# Pelvic Floor Dysfunction



## wigglesmom (Dec 12, 2002)

After researching pelvic floor dysfunction, I am quite sure that this is what I have. I have had some tests done recently and will get the results next week. Has anyone here been diagnosed with this, and if so, was it treatable and how? I assume I have it as it takes me a full hour to evacuate, and it is often incomplete. Any feedback would be appreciated.


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## AIRPLANE (Mar 15, 2004)

I have been told I have obstructed defecation and pelvic floor tension myalgia. The recommended treatment is a 2-week course of physical therapy for the obstructed defecation at the clinic I went to. It is considered biofeedback. This was recommended to me several years ago but I was unable to do it because my insurance wouldn't cover anything that was coded as biofeedback. I spoke to one of the physical therapists on this visit who said that insurance was getting better at covering it and she gave me the codes so I could check with my insurance which I will have to do. The cost of the therapy is pretty high plus I'd have lodging expenses to deal with. I would also have to have additional therapy for the tension myalgia.I'm not totally convinced that this is my issue and/or that the therapy would work but I would consider it if my insurance would cover it. The doctor at the clinic told me that their success rate was 70%- otherwise I have read other places that say that the success rate of biofeedback is only 50%. When I asked the doctor about the success rate she said something about how it had to do with how motivated the patient was which didn't sit well with me. The drawbacks for me are: 1. Having to take a lot of time off of work for the therapy (although doing a consecutive 2 week period of it would be better in this regard as opposed to having to go to therapy several times a week over an extended period of time) 2. Sometimes, when physical therapy doesn't work, the blame is placed on the patient for assumed non-compliance rather than considering that the therapy isn't really what the patient may have needed and 3. If insurance won't cover it the cost can be pretty high, along with possible travel/lodging costs 4. You may have to wait several months to get into the therapy because it is not widely available.When I went to this clinic several years ago I had an anal manometry and defecography test. The defecography showed what they called a 'small rectocele'. I did not have either of these tests this time yet for some reason she is putting in my record that the rectocele is 'resolved' which doesn't make any sense since I have had no treatment for it and I didn't re-do the test to see how it looked now. I had some other tests- a transit test and a SIBO breath test which were negative. Also some neurolgy tests where they thought they found some irritation of a nerve root but decided that it didn't mean anything. So I think she is basically just going by what was recommended the last time I was at the clinic. My issue seems to be on the left side where things get stuck which is where the small recotocele is/was and I also have left leg pain.So on this trip I did get some testing I hadn't had previously which ruled some things out but it didn't really tell me what the problems were. Besides the difficult evacuation I tend to have fairly loose stools where it seems like I haven't fully digested things. She theorized that I really had constipation masquerading as diarrhea and wanted me to take Miralax or Milk of Magnesia which I tried in the past and they made my symptoms much worse. If I took Milk of Magnesia I'd be totally housebound! If anything, I need to take Immodium but I take it as little as possible because it makes things too hard. I have been taking Tramadol for the left side pain which seems to help with the pain, rectal spasms and it also seems to firm things up a bit though I still have to struggle to get things around what feels like a bulge on the left side and often cannot fully evacuate. I disagree with her theory but figured that there was no point in arguing with her and as always the visits were too rushed. Plus, I have gone to some local physical therapists who all thought my pain/problems were due to adhesions but the doctor didn't want to consider that possibility. Ideally, it would be best if you could find a gastroenterologist who would work with you on an on-going basis over an extended period of time and consider many different possibilites but I have never managed to find one who does this. I will probably discuss my thoughts on the diagnosis with my primary doctor the next time I see her.


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## wigglesmom (Dec 12, 2002)

I was also diagnosed with a rectocele, but my GI does not feel this is my issue as I was able to evacuate past it in my defogram. My says I have anismus, and I am currently receiving phys. therapy and biofeedback for the issue. I do not yet know if it will help. Both the PT and GI feel that it is my muscles' inability to relax when they should that is making bowel movements so difficult. I am hoping that the PT can help me. I'll post back after a few more sessions with her.


