# pelvic floor dysfunction



## postmortem (Nov 11, 2006)

Sorry for reposting thread. Originally posted to GI test subforum, not sure if I might get more feedback here. Thanks.

A few years ago I had a defecogram (sp?) and they found that the angle widens during my push/relaxation maneuver, but I only evacuated a small amount of the barium paste. The report said the technician did not find any rectoceles.

I just started going to a new GI and he did a rectal exam and said that I seem to be able to perform the maneuvers. I can push, relax, hold as per his instructions. He believes I may not have pelvic floor dysfunction and may have problems higher up in the colon, but will do further testing.

I had a sitz marker test in the past as well. The markers were all at the descending and sigmoid colon days 3-5. I had a small BM at day 7 and it showed I still had a bunch at day 8 in the same area.

He ordered the anorectal manometry for me and will be doing it later this week. If I'm able to relax, shouldn't I be able to have complete bowel movements? Could this still be pelvic floor dysfunction?


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## annie7 (Aug 16, 2002)

that's a good question. hopefully someone can answer that for you.

i have pfd but my tests were all classic for it. had the sitz marker--no bm's the entire time--and most of the markers were in descending and sigmoid with the rest scattered in transverse and ascending. so the gastro dx'd slow transit and pfd.

failed the defecogram which showed pfd plus a moderately sized rectocele and a vaginal prolapse.

totally could not pass that rectal exam. i've never been able to do that--lol. and i failed the anal manometry as well. couldn't get the balloon out--and he did a bunch of other tests too during the exam.

with both the defecogram and the manometry i felt absolutely no urge to defecate--- to move out the barium paste or the balloon.

i had about seven weeks of biofeedback/physical therapy. and it did help but i still have problems with getting stool to the rectum to begin with.

i've always felt that stool was getting stuck higher up. my gastros have told me to "take what i need" (laxatives) to go. when the laxatives don't work properly (happens a lot) i have cramping bloating pain and a gurgling sound, a squishy feeling (lol) and a bulge in the splenic flexure area. it feels like stool is getting trapped here. i've mentioned that to all the gastros but no one has been able to tell me how to deal with it. sometimes--if i'm lucky--i can actually press on and massage that bulge and that will trigger a bm which relieves all that bloat and pain etc..

does putting your feet on a footstool or shoebox while on the toilet help you at all? that's supposed to straighten out the anorectal angle and allow for a more complete evacuation. it does help me.

good luck! i do hope the anal manometry will shed some light on things and provide answers for you.


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## jdinvirginia (Jul 13, 2013)

Postmortem,

Sorry about your problems as I share some of them.

Due to an old accident, I am moderately fecal incontinent, due to injury of nerves to sense a bowel movement and defecate. I suffer from severe constipation causing overflow diarrhea. It is confusing. The underlying cause is the constipation, so one treats the constipation rather than the diarrhea. I can little or no warning of an approaching bowel movement.

I also have a defecation disorder which frequently causes incomplete evacuation. Often I have to use digital stimulation techniques to prompt a bowel movement. Due to the defecation disorder I often am unable to pass hardened stools.

Three things have helped me the most: traditional bag enemas (not Fleets), Miralax stool softener, and Calmol 4 rectal lubricating suppositories (all three with the approval of my gastroenterologist). I still have to wear diapers.

I have had the defecogram, and anal manometry. I have rectal prolapse, my muscles to not engage in the sequence and to the extent required for a normal bowel movement. I was unable to pass the 60cc simulated stool.

One thing that did help was pelvic physical therapy where the Ph.D therapist performed digital mapping of my anal and rectal nerves, showing the extent of nerve damage. Like Annie7 I had rectal biofeedback training during which I had balloons inserted up my bottom and inflated to various degrees to enable me to learn to better sense stool of various sizes and at various locations in the rectum. The purpose was to enable me to use what I have to best advantage and to learn to sense smaller stool and earlier. It helped some, but some of the news was not good - that my nerve damage in the mid- and upper portions of the rectum was severe and there was not much I could do about it. However, even this was useful news as it defined my limits and caused me to plan to compensate for them.

Best wishes,

--JD

(70-year old male)


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## postmortem (Nov 11, 2006)

Passed the manometry. I think my doc is pretty credible and he believes that I don't have pfd.

Now I'm kind of stuck wondering why I have incomplete evacuation. I know i suffer from hemorrhoids a lot. Could that be obstructing the anus when I have hard stools? Doc believes my problem is within the sigmoid area since my sitz marker shows normal transit up to that point and my muscles seem ok.


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## jdinvirginia (Jul 13, 2013)

Postmortem,

When my stools are too firm, I cannot pass them or end up with incomplete evacuation.

My Gastros have me using Miralax stool softener to soften the stool to about a Bristol scale 5 - which I am able to pass. Have you tried doing that?

Miralax, in the proper doses, will help you go without making you go.

--JD


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## postmortem (Nov 11, 2006)

Sounds like an idea to try. Thanks!


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