Pelvic Health Blog

Splinting to help empty the bladder or bowel

5/25/2022

by Katelyn Sheehan, PT

Splinting

Have you ever experienced any of these symptoms?

Constipation
Fecal incontinence
Heaviness in the Vagina
Feeling like you haven’t emptied your bladder all the way
Having drops of urine come out as you stand up from the toilet

If you answered yes, then splinting may be a useful tool for you. Splinting is a technique often used by patients with pelvic organ prolapse to help them fully empty their bowels or bladder. Splinting is primarily suggested for helping with constipation, but certain splinting techniques can also help with urinary symptoms. Typically, splinting is performed by inserting a clean finger into the vagina to help hold, or splint, the pelvic organs and stabilize them in a more optimal position while using the bathroom. This can help hold the bowels or bladder in a more upright position to allow for full emptying when you go to the bathroom. You may also find that splinting externally can also help; this involves applying some gentle upward pressure to the perineum (see pictures and video below).

Internal splinting for the bladder/urethra

Begin by sitting on the toilet. Then use a clean finger with or without some toilet paper around it. Insert the tip of your finger into the vagina and gently apply some pressure forward, away from your spine.

External view (from below)

Internal view (from above)

INTERNAL splinting for the bowels

Begin by sitting on the toilet. Then use a clean finger with or without some toilet paper around it. Insert the tip of your finger into the vagina and gently apply some pressure backward, toward your spine.

External view (from below)

Internal view (from above)

EXTERNAL splinting for bowels

Begin by sitting on the toilet. Then use a clean finger with or without some toilet paper around it. Next gently apply some pressure with your finger to the perineum upward, toward your head.

Electrical stimulation for slow-moving poop

3/27/2022

By Bryn Zolty, PT

Slow-moving poop, or slow transit constipation, is a type of functional constipation. It is exactly how it sounds, stool moves slower than normal through your system. As physical therapists we evaluate your pelvic muscles and determine if the muscle tension or coordination may be playing a role in your constipation. But after addressing those causes or ruling them out, there are still ways to help your slow transit.

One treatment we consider for our patients is a stimulation known as interferential current. The use of electrical stimulation for reducing pain and muscle strengthening is well known. But this special current can help your GI tract move a little faster. For our patients, it's 2 electrodes on your abdomen and 2 placed on your back. It feels like a tingling sensation.

Studies on interferential current for slow transit show it increases colonic activity. Beyond that, there are some theories on the mechanism of action. A few of these theories include: it affects the pacemaker cells of the GI tract, stimulates the enteric nervous system to the GI tract, or it stimulates the cells that are responsible for peristalsis.
What we do know is that it is non-invasive, cost-effective, and can be done at home. Many patients that we talk to are on an endless search for supplements. Slow transit constipation typically does not respond to laxatives and fiber. Therefore, this may be a good option to reduce over the counter supplements and improve your transit time.

Our pelvic therapists would be happy to discuss this type of stimulation with you and determine if this should be a part of your treatment.

References
J Neurogastroenterol Motil. 2018 Jan; 24(1): 19–29. Published online 2018 Jan 1. doi: 10.5056/jnm17071

Ultrasound imaging for constipation

12/20/2020

Get a glimpse of Connect PT's rehabilitative ultrasound with Bryn Zolty, PT. We can use the ultrasound to teach proper pelvic muscle coordination and help conditions like functional constipation.

Watch the overview video below.

Tips for better digestion

8/29/2019

By Karen Bruno, PT

You can support digestion in many ways. Engaging the part of your nervous system that controls rest and digest, known as the parasympathetic nervous system, is beneficial to assist your mind and your nervous system to be in a state of calm and homeostasis, and signals to your body that it is ready to digest.

Do these techniques to shift out of fight or flight (a function of the sympathetic nervous system) to rest and digest, to lower stress, pain and discomfort, and encourage ease in nourishing your body.

Take 10 deep breaths before eating a meal. This stimulates your parasympathetic nervous system to calm your mind, bringing you into a more relaxed state so your body knows that it is safe to digest. As you get the smell of the food, your pancreas activates and the digestive enzymes begin to work. Your body is ready to receive the food into your stomach and maximize nutrient absorption.
Chew your food more. Digestion starts in the mouth. The digestive enzymes get stimulated in your saliva. It starts your digestive tract to prepare your stomach to receive food.The mind-body connection is a two-way street – so when your gut is happy, your mind will also be happy. Chew your food 30-40 times, or, chew until the texture of the food in your mouth changes. Mindfully eat and notice how your senses change: does the food start to taste different? Did you notice that different areas of the tongue perceive different tastes? Do you taste and discern salt, sweet, sour, bitter and pungent?
Eat smaller portions. Try eating only until you're 80% full and notice how you feel. Satiety signals can take up to 20 minutes to reach the brain and decrease your appetite.
Make sure to move after a meal. This helps digestion. Avoid slumping in a chair. This compresses your digestive organs and abdominal cavity. You could walk in the house, do some stretching or other gentle movements and activities to keep the parasympathetic nervous system active.
Hydrate. Sip water throughout the day rather than drinking a lot at once. Avoid drinking too much water with meals as this dilutes the stomach acid.
Sit in a neutral upright position. Support your feet on the floor or a foot stool. Sit with your weight placed evenly on your sitz bones (ischial tuberosities), with your knees at or below the level of the hips, and lengthen your spine. You can lengthen your spine by lifting up tall through the center of your head as you feel a long line between your tailbone and the top of your head. Relax your shoulders.You may need to place a pillow behind you to support your back. Avoid slumped sitting posture with your head forward. This will restrict digestion and can create head, neck and jaw pain while chewing. Good posture keeps your muscles, joints and digestive system in correct alignment for more efficient function and comfort.
Employ mindful reflections. Take a moment to reflect on the food and the gift that it is to you. You can silently express gratitude and appreciation and intend that this food nourish your body. Digestion starts in the mind and in the senses. Take a moment to smell your food and to be present. This moves your nervous system into rest and digest mode so you can absorb nutrients better.
Practice self-compassion throughout the day. Placing your hands over your heart or anywhere else on your body is a soothing gesture that is comforting to the nervous system. Stroking the fur of a pet is another way to regulate your nervous system and activate the release of oxytocin, a hormone that gives us a feeling of connection and love.