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## AIRPLANE (Mar 15, 2004)

I did check with my insurance about the biofeedback program that was just recommended for me. It turns out that they will not cover it- just like they wouldn't 5 years ago. The woman I spoke with said it was considered 'investigational'. The estimated cost of the therapy that the clinic gave me was anywhere from around over $7,000.00 to over $9,000.00. Plus I'd have lodging expenses because I doubt I'd want to drive back and forth every day. So I will not be doing it this time around either, obviously. Just like the last time I was willing to try it even though I was skeptical about it. More so now- especially with the suspicion of adhesions contributing a lot based on what other physical therapists told me upon examination. I remember them mentioning sigmoid adhesions a few times which I assume could contribute to incomplete evacuation because even when I do feel like I have emptied the rectum there seems to be more to come shortly after. So the problem isn't necessarily just the rectum but also probably higher up and it doesn't matter whether things are hard or very soft. I generally tend to the too-soft side. One of them did use a sensor one time and she said that she didn't think that that biofeedback was what I needed. Nobody at this clinic-doctors or PTs- wanted to discuss that adhesions were a possibility though. Anyway, that is way too much money to spend on a treatment that could be totally missing the point.I will be interested to hear your how it works for you.


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## annie7 (Aug 16, 2002)

Airplane--omg--$7000-$9000!! and calling it "investigational", too...really--biofeedback has been around for a while.... my insurance said the same thing---thanks again for the codes--they do not cover it. their term for it was "experimental".and you are so right---that's way too much money to spend on a treatment if you don't think it will work for you. i do wish your docs would find a way to help you with the adhesions. it does sound like they are causing at least part of the problem if not all.nicole---good luck! hope it works well for you.


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## AIRPLANE (Mar 15, 2004)

Annie,Yes- I agree with the 'experimental' and 'investigational' labels- I wonder how long it takes for something to be in practice before they remove those labels. Or, has this therapy in fact just had too high of a failure rate?I don't think that doctors should be pushing this therapy so much if insurance isn't covering it. And according to the info I received from the clinic about it, the costs given were an estimate- it sounded like, depending on the individual patient, it could end up costing even more. And at least either the clinic or the patient should check for coverage before the doctor makes any final recommendations if the therapy isn't a possibility- as far as I know, my clinic visit is over and I came away with absolutely no useful information as to what I should be doing. The PT I spoke to there seemed to think that it was getting covered more often by insurance now but it doesn't sound like it. When I saw a local PT she said that she thought my insurance had very good coverageas far as physical therapy went. And I wonder whether they really have to code the whole thing as biofeedback as I would think that physical therapy could involve many different treatments besides that part of it.


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## annie7 (Aug 16, 2002)

Airplane--yes i think maybe all that might have something to do with some insurances not wanting to cover it. for people whose insurance covers it, i say go for it. but for those of us who have to pay out of pocket, it's a big decision to make. i personally can in no way afford to pay for it myself)and yes you have very good insurance and excellent physical therapy coverage. i agree with you completely about how the docs shouldn't push it so much if's not widely covered or yes, at least check first before recommending it. i wonder if there's a different way they can code it so it would be covered.it's really a shame that you had to drive so far and spend all that time at the clinic (and such a renowned one at that) only to come away with no useful information at all.


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## wigglesmom (Dec 12, 2002)

I have been to 4 or 5 sessions of PT, and the therapist has incorporated biofeedback into one of the sessions. We'll be doing it again. Nothing has helped yet though. I'm becoming more frustrated and now have an appt. in October to discuss Botox injections with my rectal surgeon. Apparently, this works in some cases as it helps relax the anal sphincter. I am especially nervous as I start back at work in two weeks and have to get up at 5:15 in order to get myself to work on time. I am fine as long as I can wake up and go to the bathroom on my own schedule (it still takes me an hour though), but once work starts, I am sick as anything. I am wondering about disability and how I would go about claiming that at least until this issue is taken care of. Does anyone know?


