Written by Rebecca Ironside, PT. Rebecca is also a published Author of Fiction.
Theresa came to Connect Physical Therapy in late fall of 2017. She looked like she had it all – dark, glossy hair, olive skin and a neckline without wrinkles that belied her age of 57. Theresa has two children, is married to a man from Ireland and is gainfully employed by the State of New Jersey in Trenton. Theresa has an unmistakable air of confidence. This was surprising, given her reason for seeking help in our office for Pelvic Floor Physical Therapy.
During her first visit, Theresa confided that she had recently begun to experience fecal incontinence. It had come out of the blue, she said. A few months back, Theresa noticed severe urgency with bowel movements. She would feel spasms within her rectum and there was no warning before she would have to defecate. There were times when she could not make it to the toilet in time, and so she was forced to wear disposable pull-ups to manage her “accidents”. She had to plan her commute to work, stopping at least once in the cleanest of public bathrooms she could find, because she could not wait during traffic. Theresa’s problem was worsening. She could no longer go to social outings without scoping out for the nearest restroom. The humiliation was awful, she said.
“After I married my husband, who is from the outskirts of Donegal, Ireland, I traveled overseas to meet his family,” Theresa explained. “They live very simply, these people. They wear the same clothing most days, drive old cars with manual transmissions, and do not have the same access to healthcare that we do.”
“I am so fortunate to live in America,” Theresa continued. “My Irish in-laws call me ‘A spoiled Yank’. I used to love it when they referred to me that way. I have everything a person could want. Except that now I am terrified of being in public and have to wear adult diapers. I do not feel like a spoiled Yank anymore.”
I knew that Theresa was at the end of her tether. She had tried prescription medication, daily Imodium, altering her diet and kept her legs tightly crossed at all times to avoid what still happened. I explained to her what Pelvic Floor Physical Therapy was all about. That in this type of clinic, we would do an internal examination to discern if the muscles of her perineum might be driving the fecal incontinence.
“I have been through so much already. If you have to do an internal examination, so be it,” Theresa declared. After an exam of the musculature of Theresa’s pelvic floor, it felt as though her muscles were in moderate to severe spasm. These muscles control urination and defecation; they were firing so rapidly that she could not contain feces within her colon, and worked incessantly to force it out. The function of the large intestine is to pull water out of our foodstuffs and allow feces to become solid. This was not happening in Theresa’s case, because the food was not in her colon for enough time, and her stool was unformed and messy. This explained her chronic diarrhea.
The treatment plan for Theresa included deep breathing, relaxation of her pelvic floor muscles and some natural over-the-counter additives to bulk up her stool. “This sounds counter-intuitive to me,” Theresa said at first. “If I relax the muscles, then won’t more feces escape unplanned?” I smiled at her and explained that if she wanted to try something new, she would have to trust me.
It took almost three months of once-weekly treatment in our clinic, with a really good home program, for Theresa’s symptoms to subside. But subside, they did. She now has solid bowel movements twice daily and can control them wonderfully. Gone are the pull-ups and the fear of accidents. Her commute to work and social life have been restored to normalcy.
“I cannot believe how this treatment has helped me! I wonder if this would be available to my relatives in Ireland? I hope so. But at any rate, I feel like a ‘spoiled Yank’ once more,” Theresa remarked. Pelvic Floor Physical Therapy is gaining rank, accessibility and respect all over the world. It likely is available to her in-laws in Donegal, Ireland. The trick is to find ways to talk about these issues and overcome the embarrassment surrounding words like rectum, feces, and stool.
This is what we do, as pelvic floor physical therapists. One client at a time. For spoiled Yanks, people from Ireland and every other continent, men and women, young and older, there is help. We live in a time when anything is possible.