By lowering stress levels and promoting relaxation you can digest and absorb nutrients better, boost comfort, decrease pelvic and abdominal pain and ease digestion. This helps to heal your gut.

References:

What the research says: mindfulness for bowel health

6/12/2019

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)

(1) Jedel, S., Hoffman, A., Merriman, P., Swanson, B., Voigt, R., Rajan, K. B., & Keshavarzian, A. (2014). A randomized controlled trial of mindfulness-based stress reduction to prevent flare-up in patients with inactive ulcerative colitis. Digestion, 89(2), 142-155.

(2) Zomorodi, S., Abdi, S., & Tabatabaee, S. K. R. (2014). Comparison of long-term effects of cognitive-behavioral therapy versus mindfulness-based therapy on reduction of symptoms among patients suffering from irritable bowel syndrome. Gastroenterology and Hepatology from bed to bench, 7(2), 118.

Q&A for men: second edition

6/4/2019

While drawing from her clinical experience, Becca Ironside, PT answers specific questions from men about their urinary, bowel, and sexual concerns.

This is Connect PT's second edition of the Question and Answer series.

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.

Sit down when you pee. Go into a stall and don’t worry about what your friends think. This will allow your bladder to fully relax and empty, which might prevent the post-void dribble entirely.
Instead of shaking your penis when you think you are done peeing, take your fingers and press up into the space between your anus and your scrotum. Swipe your fingers towards the front of your penis. This will get that lingering pee out before you pull your pants back up.
Don’t wear tight pants or boxer briefs. If you have this condition, skinny jeans may not be for you. This type of clothing creates tension in the pelvic floor and prevents the penis from fully draining pee.
While these suggestions sound ridiculous, they are extremely effective. Moreover, wouldn’t you rather get back to your game? Because you will get back to that game, and you won’t leak urine anymore!

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.

Pelvic health for men

3/21/2018

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.

Why would a man need pelvic floor therapy? Our male patients can present with any combination of the following symptoms: urinary retention, urinary hesitation, urinary leakage, constipation, fecal incontinence, sexual dysfunction and pelvic pain. Male patients do wonderfully with our therapy services; however, it can take seeing 5-6 providers and more than a year before they find our office and relief. We care about male patients and want them to find us sooner, so here is our PSA (public service announcement) to help the boys.

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.

A pelvic floor PT evaluation consists of a movement, breathing and pelvic floor muscle assessment. Most pelvic pain patients have high tone pelvic floor musculature, poor breathing patterns, and inefficient functional movement patterns.

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.

Help, my gut is in a rut!

10/16/2017

Written by Michelle Dela Rosa, PT

What can I do to calm this bloated belly? What can I do to get things moving? What can I do for all this abdominal pressure and gas?

These are common questions we hear at Connect PT. One possible remedy that can be performed at home is what we call a bowel massage. The technique can help constipation, diarrhea, or any associated abdominal discomfort.

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.

Help - I'm ConstIpated!

5/14/2017

Written by Michelle Dela Rosa, PT

How do you know you’re constipated? If you have any two of the following symptoms for at least 12 weeks in the last 12 months, you could be!

Straining during bowel movements
Lumpy or hard stool
Sensation of incomplete evacuation
Sensation of blockage
Less than three bowel movements per week

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:

Poor water intake
Low fiber
Dairy
Lack of physical activity
Medications
Change in routine, like travel
Laxative abuse
Ignoring the signal to have a bowel movement
Specific conditions, like irritable bowel syndrome
Specific diseases, like stroke

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.

Recommended Resources: Let's Get Things Moving

8/19/2015

Connect PT likes Let’s Get Things Moving – Overcoming Constipation, by Pauline Chiarelli and Sue Markwell, Australian physical therapists.

The book discusses the taboo subject of constipation, normal bowel function, self-help strategies, proper evacuation technique, and the role of the pelvic floor.

Let's Get Moving Overcoming Constipation

Case Study: Constipation

10/22/2012

Patient: 40-year-old female with 8 year history of constipation.

Chief Complaint: Difficulty with bowel evacuation, normal stool consistency. Patient leans back and presses on stomach to evacuate.

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.

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