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## annie7 (Aug 16, 2002)

nicole--so sorry the pt hasn't yielded any results yet. i've read that it can take time and a lot of sessions sometimes before it starts to work. but of course, you don't have time because you need to feel better by the time school starts. maybe the botox will help. fingers crossed and wishing you good luck on both of these...about the disability. have you checked with your teachers' union about this? maybe they can offer helpful advice as to how to successfully navigate through the system.maybe you've already read these links in the working and careers section on the board which is under the living with ibs section. maybe these links have some good advice; http://www.ibsgroup.org/forums/topic/135140-the-americans-with-disabilities-act-and-ibs/page__pid__819551#entry819551 http://www.ibsgroup.org/forums/topic/136312-how-to-file-for-american-social-security-disability-for-ibs/page__pid__821780#entry821780anyway--i have read threads in the past where people filed or tried to file for disability due to ibs--and of course, as you mentioned, you have a more specific diagnosis which might provide a more successful outcome than just filing under "ibs". seems a lot of people had to hire an attorney to fight for them and it can often take quite a while..months, a year or longer. and i remember some people mentioned that they went about it by claiming depression or another condition related to their ibs and filed under that and were successful with it--rather than using the ibs diagnosis.also--there's always fmla although it's not of course the same as disability and has some restrictions. but it can cover you for periodic illness-related absences--i think for as long as six months? sorry--can't remember exactly. your employer might not like you much for using it either but it is the law--a federal law--and like it or not, they have to abide by it and cannot fire you for using it, as long as you go by-the-book with it--fulfill all the requirements etc.that's about all i can think of off the top of my head right now. i write back if i can think of anything else. i really do sincerely wish you all the best and good luck with all of this. having to work with chronic constipation problems--especially in such challenging job such as teaching---is extremely difficult and challenging-- and that's putting it mildly. i struggled with working full time for 36 years total--most of those under the employ of a large, very unforgiving federal agency-- and it was very very difficult. it finally got so bad--so much pain--that i took an early out when they offered one. i was so thankful for the early out . for me, it was the answer to a prayer and of course a whole lot easier than hiring an attorney to fight them tooth and claw for a couple years for disability (and being harrassed by management the entire time for doing it .) i do hope and pray it all works out for you.


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## AIRPLANE (Mar 15, 2004)

Nicole,You mentioned Botox injections. I too have wondered about them but no doctor has ever discussed them with me. I would think that that could actually be a better place to start than the PT- especially for those of us whose insurance doesn't cover it. I would think that at least it would provide some evidence, if it worked, as to whether tight pelvic floor muscles were indeed the problem. As I've said, I'm not even totally convinced that that is my real problem because of what my previous PTs said about adhesions. Plus I do have a bit of a rectocele. I'm not sure if insurance would cover it and have no idea of the cost but at least in a case like mine I'd guess it'd have to be cheaper than the therapy which would probably end up costing over $10,000.00 by the time I factored in lodging expenses. Plus I assume that if one did have problems due to tight muscles then the Botox would work much faster and wouldn't require the massive amounts of time investment like the PT does. And like you, I have to be to work fairly early and on those days I'm exactly like you once I get to work. My only concern would be that it might work too well and then of course you'd be stuck with it for as long as it lasts and I'm not sure how long that is per injection.I too have heard that this therapy can take quite awhile which would be OK if I had good enough reason to think that it was the treatment I needed (and could get insurance coverage) but I suspect that it probably isn't in a good percentage of cases- that is,something else is going on that also needs to be addressed or treated instead. I think that that is probably why so many insurance companies aren't covering it- because it hasn't proved itself enough yet. Did they give you a time frame as to how long it should take to see any improvement?


