Recent studies support the benefits of mindfulness for bowel health. A 2014 study of 53 patients reported that mindfulness-based stress reduction (MBSR) “had a significant positive impact on the quality of life…” on people diagnosed with ulcerative colitis compared to a control group (1).
Another study the same year examined 24 people with irritable bowel syndrome (IBS) and compared them to a control group. Authors concluded that mindfulness-based therapy was more effective than cognitive behavioral therapy (CBT) to decrease symptoms in those with IBS at a 2-month follow-up. (2)
Question from Marc: I have premature ejaculation. It has been part of my life since I was sexually active at 16 years old and I am now 33. Is this something that can be helped by pelvic floor physical therapy?
Answer from Becca: Marc, I would imagine that you may have been treated by psychotherapists for your issue. In the last century, many specialists have placed premature ejaculation into the category of a problem of the brain. However, pelvic floor physical therapists now treat your particular diagnosis in an entirely different manner. What we have discovered in treating men like you, is that those who experience early climax often have tight musculature in their saddle muscles (the muscles of your body that would be in contact with the saddle of a horse, were you seated upon one). In the ideal situation of arousal, these saddle muscles should expand and allow blood to flow into the penis and testicles. This blood should be retained in this saddle area to allow for an adequate time span during arousal and penetrative sex before ejaculation. In the case of premature ejaculation, the muscles of this saddle region are taut and cannot allow accumulation of blood to pool in the testicles and penis, which then creates an emergency expulsion of the seminal fluid from the penis.
This condition of premature ejaculation is treated in pelvic floor physical therapy. We assist men in reaching longer time durations of their erections by teaching them to lengthen their pelvic floor (saddle) muscles. We also instruct patients and their partners to increase the time of arousal and defer climax, thereby encouraging the blood flow necessary to prolong the sexual experience. In answer to your question, Marc, you can find help with a pelvic floor physical therapist.
Question from Steve: I suffer from chronic constipation. While that is terrible by itself, I also find that I cannot get fully hard during sex when I am constipated. Am I imagining this, or is there a correlation between constipation and erectile dysfunction?
Answer from Becca: Steve, I wish that more of our patients made this connection between the bowel and sexual function. The organs that sit within the relatively small cavern of the bony pelvis in men are the bladder, prostate, and the end of the colon (rectum). These organs are crammed into a very tight space. Which means that when one of these organ systems is a little bit off, the other systems invariably feel askew as well!
When the bowel is impacted with stool, as it is with constipation, this organ presses on the prostate and then the bladder. Also, the pressure on the perineum (the saddle region we discussed in Marc’s case), is created by too much fecal matter accumulating in the bowel. This excess pressure inhibits a full sexual response and limits full erections in men. The long-term discomfort associated in prolonged constipation can also distance a man from wanting to engage in sex.
The solution: pelvic floor physical therapists treat bowel dysfunction. We educate our patients in how to improve bowel regularity with stretches, exercise and lengthening of the pelvic floor muscles. What we find in treating patients like Steve is that when regular bowel movements are achieved, more satisfactory sex follows!
Question from Chen: I have trouble urinating from time to time. Sometimes, I think I am done peeing, I pull up my pants, and then I dribble urine. I am only 25 years old. Why is this happening and what can help?
Answer from Becca: Chen, I wish that you would start an online social media feed about your problem! Because it is so common and so very easily addressed. Many men come to pelvic floor physical therapy with complaints of leaking after peeing, or what we refer to in our line of work as “the post-void dribble.” Guys think there is something terribly wrong when this occurs, and because they won’t talk about it, they don’t know that many other guys have exactly the same problem!
Many men stand up to pee in urinals. This is the cultural norm in our society. But for men with tight pelvic floor muscles, or even men with moderate anxiety in a public restroom, the bladder cannot completely empty when a guy is in a standing position or when there are other men around him. What happens in this case is that the bladder cannot fully relax and the urine within it will not completely drain from the pelvis. Many guys shake their penises to try to get excess pee out of it. But this technique doesn’t always work to sufficiently drain the bladder. Hence, the dribble occurs after you think you are done peeing, Chen, and so many other men like you leave the bathroom to return to the tavern or sports arena, because they never allowed their bladders to fully empty.
Here is what a pelvic floor physical therapist may tell you, Chen.
