# Pelvic Floor Dysfunction and IBS



## Naomi889 (Sep 11, 2005)

What does everyone think about the association of pelvic floor dysfuntion with IBS? The pelvic floor is a big sling set of muscles that go under the rectum - I believe the puborectalis muscle (the one involved in defecation) is acutally part of the pelvic floor, though it's not the voluntary part - i.e. the part you can move. Anismus is often referred to as pelvic floor dysfunction. For example, has anyone found pelvic floor exercises (kegels) to be of benefit? I have seen a minor improvement in my IBS-C since I started doing over 100 of these per day. Airplane and Mary2001, were you discussing this recently? Has anyone every used a vaginal cone or any other type of equipment to do Kegels?Also, for those whose IBS started after they gave birth - which I have observed is not uncommon on this board - I saw this in an article lately. They are talking about incontinence but I should imagine that if structural damage is so common it could also affect the bowel in other ways"Ultrasound has revolutionised our understanding of the damage done to the bowel by childbirth and our ability to treat it effectively, said Dr Michael Kamm, Consultant Gastroenterologist at St Mark's Hospital, Harrow. Nerve damage is responsible for only a very small percentage of faecal incontinence related to childbirth, but structural damage is much more common than we realised. Of patients with third degree tears, 85% have persistent structural damage and as many as half have symptoms of faecal incontinence. "When we looked at 62 women with faecal incontinence, for whom the only known predisposing factor was childbirth, 90% had ultra-sonal evidence of structural damage, always in close proximity to the vagina. The internal sphincter was affected in two-thirds of patients, and 60% had evidence of damage to both internal an external sphincters," said Dr Kamm."


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## Naomi889 (Sep 11, 2005)

Just for clarity, here's a link to two diagrams of the pelvic floor and bowel - firstly in women, and secondly in men.http://www.pelvicsupport.com/femalepelvis.html


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## Kathleen M. (Nov 16, 1999)

Some IBSers have pelvic floor dysfunction (can't hold it in or can't let it out) but it is not something you find in every last one of us.I do not know if having IBS makes you at more risk of getting pelvic floor issues or not or visa versa.I mean lots of women (and lots of men







) who never gave birth have IBS. A lot of women had IBS before they were pregnant (after all it went away during my first pregnancy is a very common story on here as well)Just because you have incontinence or have outlet obstruction doesn't mean you end up with the whole cluster of IBS symptoms (altered stool consistency with abdominal pain and discomfort).That being said seeing if Kegels make things easier for you isn't a bad idea, but I doubt it is the one thing we all need.


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## Naomi889 (Sep 11, 2005)

"It is not something you find in every last one of us"Er, no, I'm not saying that all, naturally. IBS is a multi-faceted condition as you know, and I would say there's a distinctive possibility that pelvic floor dysfuntion is an under recognised facet of SOME people's "IBS". It could be 1) Causitive - i.e. malfuction of the puborectalis (the defecation muscle, part of the pelvic floor!) - is causing some people's symptoms in their entireity therefore they could be classified as having a pelvic floor disorder.. or 2) merely correlated - malfuction of the gut i.e. "IBS" promotes or tends to be seen with pelvic floor malfuction and the PF malfunction may exacerabe the symptoms, but pelvic floor malfunction is not the root cause. In either of these 2 cases, kegels etc may well help some.


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## Kathleen M. (Nov 16, 1999)

Usually the pelvic floor issues I'm more concerned about are on the constipation end rather than the fecal incontinence end of things.If you strain for a long time (like 10-15 minutes or more) to try to get a stool out even if you can get the stool consistency to be something that should be passed, I certainly do think pelvic floor testing is needed and that is probably not done often enough for the constipated folks.Most of the urgency in IBSers is higher up than the pelvic floor. It is part of rectal hypersensitivity and while a few people may have accidents when he extreme urgency hits, it doesn't seem because the sphincter is too loose and it just falls out (I think that often happens without urgency or sometimes even awareness you really need to go it is more of you cannot sense stool is there or keep it in like you should or something like a cough or sneeze will overcome the tension of a too loose sphincter).Something like 70% of IBSers have rectal hypersensitivity and I don't think Kegels do much to increase the volume the rectum will hold before it starts sending way too many "gotta go now" and "I'm in pain" signals that it shouldn't be sending when it is 1/4 to 3/4 full but only when you really really do gotta go.Like I said, it probably doesn't hurt any human to do some Kegels (some people recommend all people do them). However I don't know that it will over come the problems in the nervous system or anything higher up. I just don't see how it would help for most of the issues IBSers have which usually are a bit higher up in the system than the pelvic floor.Also a lot of people who have incontinence from child birth do not have any of the other problems that IBSers have so I'm not sure how well co-related incontinence is with IBS problems.But like I said, trying some Kegel exercises isn't ever really a bad thing, although if you tend to the too tight end of things rather than the incontinence end of things usually tightening that up with conscious thought is not going help in the relaxing it. That often takes specialized biofeedback therapy.