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## wigglesmom (Dec 12, 2002)

Thanks so much for the replies, Annie and Airplane. I am not sure how long the physical therapist thinks she'll need to see me. We have appts. scheduled through October. I just keep doing my exercises and all of the other things she said I should do (massage, elevated feet, breathing exercises, aerobic exercises, steel cut oats with flax, lots of water, meditation). When I last saw her, she said that my sphincter muscles were very, very tight-so tight that they were cutting off her circulation when she inserted a finger. It's puzzling as I myself was very relaxed. I am combining the PT with EFT (emotional freedom technique) and a homeopathic that I think might work (silica) and hoping for the best. I really appreciate the advice around FMLA and disability as I am just so tired of dragging myself into work and looking and feeling like a zombie while there. I've made a promise to myself this year that if I'm sick, I'm not going in. I really need to get this under control, and teaching is to demanding of a job to do when I get as sick as I do. I am going to start back on Miralax today and am hoping for results from that as well. I will keep you posted as things unfold.


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## annie7 (Aug 16, 2002)

Hi Nicolethanks for the update. it sounds like you have a terrific physical therapist and that she has worked out a very thorough program for you with lots of positive therapies, diet advice etc in addition to the pelvic floor exercises--that's great! it really sounds like all this will help, especially to relax you and your muscles as well so your bm's will become easier and more complete.and it's good that she included meditation. i have meditated for many years and have found it to be, among other things, extremely helpful and relaxing. it has taught me to let go of thoughts--especially stressful thoughts, thoughts of pain, etc thus helping me to relax both physically and mentally. i also find it very grounding and inspirational as well. and yes that's a good idea to not force yourself into work on days when you are feeling very ill. give yourself permission to stay home and rest and yes, also give yourself time to get this under control. FMLA can help you with that and also protect your job rights.i am so glad to hear you have such a positive and healing program going on! and thanks for keeping us posted. wishing you all the best.


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## deborahr (Aug 13, 2012)

I have technically been diagnosed with this after having a Anorectal Manometry test performed, and despite the results, I'm not entirely convinced that it is what I have. I feel that my problem isn't 100% a result of poor pelvic floor muscles and that my problems might be more related to something higher up in the GI tract.I have tried therapy for it and went to probably 10 or so sessions once a week, but it wasn't that much help.


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## waterlilybelly (Aug 11, 2012)

Sounds so frustrating. The pelvic floor muscle issues I saw my doctor for were urinary rather than colon-related, but I'll say more in case any of this is helpful. I got very frustrated with the options I was offered. I've been doing exercises for said muscles from a blog called katy says, and after 6 wks I noticed definite improvements. I also bought two of her exercise DVDs -- they're inexpensive and easy to follow. I also put a stool in front of my toilet so I can get my feet up into more of a squatting position, and that seems to really help for more-complete evacuations.Other note -- are you eating GF oats or regular ones? For me, gluten and too much flax can be constipating (straining, pellets, etc).Best wishes with all of this!


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## AIRPLANE (Mar 15, 2004)

