By: Melinda Fontaine, DPT, PHRC Walnut Creek
Darnell took a trip to Europe a few months ago with his spouse. They had planned a wonderful vacation, but what they didn’t plan for was Darnell not being able to urinate or have a bowel movement (BM) for nine days! He took magnesium citrate which helped him produce partial BMs. When I met him and his wife two months later, he just had a urinary catheter removed. He was emptying his bladder three times per day using an intermittent catheter (a soft thin tube inserted in the urethra to drain the bladder). The doctor had recommended Miralax (an osmotic laxative) and Citrucel (a fiber supplement) twice a day, and he could evacuate stools with only a little bit of straining if they were lucky enough to make it all the way through his system to the rectum (the final part of the colon where a stool collects until it is pushed out of the body). He was still having significant difficulty emptying his bowels and bladder. Darnell was also a survivor of anal cancer which was treated about 10 years prior with radiation only. He was told the radiation would cause some symptoms 10-20 years later, so he wondered if this was what they meant.
What he experienced:
Over the last two years, Darnell had been experiencing elevated heart rate and blood pressure when he stood or walked. He had seen his doctors about it, and they recommended more consistent exercise. However, he had not done much exercise in the past two years because standing and walking caused his heart rate and blood pressure to rise. He also retired from working retail about two years prior when the pandemic hit. He drank about 2400cc of sparkling water per day, and his goal was to avoid a colostomy. His gastroenterologist referred him to physical therapy.
What the PT found:
When I evaluated Darnell, he held his breath with each activity and when he tried to bear down as when having a bowel movement. He accredited this to many years of swimming and having to time his breaths with his strokes. However, holding one’s breath prevents the pelvic floor from fully relaxing and opening to allow the urine and stool to come out. Fun Fact: holding one’s breath while bearing down can also cause a temporary change in heart rate and blood pressure. When I reminded him to breathe, he had limited expansion of his ribcage. Darnell’s deep abdominal muscles were also weak. Strong abdominal muscles are needed to help food move through the digestive system and create the downward force that pushes urine and stool out. Lastly, when he told his pelvic floor muscles to push out, sometimes they squeezed instead. This is known as paradoxical movement and it leads to straining on the toilet often without passing any stool. Darnell also had thickened tissue at the anus and the left lower quadrant of his abdomen due to the radiation. These thickened areas create speed bumps that are difficult for the stool to pass. He also had some restricted connective tissue at his sits bones and inner thighs which contribute to more tension and difficulty relaxing around the anus.
Why is this happening and What can be done about it?
Darnell’s difficulty emptying his bowels and bladder were likely due to multiple factors. The lack of coordination of his pelvic muscles and holding his breath made it so he could not open the sphincter enough to get all the stool out of his colon. The change in his fitness level when he stopped exercising regularly slowed down his digestion and weak core muscles led to ineffective straining on the toilet.
Darnell and his wife learned about all of the above physiology in the first appointment. His wife was eager to help and he wanted to include her, so she learned to do a massage to his abdomen to help move stool through his bowels. My goals for his first few visits were that Darnell would learn and become proficient at an exercise program to improve his breathing, core strength, and pelvic floor coordination. He also increased his exercise in multiple short bouts to avoid sustained tachycardia. During sessions, we continued education on the physiology, visceral mobilization of the colon, myofascial release of the connective tissue, and muscle retraining. We also reviewed healthy bowel habits, such as chewing food well, drinking plenty of water, and leaning forward on the toilet when moving bowels. He came in every other week for six visits.
Progress Towards Goals:
On the second visit, he reported that he tried to clean out his bowels with a high dose of Miralax/osmotic laxative, but he only produced small amounts and he felt like the stool was not getting to the end of the colon unless it was the exact right consistency. We continued to work on breathing, core strengthening, and abdominal massage. By the fifth visit, he reported that he was not having daily bowel movements with much less straining, and he felt confident he could avoid a colostomy. He also noticed that he was able to empty his bladder without using the catheter since his bowel issues cleared up. Reducing the pressure from the colon also took pressure off his bladder, so he could urinate. At the sixth visit, he met his two main goals:
#1 Daily bowel movements without straining and
#2 Able to urinate without a catheter.
Many people suffer from constipation and urinary symptoms that can be helped by pelvic physical therapy. Schedule an appointment with us if you would like better bathroom habits!
Check out these links for more information:
Are you unable to come see us in person in the Bay Area, Southern California or New England? We offer virtual physical therapy appointments too!
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
Melissa Patrick is a certified yoga instructor and meditation teacher and is also available virtually to help, for more information please visit our therapeutic yoga page.
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