Constipation & Pelvic Floor Dysfunction

After a 16-hour drive (in my new car, at least!), I’m back at the Mayo Clinic in Rochester, MN.

While I will be seeing Dr. Fox for a neurostimulator check-up while I’m here, that’s not the main reason for my visit this time. I’m here for a two-week biofeedback program to address chronic constipation due to pelvic floor dysfunction.

Disclaimer: the rest of this post is about the pelvic region and constipation. This is a common issue that I know many people can relate to, so I’m putting it out there without embarrassment!

Over the past few years, constipation has become more and more of an issue for me. While I first assumed, probably rightly so, it was due to the lack of fiber in the strict GP-diet I was following, it eventually seemed that something more significant might be going on. When it got to the point that I could no longer go without taking stimulant laxatives, I underwent some testing and was diagnosed with pelvic floor dysfunction last April. (I had to wait until after the gastric pacemaker surgery to undergo treatment, however.)

What the heck is pelvic floor dysfunction? That was my first question, too. Here’s the official explanation:

Your pelvic floor muscles are a group of muscles that form the base of your pelvis. This “hammock” of muscles supports your internal organs including your bladder, uterus, and rectum. Sphincter muscles surround the openings to the bladder, the rectum, and, in women, the vagina. The sphincter muscles control the opening and closing of your urethra and anus.

Normally, the anal sphincter and pelvic floor muscles relax in coordination with the abdominal muscles, allowing you to pass stool. Sometimes, the anal sphincter muscles do not work or coordinate with the pelvic floor muscles. This can cause difficulty when trying to pass stool. This is known as pelvic floor dysfunction (PFD) or dysseynergia.

Though it often goes undiagnosed, PFD occurs in about 7% of the adult population. It’s one of the main causes of chronic constipation that fails to respond to diet, lifestyle, or even laxative intervention. While the cause of pelvic floor dysfunction isn’t well understood, factors that may contribute include long-lasting or sudden constipation and childbirth. The nurse I spoke with today also mentioned gallbladder surgery among possible precipitating events.

While I don’t have any statistics, it seems that many gastroparesis patients may also suffer from pelvic floor dysfunction due to the constant physical stress GP puts on the muscles in the abdominal region (not to mention the emotional stress and low-fiber diet). Dr. Fox actually thinks that the PFD is preventing me from experiencing the full benefits of the gastric pacemaker, since constipation itself can cause symptoms like nausea and bloating. In addition, PFD can slow motility throughout the GI tract since once the rectum is full and cannot be evacuated, it sends signals to the brain to slow transit in the intestines.

The most effective way to correct pelvic floor dysfunction is through a bio-feedback program that retrains the muscles. Mayo Clinic offers an intensive, two-week outpatient program. It looks like this:

Week 1

• Average of 3 sessions lasting 30 to 45 minutes every day.
• Insertion of a rectal sensor that monitors muscle tension through electromyography (EMG). The EMG activity is visually displayed for the patient to indicate tension and relaxation of the pelvic floor.
• Verbal explanation and cueing from the therapist on what pelvic floor relaxation feels like and how to relax these muscles. Simultaneous visual feedback strengthens learning by showing improvements in relaxation.
• Learning to identify the internal sensations associated with day-to-day relaxation (baseline relaxation) and how to sustain that point.
• Education on the negative effects of both pelvic floor and general tension. Relaxation training may be augmented with the help from occupational therapists who teach diaphragmatic breathing.

Week 2

• Average of 2 sessions each day.
• Insertion of a rectal balloon inflated with varying volumes of water to simulate a bowel movement. The patient learns to sustain relaxation with rectal volume present, to coordinate abdominal activation with dynamic pelvic floor relaxation, and to avoid habit co-contraction of the pelvic floor. The goal is unpressured release of the rectal balloon to simulate normal defecation.
• Teaching long-term skills and exercises for home use to maintain pelvic floor relaxation.
• Education regarding normal bowel function, identification of problematic toileting habits, and behavioral modification.

The program has an 75-80% success rate, with up to 40% of participants noticing improvements by the end of the two week retraining period. While there’s no way to predict which patients will be most successful, I was told that a positive, relaxed attitude guarantees the best chance of success.

Positivity? Check! At the DDNC, I talked with a mom whose daughter completed the program at Mayo in August. In the months following, her GP improved so much that she now basically symptom-free! I see this as an important piece of the very complex motility puzzle that I’ve been gradually putting together for the past year or so. It can only lead to even better results!

As for the relaxation part, that’s my real focus for the next two weeks. Lots of breathing, blogging, reading, and resting. I’ll be posting throughout the program to let you know how it’s going and share any interesting tidbits of info that I gather along the way. In fact, here’s one such tidbit to kick off the week:

• Today I was told that consuming hot foods/beverages or very cold foods/beverages stimulates the brain to increase motility in the GI tract. Personally, I have a very strong preference for very hot drinks and the therapist that I’m working with said we’ll be using this as part of the program. Interesting, right?

I’ll keep y’all updated. In the meantime, if you’ve gone through a treatment program for PFD, please share!

Related Posts:

• Gastric Pacemaker: 4 Months
• Gastric Pacemaker: 3 Months
• Gastric Pacemaker: Back on Track!
• Gastic Pacemaker: Temporary Setback
• Gastic Pacemaker: 1st Adjustment