Using your belly and pelvic floor muscles to help bring about a bowel movement is instinctive for most people. However, people sometimes have problems with these muscles and must relearn proper emptying techniques. If you discover weaknesses in your muscles, continuously ignore and fight the urge to go to the bathroom, or consume a diet low in fiber and water, you may be straining to conduct a bowel movement. You may be doing this if you:

• Hold your breath or take in a gulp of air and hold it.
• Keep your lips and jaw tensed and closed tightly.
• Turn red in the face because of excessive pushing or forcing.
• Develop hemorrhoids or have existing hemorrhoids worsen.
• Get faint while pushing.
• Aren’t emptying, resulting in many trips to the restroom to feel complete.

Straining makes it harder to conduct a bowel movement. In some cases, the anus can tighten instead of relaxing and opening, resulting in difficulty getting stool out. Here’s how to sit on the toilet to relieve constipation.

EVACUATION PLAN: Conducted in 4 Basic Steps

When conducting a bowel movement, it is essential to position yourself appropriately.

1. Lean forward enough for your elbows to rest on your knees. Keep your back straight and avoid slouching.
2. Support your feet on the floor or use a low stool if your feet don’t touch the ground.
3. Push out your belly as if you have swallowed a beach ball. You should feel a widening in your waist.
4. Exhale and keep your stomach out.

 

Proper Bowel Elimination

Your healthcare practitioner may make the following additional suggestions and adjustments:

• Sit on the toilet.
  • Make sure your feet are supported.
  • Notice your hip angle and spine position – most people lean forward or raise their knees, which can help the muscles surrounding the anus to relax.
  • when you lean forward, place your forearms on your thighs for support.
  • With proper positioning, the pelvic floor muscles relax, and the bowel angle decreases, allowing ease of elimination.
• Relax.
  • The digestive tract starts at the mouth and ends at the anal opening, so be sure to relax both ends of the tube.
  • Breathe deeply in through your nose and out slowly through your mouth.
  • Keep your pelvic floor muscles relaxed; let your belly bulge out.
• Empty.
  • Inhale and stick your belly out as if you swallowed a beach ball.
  • Exhale, keep your belly out and make it hard; this widens the anal opening.
• Complete.
  • After completing your bowel movement, you can consider performing one or two pelvic floor muscle contractions.

Consider these steps when you sit on the toilet to relieve constipation. If you don’t feel any progress after conducting these steps, consult a health practitioner about the next steps in the process. Visit our Pelvic Health Page for more information about how physical therapy can help.

Written by Life Fitness Physical Therapy, with multiple locations throughout the Baltimore Area.

What is pelvic organ prolapse?

Pelvic organ prolapse, categorized as a pelvic floor disorder, affects almost 3% of women in the U.S. The pelvic floor is a group of muscles that form a hammock across the patient’s pelvic opening. These muscles and the tissues surrounding them keep the pelvic organ in place. These organs include the bladder, uterus and cervix, vagina, small bowel, and rectum. These muscles and tissues can develop problems or disorders and become more common as women age.

What is a prolapse?

Prolapse can happen when the pelvis muscles and tissues can no longer support these organs because they are weak or damaged and can cause one or more pelvic organs to drop or press into or out of the vagina.

What causes pelvic organ prolapse?

Pelvic organ prolapse is when the muscles and ligaments supporting a patient’s pelvic organs weaken, and the pelvic organs can drop lower into the pelvis, creating a bulge in the vagina (prolapse). Pelvic organ prolapse most commonly develops years after childbirth, a hysterectomy, or menopause.

Patients may experience pelvic pain for a variety of reasons. These reasons could include:

• Myofascial (muscle & fascia): Muscles of the pelvic floor can be tense, weak, shortened, or uncoordinated. Scars and fascia tightness may contribute to pain.
• Organ-related: The origin of the pain is primarily from an organ: the vulva, bladder, bowels, or uterus; Common medical diagnoses include vulvodynia, interstitial cystitis, painful bladder syndrome, endometriosis, irritable bowel syndrome, or menstrual pain.
• Nerve-related: Pudendal neuralgia is often referred to as “the carpel tunnel syndrome of the pelvic floor”. This condition is brought forth by the pudendal nerve compressing and can cause perineal or rectal pain. Injuries during childbirth, prolonged downward pressure on the pelvic floor, prolonged sitting, and bicycling are common causes of pudendal neuralgia.

What are the symptoms of a pelvic organ prolapse?

• Feeling of pressure, discomfort, aching, or fullness in the pelvis.
• Pelvic pressure that worsens with standing or coughing as the day continues.
• Trouble controlling bowels or urine, leading to leaks.
• Uncomfortable pressure during physical activity.

*Symptoms could worsen at certain times of the day, during physical activity, or after standing for a long time.

Physical Therapy for Pelvic Organ Prolapse

Pelvic Floor Physical Therapy is one of the most common treatments for pelvic organ prolapse. This specialized physical therapy relieves the symptoms of pelvic floor dysfunction and strives to help the patient’s muscles work how they should.

Pelvic floor therapy typically includes several exercises and helps the muscles relax and gain strength. A pelvic health physical therapist will work with the patient to see how strong their core muscles are and how much endurance their body has while checking the coordination of their pelvic floor muscles.

This initial assessment will help develop a plan exclusively for the patient’s body. Pelvic floor therapy plans commonly include both external and internal therapy.

Dry Needling Trigger point therapy

Trigger point dry needling is a safe, effective, and efficient treatment technique to release pain from taut bands of skeletal muscle. Trigger point dry needling uses small, thin needles to stimulate underlying myofascial trigger points, muscular and connective tissues for the management of many orthopedic conditions, both acute and chronic. By inserting a needle into the dysfunctional tissue, it often leads to a contraction of the muscle which then stimulates a release. This leads to a reduction of pain, improvements in flexibility, and restoration of normalized movement when combined with corrective exercises.