Finally, for Chen and the vast number of guys like him, view this PDF for the technique on how to avoid the post-void dribble.
Written by former staff physical therapist, Aisling Linehan, PT
Pelvic health therapists are sometimes known as women’s health therapists; however, it’s important to note many of them also treat men. Our pelvic floor therapists treat men as well as women. Pelvic therapy is effective and often life-changing for both genders.
Let’s use male pelvic pain as an example. When pelvic pain strikes, males often wait a few months for it to go away on its own. They finally visit their primary care doctor who commonly refers them to a urologist. Urologists do their best to work up patients for any harmful pathology like infection and cancer. For males with non-bacterial prostatitis, the tests for infection will be negative, and frequently prescribed antibiotics like Cipro may not help. Unfortunately, many men will continue to take it in hopes of future relief all whilst suffering from its many side effects. When urologists have sufficiently ruled out pathology but the pain remains, the patient is left wondering where to turn next. Many males turn to the internet to find that there are other people like them, in pain, alone and suffering but have found relief with pelvic floor therapy. Urologists are so effective at ruling out pathology that almost every male who ends up in a pelvic PTs office is suffering from a musculoskeletal issue.
Pelvic floor tone is assessed digitally through the rectum and electronically with biofeedback. It is important to note that a high tone pelvic floor can cause any combination of the following symptoms: urinary urgency, urinary frequency, constipation, penile pain, and testicular pain/pulling/burning/retraction. Many of these symptoms can be relieved with PT interventions that may include: soft tissue release for pelvis and hips, breath training, rib/diaphragm mobility, internal pelvic floor trigger point and myofascial therapy, perineal mobility, light stretching, and gentle core strengthening.
Pelvic floor therapy is a safe space. It is not scary or threatening. Many patients feel immediate relief knowing that we have treated and helped patients just like them. We are here to educate and make space for the healing to happen. Knowledge is power and the more you know about your body they better you can treat it. If you’re looking for help and education regarding pelvic pain, contact your local pelvic floor physical therapist for an evaluation today.
Start by lying on your back. Use a fist, heel of your hand, or fingers to apply gliding pressure on the left side of the belly from the left ribs down to the pubic bone. This works on the descending colon. Next, use the same pressure to glide just under the rib cage from right to left. This works on the transverse colon. Lastly, glide from the right side of the pubic bone straight up toward the right ribs. This works on the ascending colon. Each glide should be performed 10 times on the descending, transverse, then ascending colons. Use light to moderate pressure to comfort; nothing should hurt!
You can use a heating pad on the abdomen to soften the tissues prior to the massage. It can feel nice to do the massage before bed as you are winding down, but it can be performed anytime. So take some time out, slow down, and get those bellies feeling happy again.
Written by Michelle Dela Rosa, PT
Bowel movements can be painful and accompanied by bloating and straining. Constipation can occur when the colon absorbs too much water or the colon’s muscle contractions become sluggish, causing the stool to become hard and move too slowly.
More than 4 million Americans have frequent constipation. Many are women and adults age 65 and older. Common reasons for constipation include:
Signs like blood in stools, recent changes in bowel habits, or weight loss are important signals to see your doctor. Many people may not need extensive testing and can be treated with proper diet, exercise, and lifestyle changes. Increasing water intake to six to eight cups per day, and fiber intake to 20 to 35 grams per day can work wonders for the colon!
Physical Therapists at Connect PT specialize in treating constipation related to a pelvic floor disorder. Muscles in the pelvis that surround the anus and rectum may be tight and restrict emptying. Our therapists look at breathing, abdominal tension, and posture for other factors that may feed into pelvic tension. We use biofeedback, manual (hands-on) work, and pelvic stretches to release tight muscles. We even review your bowel elimination technique - we recommend placing a small step under your feet during evacuation to open up the pelvis and allow for a clearer pooping pathway! We are committed to helping you achieve normal bowel movements, feel energized, and get back to life.
Past Medical History: 2 vaginal births, insomnia since last birth 3 years ago.
Physical Therapy Treatment: Manual therapy to pelvic floor and abdomen; review of proper bowel evacuation and stool formation; breathing mechanics; postural education and exercise; LE stretching; core strengthening exercises; HEP.
Results: Complete bowel evacuation 1-2x per day without straining or altered mechanics after 8 visits.