When I got home from work today, there was a message from the physical therapy department at the clinic so I will have to call them back tomorrow. I'm trying to figure out what to say to them. I know what I'd like to say! I've been reading other forums about patient experiences at this particular clinic and several of them did not have very good things to say about it. It does seem like this clinic caters more/better to well-known and wealthy patients who generate publicity for them and can pay big money out-of-pocket and also make huge financial donations. As one person said, the main building at this clinic has photos and info about Prince so-and-so and some wealthy people who have made donations. Anyway, I'm sure that no matter what I say, she'll just tell me to talk to the doctor which I'm sure won't do any good. I'll probably say that this is the second time this clinic has left me high and dry! Plus, it doesn't make much sense to me that they recommended this therapy without any preliminary testing to see if it was right for me. As I mentioned, one PT who I saw locally a few years ago did put the sensor in me and she said that she didn't think that that was what I needed. I also had no pelvic floor testing this time, just motility tests. And I disagree that the rectocele that showed up on the defecography last time is resolved- I still sense a bulge pretty plainly!Also, I get the impression that the gastro doctor that I thought I'd be dealing with had a big hand in developing this therapy and maybe that's why they are so eager to push it, besides the big $$$ they get from it. Part of the reason I chose him was because his expertise included both the pelvic floor as well as the rest of the GI tract. I ended up instead with a young doctor with a thick accent who spoke a mile a minute and who dismissed all of my ideas about possible contributing factors to my issues- like adhesions.This reminds me of another experience I had a few years ago with a local urologist that someone recommended for pelvic floor issues. I went to him thinking that I'd be given a variety of pelvic floor tests and exams but he only spent about 5 minutes with me. He immediately wanted me to try the InterStim device (it does sacral nerve stimulation) which he had a big hand in developing. I did do the one week trial of that but was unimpressed and also figured it would do nothing for my bulging and tightness issues. When I went back after the trial, the doctor wasn't even there- I dealt with his crabby physical therapist who wasn't interested in what I had to say- she just kept pushing the device and also said that the trial really didn't tell you how it would work as well as actually having the device inside of you. Frankly I would never go for having a metal piece under the skin in my back which I could picture getting irritated/infected from pressure and also could set off security alarms without very good evidence of benefit.I'm not saying that these ideas don't help anyone but I have not heard of a lot of impressive results from them. If they were really as good as they'd have us think we'd be hearing a lot more about them from patients (success stories). IMO, these experiences make me feel that there are people out there who have no problem trying to make a big profit off of our medical misery and they don't really care if their big $$$ ideas really help us or not as long as we pay up!IMO, especially since this biofeedback therapy is so costly and obviously not widely covered by insurance, I think I should have been offered other options. Also, I read a good article about this therapy by a Dr. Moldwin who deals with Interstitial Cystitis and he mentioned the part about patients not being able to get insurance coverage for biofeedback. He said that in cases like that then the therapy could be coded as muscle spasm therapy. I mentioned this to the PT I spoke with at the clinic and she just shook her head. I suppose coding it differently might mean less $$$ for the clinic!


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## annie7 (Aug 16, 2002)

Airplane--yes that is strange that they recommended the therapy to you with no pelvic floor testing to verify the need and also after the pt you saw earlier said she didn't think it was what you needed. it does sound suspiciously like they are just trying to use you as a cash cow and yes, recommending it because it's the gastro's "big idea". from what i've read about people's experiences on another board it does seem that with some of these big famous clinics, if you fit in with (or they try to force you in with) the head gastro's current research parameters or prize project, you're golden--otherwise--they just don't care. it's really a crime especially because the patients who come there are really ill and spend a lot of time and money at the clinic desperately hoping to get a treatment plan that will help them. and here you came away with nothing. and oh yes, i've heard that too--that they do tend to cater to the wealthy.and yes they definitely should have mentioned to you that biofeedback may not be covered by insurance and given you other options.i have a rectocele and have done some research on it and never read/heard about one resolving??? do they just do that? if you feel a bulge, it's still there! it'll be interesting to see what the pt says when you talk to her/him today....


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## wigglesmom (Dec 12, 2002)

Airplane-I'm curious about the Interstim device as I'm really ready to try anything that'll work. I think I might ask my doctor about it when I go to talk to her about the Botox injections.


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## AIRPLANE (Mar 15, 2004)

