post-natal Physical Therapy
After childbirth, women may experience changes that may not have been present before the pregnancy. Whether delivery was a Cesarean section or vaginal birth, most women can benefit from some post natal physical therapy following delivery. Along with teaching the best postures and body mechanics for feeding, lifting and carrying your new baby, therapists at Zion Physical Therapy can address these issues: