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Discussion Starter · #1 ·
ver the past ten to fifteen years, clinicians treating urological, gynecological, and gastroenterological disorders have gained a significant respect for the muscles of the pelvic floor. As has been noted in previous issues of the ICA Update, this complex group of muscles is involved in sexual intercourse, the maintenance of urinary continence, and bowel function. Abnormal function of these muscles can be seen in as many as 70% of IC patients and can be responsible for complaints as varied as pelvic pain, urinary urgency and frequency, or lower back pain. This short discussion will focus on the relationship between pelvic floor dysfunction and two common bowel problems, constipation and irritable bowel syndrome. Constipation and Pelvic Floor Dysfunction Constipation is one of the more common conditions associated with interstitial cystitis. There are lots of reasons for constipation to occur. Some of these factors include:1. Dehydration. Many IC patients believe that limiting their fluid intake will result in less frequent bathroom visits. Unfortunately, this strategy usually backfires. The result is a more concentrated urine that causes more pelvic discomfort. It also tends to worsen constipation.2. Use of Certain Medications. Medications such as opioids are notorious for causing chronic constipation. Other medications that can cause similar problems include tricyclic antidepressants (like Elavil �), calcium channel blockers (usually used to treat high blood pressure and abnormal heartbeats), aluminum and calcium-based antacids, and anticholinergic agents (like Ditropan �, Detrol �, or Levsin �). Diuretics can also cause dehydration. Dehydration, as noted in #1, can cause constipation. 3. Inactivity. Bowel function is stimulated by physical activity. People who lead sedentary lives and rarely exercise are more likely to have problems with constipation.4. Hormonal and neurological disturbances. Diabetes and thyroid disorders can lead to constipation. Multiple sclerosis, spinal cord injury, and scleroderma are other medical problems that may be associated with constipation.5. Intestinal Blockage. Blockages within the intestines from cancer to inflammatory bowel disease can slow down bowel transit and thereby cause constipation.Finally, we come to the pelvic floor muscles and how they might participate in the development and maintenance of constipation. As in the urinary tract, the pelvic floor muscles are responsible for relaxing and contracting at appropriate times and with appropriate force. In the case of bowel function, these muscles are responsible for maintaining some tightness�just enough to allow stool to accumulate in the rectum without allowing the stool to escape at inappropriate times. The frequent problem seen in the IC patient is that the pelvic floor muscles contract too tightly in the region around the anus. This often leads to complaints of lower back pain, pain in the perineum (the region between the vagina or scrotum and anus), pain in the region around the anus, and constipation. The question arises, "How then, does muscle tightness in this area cause constipation?" It�s actually quite simple: the act of defecation involves a contraction of the rectum. People often push a little bit to aid this process (remember, too much pushing can worsen these problems). At the same time, the muscles of the pelvic floor (in the region of the anus and rectum) should relax�just as the pelvic floor muscles should relax when one wishes to urinate. Unfortunately, instead of relaxing, many people unconsciously tighten those muscles even more. The result is that the stool doesn�t empty effectively because the muscles are blocking its exit. Once you are constipated, the natural tendency is to push that stool out. This results in more pelvic floor muscle spasm, which then causes more blockage. You can readily see how this can become a rather nasty vicious cycle! If you couple this problem with any of the factors listed in #�s 1-5, you�ve got even more of a dilemma. In order to get rid of constipation, it�s important to treat not only the pelvic floor spasm but also all of the other factors that might be involved. Irritable Bowel Syndrome and Pelvic Floor Dysfunction Irritable bowel syndrome is characterized by intermittent bouts of diarrhea and constipation. It is often accompanied by episodes of severe abdominal cramping, the sensation of "bloating" or out-right knife-like abdominal pain. IBS seems to occur as the result of abnormal contractions of the intestines, but pelvic floor dysfunction and increased rectal sensitivity may also play a very important role in the development and maintenance of symptoms. The association of pelvic floor dysfunction and IBS is probably best exemplified by the frequent comments from patients that their IBS symptoms have significantly improved when their PFD was treated.Although, therapy for pelvic floor dysfunction has been discussed in past ICA Updates, the basic methods of care merit repeating. These are: 1. Don�t make it a habit to strain when urinating or having a bowel movement.2. Frequent warm baths are often helpful to relax the pelvic floor muscles. We usually recommend baths twice daily (15 minutes) when PFD is acting up.3. Muscle relaxants can be helpful as recommended by your doctor.4. Transvaginal or transanal biofeedback and/or electrical stimulation may help (transanal biofeedback is the preferred method of therapy for constipation or IBS).5. Treat constipation aggressively. Stool softeners and various laxatives are very important in the management of constipation. Your doctor may have specific brands that he/she believes are best suited for you.6. Avoid other associated causes of constipation. This means going back to points 1-5. Watch out for medications that might worsen constipation and discuss the issue with your doctor. The dosage might be lowered or the medication discontinued if the problem is severe enough. Make certain to drink enough fluids. Becoming dehydrated will only get or keep you constipated or worsen the symptoms of IC. Many IC patients live extremely sedentary lives because of chronic pain or constant fatigue. This inactivity is a sure-fire way to perpetuate constipation. It�s extremely important to get some exercise in during the day. It doesn�t have to be overly strenuous physical activity. Just taking a short walk periodically during the day is usually just fine. In fact, exercises that promote a great deal of bearing down sometimes worsen PFD.In summary, pelvic floor dysfunction can have a profound negative impact on both constipation and irritable bowel syndrome. Therapy directed towards PFD can result in significant improvement of bowel function, however, only when other causes of bowel problems are addressed. Additionally, please remember that other therapies for the treatment of constipation and IBS exist. These therapies are beyond the scope of this discussion. Questions regarding these issues should be addressed to your primary care doctor or gastroenterologist.
 

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Discussion Starter · #2 ·
When i was young,i have hurt my coccyx badly and it's still misaligned.My worst IBS area is exactly at the same heigth that the coccyx.I have read that a pinch nervefrom the coccyx may altered the pelvic area.But it sound like a chiropractor diagnosis.
 

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Discussion Starter · #3 ·
Flux,you must be happy,i post about P.floor dysfunction!
 
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i've often wondered if this is responsible for my problem. i'd heard about pelvic floor dysfunction but never realized that you could have too tight and active muscles - which i think might be my problem. there are therapies and medical procedures you can do for this. i plan to explore it after i explore other possibilities.
 

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Spasmanyou just start to make sense.I always posted my experience against the practice of "too much water" many IBS C follow.It makes the symptoms worse.Daisyspplease read this
quote:1. Dehydration. Many IC patients believe that limiting their fluid intake will result in less frequent bathroom visits. Unfortunately, this strategy usually backfires. The result is a more concentrated urine that causes more pelvic discomfort. It also tends to worsen constipation.
 

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Discussion Starter · #6 ·
They symptoms seems to really fit with me but i think a phisyotherapist learn me to contract these muscle.IT's so boring and long term excercises.I'm not sure it was the best way to relax these muscles.
 

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Discussion Starter · #8 ·
Yeah i would like to try Biofeedback.Is there anybody who tried that?I hope that work.My G.I. troubles are in the pelvic area.I will track the therapist here.
 

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Discussion Starter · #10 ·
Findind of trained therapist seems complicated.But these infos are interesting:Biofeedback & Bowel Disorders: Teaching Yourself to Live without the Problem By: Jeannette Tries, Ph.D., and Mary K. Plummer, O.T.R., Wisconsin What is biofeedback? Biofeedback is a neuromuscular reeducation tool we can use to tell if certain processes in our bodies are working correctly. It is a painless process that uses a computer and a video monitor to display bodily functions that we usually are not aware of. Special sensors measure these functions, which are displayed as sounds we can hear, or as linegraphs we can see on a computer screen. In this way, we receive more information on how our bodies work. A therapist helps us use this displayed information to modify or change abnormal responses to more normal patterns. That may mean increasing a response, decreasing a response, or learning to coordinate two responses more effectively. How can biofeedback help? Bowel control is a bodily function that can be shaped by biofeedback. Bowel control is something most of us master in our early childhood years. Once control is established we think very little about these processes. That is, until something goes wrong. Disease, trauma, or age-related changes in the body may interrupt our ability to command this crucial body function. Biofeedback techniques help us reestablish these learned patterns. The technology allows us to retrain defective processes, and to restore more normal function. Does biofeedback work for everyone? Biofeedback and home strengthening exercises are a nonsurgical, non-invasive therapy option that have been shown to reduce symptoms in a large percentage of people. However, the benefits of biofeedback will vary from person to person. Participating in this therapy can help restore a sense of personal control which may have been lost as a result of dealing with a functional bowel disorder. What disorders may be treated by biofeedback? Biofeedback therapy may be used to treat a variety of bowel disorders including incontinence, constipation, painful spasms of the pelvic floor muscles and symptoms associated with the irritable bowel syndrome. When should biofeedback therapy be used? It is important to consult a qualified physician when considering treatment options. One or more of a variety of diagnostic tests may be suggested. Before treatment for incontinence is implemented, a thorough assessment of the muscles and nerves in the pelvic floor should be carried out. In order to implement a neuromuscular reeducation program that best fits your needs, detailed information relating to your symptoms needs to be given to your physician and therapist. Once an evaluation has been made the correct treatment option can be implemented. Who administers biofeedback therapy? Biofeedback may be administered by a well trained and qualified physician, nurse, or physical or occupational therapist. How long does biofeedback therapy last? Therapy sessions may vary. A person with a non-neurological problem may be seen an average of six to eight treatment sessions over a three month period. Treatment sessions may be scheduled weekly and decrease in frequency as improvements occur. Home practice is the key to improvement. It is important to take what is learned in therapy sessions and apply these same exercises and strategies at home. Repetition of the correct patterns and application of these patterns to everyday situations is critical to reestablishing bowel control. This specific treatment is based on extensive research done at the National Institutes of Health. Research shows that an average symptom reduction of 75% to 80% is possible with this type of therapy. Biofeedback offers an important treatment alternative for people affected by bowel disorders. Last updated: October 20, 2001
 

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Discussion Starter · #11 ·
Oh Bonnei,i just realize you really doing it.Do you feel any improvement with the motility or sensitivity or others?
 

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Thanks for such incredibly interesting and informative, helpful information which explains so much.What type of diagnositic tests are used to determine if one has pelvic floor disfunction and therefore what treatment is required?Do you know if most health insurance covers biofeedback, like Medicare?Sounds like I really need testing for this, I have to strain like crazy and my stools are extremely thin - I dont have lower back pain or pain sensation near the rectal area though. Could this still indicate pelvic floor dysfunction? I am extremely constipated and dont even have a colon!
 

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It would be nice if insurance covered it. Also, I was wondering if anyone has tried an at-home system. I have been trying the kegels myself for awhile, but I think I am doing them wrong, and I think that an at-home device might help. Pretty expensive, though (like $350). I found this one. http://www.thoughttechnology.com/ucont.htm
 

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Discussion Starter · #14 ·
Yeah,i like the idea of facing my ennemy rigth in his territory!
 

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Discussion Starter · #15 ·
Apparently,the treatment consist of inserting a probe
into your rectum like a vibrator.
Seriously,they use a probe and i don't know after...
 
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