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Physio for your… Behind?! Anorectal Disorders Explained!

Pelvic floor physiotherapists are physios who have had additional training to perform external and internal pelvic exams in order to treat a variety of pelvic floor disorders. Among those disorders include some that pertain to the dysfunction of the bowel – your behind. These anorectal disorders may include

  • Leaking of stool from the rectum (fecal incontinence)
  • Inability to control flatulence (being unable to hold back a fart)
  • Chronic constipation
  • OASIS (obstetric anal sphincter injuries) which include 3rd or 4th degree perineal tears sustained during labour and delivery, rectocele, rectal prolapse, and pain disorders of the anus
There is something we can do to help!

Fecal incontinence refers to the uncontrolled passage of fecal material (aka poop) in individuals who are 4 years old or older. There can be various reasons why fecal incontinence may be present. There may be damage to the internal or external anal sphincters during OASIS. Radiation therapy for certain pelvic cancers may have reduced the ability of the rectum to stretch contributing to incontinence, stool consistency may be too liquid making it difficult for the sphincters to stop the feces from exiting the anus (possibly due to partial bowel resection surgery due to various medical conditions. Food intolerances/poor diet may also cause stool consistency to be too loose. There may be some weakness in the external anal sphincter muscle or the puborectalis portion of the levator ani muscle (the main pelvic floor muscle group) contributing to leakage of stool.

Some leakage can be due to nerve disorders (example multiple sclerosis). Sometimes even chronic constipation can be a source of loose stools leading to fecal incontinence!

 

What does it mean to have a 3rd or 4th degree tear during labour and delivery?

A 3rd degree tear is a tear into the external anal sphincter and a 4th degree tear includes tearing into the internal anal sphincter. These two sphincters are what control the exit of the stool and gas out at the anus from the rectum. When there is a tear in the sphincters, the scar tissue that forms from the injury may cause problems. Common issues to these injuries include having pain during bowel movements and it can contribute to constipation. There can also be low tone of the IAS or EAS (internal or external sphincters) or weakness of the external anal sphincter that may cause fecal incontinence or difficulty with controlling an unwanted fart. Fecal urgency can also be a symptom following 3rd or 4th degree vaginal tears.

Even if there is no bowel dysfunction in the post partum period following labour and delivery with a 3rd or 4th degree tear, having a pelvic floor physiotherapist examine the pelvic floor and provide an individualized home exercise program to optimize the scar tissue mobility, pelvic floor mobility and strength, and provide education on optimization of defecation strategies. This can be very helpful as sometimes occult injuries (meaning those without obvious injury to the anal sphincters) are present. They could result in symptoms like fecal urgency and loss of control of farting or fecal incontinence later in life (post menopausal).

Proactive treatment can be beneficial in these cases!

Chronic constipation is often characterized by:

  • having a bowel movement less than 3 days/week
  • and/or a stool consistency on the Bristol Stool Chart of Type 1 or Type 2
  • history of very large bowel movements (plugging the toilet for instance)

A pelvic floor physiotherapist can be helpful in providing various strategies to assist with the evacuation of the bowels. Some basic recommendations may include:

  • general advice on fibre and fluid intake recommendations for optimal stool consistency
  • activity recommendations
  • manual therapy techniques to assist with motility of the stool through the rectum
  • education on various physical evacuation strategies
  • breathing techniques to assist with optimal bowel evacuation
  • minimization/elimination of straining

 

 

 

For those suffering from prolapse, a physiotherapist can help by teaching optimal defecation techniques to reduce strain to the area, thereby reducing strain to the tissues. There may also be too much tension in the pelvic floor muscles or there may be scar tissue present from obstetrical or other surgical injuries which can lead to pain in the pelvic floor or anus with or without having a poop.

Struggling? Book online with a physiotherapist today in Warman at Warman Physiotherapy & Wellness or Saskatoon, at Warman Physio Saskatoon. Don’t see a spot that works? Add yourself to the waitlist! You can even select if you have a therapist, location, and day/time preferences!

 

 

This post was created by Maja Stroh MPT and pelvic health physiotherapist at Warman Physiotherapy & Wellness

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Headaches – From the Neck Up

We have talked before about headaches from a massage perspective previously. However, there are many reasons for headaches that may be cause to see a physiotherapist as well. Check out this case study for headaches from the neck!

Case Study NP

What does it feel like?

NP comes into the clinic, he is a 35 year old father of 3 and works a desk job for the past 5 years. Before that he was working on-site in construction, often looking overhead. In the past 2 years since his third child was born he is noticing he is getting more frequent headaches. Often his headache is is on the right side behind his eye and in the temple. As NP gets talking he realizes that he also has some dull pain in the shoulder and arm; but this pain is occasional compared to the headaches. He finds that when he is working at his desk by the end of the day the headache is nearly unbearable. By the time he gets home he has difficulty playing with his kids, and it’s starting to impact his ability to work around the house and cabin.