Kegels

Kegels are known for strengthening the pelvic floor as well. This exercise can help the pelvic floor muscles by contracting and relaxing them. Pelvic floor exercises such as Kegels are personalized exclusively for each patient. These personalized routines include the number of repetitions, variety of positions, time holding a pose, time relaxing, and coordination with breathing and other key muscle groups. Talk to a pelvic health physical therapist about conducting this exercise and adding it to your personalized plan.

Electrical Stimulation (ESTIM)

Pelvic health physical therapists may include ESTIM as part of treatment.  Electrical stimulation works by inserting a small probe into the vagina and sending mild electrical impulses to stimulate the muscles in your pelvic floor. Electrical Stimulation can help reduce pain and muscle spasms in the pelvic region.

Biofeedback

Biofeedback, like electrical stimulation, uses a device to check the contraction of the pelvic floor muscles. It works by placing electrodes on the outside of the body or using internal probes to measure the tension and relaxation of the pelvic floor muscles. Pelvic health physical therapists use biofeedback to help guide patients as they work to strengthen or relax pelvic floor muscles.

Pelvic floor physical therapy can help reduce and eliminate symptoms of pelvic organ prolapse. Research supports using pelvic floor muscle training as an effective treatment option for patients with Grade 1 or Grade 2 pelvic organ prolapse. Once an individual’s prolapse exceeds Grade 2, they may still be able to proceed with pelvic floor therapy, but surgery is the recommended treatment for Grade 3 and Grade 4 pelvic organ prolapse.

If you find yourself in need of a pelvic health physical therapist, talk to your Ob/Gyn about what options are right for you.

Pregnancy is a wonderful process, but as part of the process, women endure many physiological changes, including an intense physical strain that can lead to discomfort and pain in certain parts of the body.

Most people associate physical therapy with patients that have suffered severe injuries from an accident. But they are not the only ones in need of it. Proper therapy is also fantastic for helping expectant mothers prepare for labor as well as remedying common discomforts associated with this special time. Since labor and delivery can be tedious, the need to prepare the body for the challenge should not be overlooked.

If you’re pregnant, don’t wait until the pain or other issues associated with pregnancy becomes unbearable before seeking help. Here, the PTandMe team takes a look at some of the reasons to consider physical therapy during this unique part of your life.

1. Lower back pain relief

The fact that there is new life forming inside a woman forces her body to change in wonderful ways that in turn leads to bouts of discomfort and even pain. Her center of gravity changes as the baby increases in size, leaving her struggling to maintain balance, especially while standing. The muscles of a woman’s bodywork to continuously provide support.

The alignment of a pregnant woman’s spine is eventually affected too, straining the back, shoulder, and neck muscles. If these changes go unchecked, many pregnant women develop lower back and/or SI pain. A recent study has shown that pregnant women with lower back or SI pain felt better with physical therapy. Physical therapy during the prenatal period helps manage these new aches and pains, thereby improving the quality of life.

2. The right choice of exercises

During pregnancy, women struggle with joint and spinal alignment, posture, muscle strength, weight gain, and nerve involvement. This could eventually lead to stress and fatigue, with a reduced willingness to participate in physical activity.

However, a physical therapist can recommend targeted exercises that increase muscle strength, easing the discomfort during pregnancy and after delivery.
Better still, the majority of these exercises are ones that can be performed at home without having to visit a gym. With improved metabolism and endurance, women are in better shape to drop some pounds after pregnancy – if that’s something they would like to do.

3. Ease other pregnancy complications

There are hormones released in the body during pregnancy that helps pregnant women adapt to their new reality. As these changes continue, women tend to struggle with other issues like nausea, heartburn, abdominal pain, and urinary problems, as well as musculoskeletal problems. Urinary issues typically involve difficulty in controlling the bladder due to the stretched pelvic floor muscles.

The right sleeping posture and a quality mattress can help with easing pregnancy pains and woes. Many experts advise placing a pillow between your legs and behind your back or investing in a wedge pillow. Similarly, if you are struggling to get precious zzz’s in bed, try sleeping in a recliner in a semi-upright position. This will take the weight off your feet and spine, relieve pressure and pains, and help with back pain. With physical therapy, women learn pelvic floor exercises, strengthening the muscles, and alleviating many common pregnancy issues, including incontinence.

4. Smoother labor and delivery

Unless advised otherwise by a physician, physical activity can improve strength and flexibility during pregnancy and childbirth. A perineal massage may also be recommended by your health care provider as it improves stretching during labor and reduces the chances of tears within that region while giving birth.

Electromyography (EMG) can also be used by the physical therapist to detect a suitable position that will be more comfortable for a more natural delivery. With proper testing, the biofeedback can provide enough information to guarantee a smooth process without complications.

5. A quicker recovery post-pregnancy

Like athletes and victims of accidents with severe injuries, women also need physical therapy to recover faster after childbirth.

Whether there was an episiotomy or not, all women would like to resume normal activities as soon as they can post-childbirth, without difficulties. With the right treatment and program, women can ease that pain much faster postpartum. Through strengthening those weakened muscles with selected exercises, you can enjoy a healthier and happier life.
Consider booking an online physical therapy appointment

Although we strongly recommend consulting a physical therapist, COVID-19 has made it difficult for them to offer regular assessment and treatment services in person. Fortunately, we work with some fantastic physical and occupational therapists who provide a range of assessments and recovery programs to help you get back to your routine fitness after injury.

To find out more about how physical therapy benefits pregnant women, contact a physical therapist near you.