I know that the InterStim was initially intended to be used for patients with bladder issues.The urologist I saw said that they had patients who reported that it also improved their evacuation issues. If I recall correctly, if I had gone ahead and had the device implanted, then they would have to have coded it as being done for bladder issues (which I do have) because it wasn't approved for gastro issues at that time- I think it was in 2008 when I did the trial.I remember I had a small lead piece placed into my lower back and it was hooked up to a device where I could adjust the intensity of the stimulation. It was a bit cumbersome but I was able to fit the device in my pants pocket so nobody knew I was wearing it.It would certainly affect the clothes that you would wear- obviously it wouldn't be as easy to wear a one-piece outfit with this device and I don't know where you would carry the adjustment part of the device without pants pockets.I certainly did consider it briefly but did not like how fast this urologist recommended it- just like with the Pelvic Floor Retraining which was recommended so quickly without really doing any preliminary testing to see if it really was the best treatment for me and of course the fact that it was being pushed by doctors who had the most to gain financially from it.But at least the InterStim would have been covered by insurance as long as it was coded as being for urinary issues as opposed to gastro issues. I don't know if this has changed but I doubt it. Also, I was told that sometimes they have to re-operate- don't recall why- if it is because the device moves out of position or what.And as I mentioned previously, the device would set off alarms just like a pacemaker which could get old.They also gave me a DVD to watch with patient testimonials. Of course, all but one said it worked great and the majority of them were elderly women who I think tend to say good things just to be polite. I personally haven't heard any or enough good testimonials by patients on various forums about these things to be convinced that they are worth it whether it is the InterStim, Pelvic Floor Retraining or Clear Passage Physical Therapy for adhesions. I would probably try the physical therapy if they had a location near me so I wouldn't have travel and lodging costs, even though that is about as expensive as the pelvic floor retraining.So I'm guessing that the pelvic floor retraining isn't giving you the results you'd hoped for? I'm going to go see my primary doctor in a couple of weeks for hopefully more pain meds which only help part of my problem. She had referred me to a physical therapy place a few miles away that did soft-tisue manipulation. I wanted to go but never did because of my work schedule. I may go to them for a consult and see if they'd be willing to work with my schedule. It is hard to keep trying different therapies when you have a job and they insist that you come 3 times a week when going just once a week is bad enough. Wish some of these places would have evening hours! I go to a very good massage therapist once every several weeks but she cannot do any internal work and she also recommended this same physical therapy place.


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## wigglesmom (Dec 12, 2002)

Thanks for the information. I will ask my doctor more about this device. The physical therapy has done absolutely nothing for me. It still takes me over an hour to go to the bathroom. I'm a bit down now as I return to work next week and need to be there at 7 a.m. This makes it even more difficult to fully evacuate before getting out the door at 6:40 every morning.


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## annie7 (Aug 16, 2002)

Nicole--so sorry to hear the physical therapy hasn't helped--what a disappointment, especially with school starting next week.hopefully the interstim device will work for you.do glycerin suppositories help you at all? maybe try using one after your first bm, if you're still feeling incomplete. i've read that some bowel retraining programs recommend them as sort of a back up solution.or you could use one prior to your first bm. or some people say those small enemas like enemeez or the small glycerin enemas help.one possible ray of hope. linaclotide--a new drug to help those with constipation problems--is currently going through the fda approval process and set to be approved sometime in september--some say sept 12. this med sounds like it works a lot like amitiza--it is supposed to accelerate intestinal transit by increasing luminal fluid in the intestine. but it's said to be more effective than amitiza with fewer side effects. hopefully it might help move things out for you.good luck with everything. i do hope you can find something that will help.


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## tummyrumbles (Aug 14, 2005)

What is pelvic floor dysfunction supposed to feel like? Pelvic floor dysfunction sounds as though the stool is there, ready to be evacuated, but the muscles aren't co-ordinated enough in moving it out. So if you had pelvic floor dysfunction you'd feel the weight of stool in your lower colon, which can't be evacuated because the muscles aren't co-operating? This would be the standard view of constipation. My problem is I only evacuate a bit at a time over a long time. Each time it feels as though the stool suddenly moves down from higher up in the colon. So the pelvic floor itself is co-ordinated, it's more an issue that the stool isn't all there in one area in the lower colon. I think for normal people one or two really big contractions move everything down, but for us, it's a series of many, weaker contractions. I don't know how expensive biofeedback will help if the problem is related to stool that is pocketed in different places in the higher colon. Maybe we need to bulk up the stool (a problem if you're sensitive to fibre) so that it stimulates one big contraction. The trouble is bulking up usually means more fibre, and for me, more mushiness and colic.


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## annie7 (Aug 16, 2002)

i've found Barbara Bolen's article on pfd quite helpful. it provides a good explanation and description of what it's like etc. http://ibs.about.com/od/causesofibs/a/What-Is-Pelvic-Floor-Dysfunction.htm


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## ibsbank (Aug 25, 2012)

Nicole Graziano said:


> After researching pelvic floor dysfunction, I am quite sure that this is what I have. I have had some tests done recently and will get the results next week. Has anyone here been diagnosed with this, and if so, was it treatable and how? I assume I have it as it takes me a full hour to evacuate, and it is often incomplete. Any feedback would be appreciated.