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## Naomi889 (Sep 11, 2005)

Sorry Kathleen, I've realised I should have made myself much clearer in my first post. At the moment the strong evidence for an association between pelvic floor/publorectalis - malfunction seems to be in those with IBS-C only.I have noticed on this board and other board that those who mentioned any pelvic floor/publorectalis testing/diagnosis seem generally to be those with IBS-C and very often they mention incomplete evacuation. You say " I just don't see how it would help for most of the issues IBSers have which usually are a bit higher up in the system than the pelvic floor." From what I've read, when it comes to C, it is actually possible that all the issues, for some people with "IBS" could be anorectal/pelvic floor malfunctionings rather than nerve problems higher up. Once paper ended up theorising that "ano-enteric reflexes are a significant factor in irritable bowel syndrome, if not the major cause." (they are talking more of rectoceles, and they really ought to have said "a factor in some people's irritable bowel syndrome " but you take my point). Read the abstract at http://www.ncbi.nlm.nih.gov/pubmed/12355216It may be that pelvic floor malfunction is involved in those with D/ pain but as you say if you look at the physical evidence it does seem less likely than for those with C.I should also emphasise that when I mentioned incontinence it was just to highlight that the pelvic floor can be damaged during childbirth - I don't think ladies who get incontinence from this damage are being diagnosed with IBS, but I think it is possible that there is damage being done to the pelvic floor sometimes during childbirth and those ladies are later given an IBS diagnosis. I did biofeedback therapy for puborectalis muscle re-training and the nurse who did the sessions said that most of the women she saw were women who had given birth, developed problems, then been given an IBS diagnosis, but eventually referred to her. (Again, just to re-iterate, I'm not saying everyone with pelvic floor problems who had IBS has given birth - clearly these problems can develop in other ways)


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## Kathleen M. (Nov 16, 1999)

I am trying and failing miserably to agree that those with symptoms of pelvic floor related constipation like straining for a long time before passing stool should be tested.I agree that not enough people get tested.I tell lots of people on the board to go and get themseles testedThe recommended treatment for that is biofeedback not kegel exercises Usually kegel exercises are recommended for incontinenceI hope this is clearer than my last poststypically constipation from pelvic floor issues tends to be more severe than the average IBSer from what it sounds like from the research, etc.


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## eric (Jul 8, 1999)

This has a lot to do with a lot of the topics on this thread, especially the childbirth numbers and much more. There is more to this presentation then the topic.An Evening With The Experts - ArchivePresenter: William E. Whitehead, PhD Professor of MedicineAdjunct Professor of OB-GYN "Bowel leakage: Who gets it and what can you do about it?" You can watch the video presentation here.http://uncfunctionalgi.net/ewe_archive.html


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## jaumeb (Sep 1, 2014)

I think that in some cases there might be a link. I've started doing stretches and meditation to lengthen and relax my pelvic muscles.


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## annie7 (Aug 16, 2002)

i have pelvic floor dysfunction and some other problems as well...

biofeedback is wonderful! it has helped teach me to relax my pelvic floor muscles so that now, if i can get stool to the rectum, i can get it out. it hasn't helped with my slow transit but then it wasn't expected to, either, because, for me, my slow transit has other causes--it has not been caused by my pfd.

Kathleen is right--you don't want to do the regular kegels that strengthen those muscles because that's the last thing we need when our pelvic floor muscles are too tight. there's a sort of "reverse kegel" that one can do to help teach you to relax those muscles.

these are the exercises my biofeedback PT told me to do daily. they really do help:

1) gently squeeze your pelvic floor muscles--the muscles around your anus-and then relax them. squeeze just enough so that you can "get the release" as my pelvic floor PT puts it--- get the relaxed feeling. this helps you identify your pelvic floor muscles and also helps you to relax them.

2) slow contractions: contract your pelvic floor muscles for 5 seconds (gently) then relax them for 5 seconds. 10-15 times in row, twice a day. always relax for at least as long as you squeeze.

3) quick contractions: contract your pelvic floor muscles gently for 1 second and then relax for 1 second.

never hold your breath while doing any of these exercises..always breathe..

and oh yes--meditation is very helpful in teaching one to relax. and it has so many other benefits too.


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## jaumeb (Sep 1, 2014)

Yoga and meditation. That's what I am trying. Together with the diet.


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