Hi pelvic floor dysfunction means actually nothing .I did the defecography test which said pelvis floor dysfunction and that doctor said its a condition that needs to be treated through some exercise.when I went to another gastro doctor , he dismissed that saying it means nothing and many people have it and not to bother .Net net it was waste of money


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## ibsbank (Aug 25, 2012)

tummyrumbles said:


> What is pelvic floor dysfunction supposed to feel like? Pelvic floor dysfunction sounds as though the stool is there, ready to be evacuated, but the muscles aren't co-ordinated enough in moving it out. So if you had pelvic floor dysfunction you'd feel the weight of stool in your lower colon, which can't be evacuated because the muscles aren't co-operating? This would be the standard view of constipation. My problem is I only evacuate a bit at a time over a long time. Each time it feels as though the stool suddenly moves down from higher up in the colon. So the pelvic floor itself is co-ordinated, it's more an issue that the stool isn't all there in one area in the lower colon. I think for normal people one or two really big contractions move everything down, but for us, it's a series of many, weaker contractions. I don't know how expensive biofeedback will help if the problem is related to stool that is pocketed in different places in the higher colon. Maybe we need to bulk up the stool (a problem if you're sensitive to fibre) so that it stimulates one big contraction. The trouble is bulking up usually means more fibre, and for me, more mushiness and colic.


I tried bio feedback with no use.money waste.


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## AIRPLANE (Mar 15, 2004)

Nicole,Sorry to hear that the therapy didn't work. And I agree that this stuff makes going to work so much more difficult than it should have to be. I also have fairly early work hours and a bit of a commute although even when I worked afternoons several years ago I still had the same problem. It makes it difficult to concentrate on your job or enjoy it if it's a job you like. I know that feeling of trying to come up with a solution for this before going back to work or a job change where I'd like to start off on a good note! So frustrating.Anyway, I will be going to my primary doctor this week to tell her about the lack of any useful information and I will definitely let her know what I think of the therapy and hopefully she'll understand. Unfortunately, often doctors think of Mayo as being the top experts when really the only benefit of going there that I've seen is that they have some tests available that you can't get anywhere else but that's about it. The doctor I dealt with was very young, obviously inexperienced with very limited thinking capabilities. I know in the past when I've told doctors I'd been to Mayo they immediately said that if Mayo couldn't help me then neither could they which is ridiculous. It almost seems like this PFD is a sudden 'trend' among doctors as far as diagnosing patients with it yet they seem to do so without any kind of preliminary testing to help determine if that's what the patient needs which is so dumb with this therapy costing an arm and a leg.Hopefully my doctor will agree to continue the Tramadol and I will tell her that I'm finally going to go to the physical therapist she recommended. I haven't been to my massage therapist for a few months due to work scheduling so I will go to her next week and then I have 3 appointments lined up with the physical therapist. My massage therapist knows the physical therapist I'll be seeing and I will ask her if she has made any observations that would be worth mentioning to the therapist to maybe help get things started in the right direction. This physical therapist does visceral manipulation, myofascial release, something called strain/counter-strain, and lymph drainage which I've heard of but never been to anyone who does it. Her website made it 'sound' like they do deal with adhesions so I'm hoping she will have some useful treatments. I'm pretty sure I have vaginal cuff adhesions on the left side which I've heard of many women getting after hysterectomy when they also have the cervix removed. The last physical therapist I went to constantly told me to breathe and gave me postural exercises which did absolutely nothing and then she blamed me for the lack of progress.All we can do is keep trying! So are you thinking of doing trying the Interstim instead of the Botox? As I mentioned, I've wondered about the Botox but would worry about it working too well and then being stuck with it until it wore off. And of course, if you don't know for sure that the issue is due to tight muscles then Botox wouldn't be the right treatment anyway. As much as I dislike incomplete evacuation, I wouldn't want to end up with incontinence either!


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