He doesn’t recall a specific injury to his neck, but NP does have a cabin and boat at the lake and loves trying new water sports. Just before his third child came friends came to the lake and decided to take the tube out where he was flipped multiple times.

This all-too-familiar story can have multiple ways that it could have begun – a whip lash injury, strain of the neck or shoulders, etc. Let’s focus on this case study and some of the possible reasons WHY this happens, what we can do about it, and how you can start your road to recovery TODAY! 

What Causes Headaches?

The neck is actually a highly complex unit. We have multiple bones in the neck (seven to be exact!), nerves that travel from the neck up into the scalp and down into the arms, plus all the ligaments, tendons and muscles. The body is an amazing thing when you think of all the moving parts. Generally speaking we are able to maintain a pain-free lifestyle; however sometimes we need a little help.

One of the reasons that we can develop headaches is because of neck dysfunction. In this instance NP is experiencing referral from the upper cervical spine (C1-3). This is why he has pain near his eye. Increased stress and posture issues can also significantly impact headaches.

If you have headaches, a physiotherapy assessment could benefit you!

What does an assessment look like?

NP came for an appointment at the beginning of the day because it worked better with his schedule. He was worried that not being severely symptomatic would be a problem for the assessment. He was relieved when he heard that the therapist would be able to evaluate the neck regardless of the amount of current pain.

The assessment took a look at his overall neck range of motion. NP was surprised to discover that he had more difficulty tipping his right ear to his right shoulder, and shoulder checking over the right. When the therapist had him lay down to evaluate the neck movement and muscle tension he was significantly more tender on the right side at the base of the skull.

During the assessment the therapist identified some specific muscle weakness and tension that would need to be addressed.

NP was surprised that during the appointment the therapist was able to recreate his headache symptoms and shoulder pain. He wanted to make sure that he could get back to his normal home-life routines. NP booked his next 4 appointments weekly and was sent home with exercises and stretches to get him started.

Over the next four weeks NP attended his appointments for some manual therapy from the physiotherapist and updates to his home program. He was pleased that by week 3 his headaches seemed to be significantly better.

NP resolved his headaches within 6 weeks, and returned for a flare-up 4 months later. The flare-up lasted 2.5 weeks and after resolving has not returned since he is able to manage any issues with his home program.

How long until I am better?

The recovery period usually varies from client to client, depending on the severity and frequency of signs and symptoms. Other factors include:

  • How long the headaches have been going on, how severe they are
  • What areas are contributing (neck mobility, muscle tension, etc)
  • Commitment to the home exercise program

Straightforward cases we tend to see client’s 1x/1-2 weeks for a total of 4 to 6 sessions. These sessions include manual therapy to help restore joint and muscle mobility as well as exercises for their home program.

Don’t delay! Schedule your assessment today to get started your journey to recovery!

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Ankle Sprains: A Case Study

With icy sidewalks and streets, falls during the winter can become more prominent. One injury that can occur is ankle sprains.  Have you ever sprained your ankle before? Wondering if you should seek physiotherapy? Lets look at a case history of one example of an ankle sprain and what physiotherapy may involve…

Ankle Sprain: Case Study

A 35 year old woman attends the clinic after she was walking her dogs outdoors when they lunged suddenly, causing her to slip on some ice. She fell, rolling her right ankle to the side and was able to get back up and weight bear through her injured ankle, although limping back home. Her ankle was pretty sore with some noticeable swelling so she went to see her family physician the following day. X-rays were taken of the ankle and she was advised she did not have a fracture, but rather sprained her ankle. She was recommended to rest the ankle for the next 3 days and to limit her weight bearing as tolerated using a lace up brace. She was also prescribed anti-inflammatories and referred to physiotherapy.

Dance Ankles and Feet

For the assessment she was weight bearing with a lace up ankle brace. The ankle was noted as still sore but improving.

Some mild swelling over the lateral ankle and some tenderness to touch over the ankle ligaments were noted. With in-clinic testing it was determined she was dealing with a moderate ankle sprain. She was prescribed some basic neuroproprioceptive and gentle strengthening exercises. These early phase exercises set the base foundation for return to regular activity and sports and she was eager to get back to her regular routine with her dogs.

The client was seen for 6 further follow ups over the next 3 months.  During this time she was provided with some manual therapy techniques to the ankle. She was also given a progressive home exercise program which included progressive strengthening, balance and proprioceptive training. The client noted full resolution of symptoms at the conclusion of her treatment and return to her activities which included walking her dogs and her dance class.

Often people find that their ankle will feel “good enough” part way through rehabilitation but ensuring that all systems are truly “go” will help prevent a recurring injury from incomplete rehab programming.

What is the current evidence for acute lateral ankle sprains and the role of physical therapy?

If required a short period of immobilization may be used, however exercise and a functional support (either bracing or taping) is recommended over immobilization. Clinical practice guidelines support the inclusion of an active exercise rehab program following an acute lateral ankle sprain as soon as possible to help prevent recurrent lateral ankle sprains. 1

It is commonly misunderstood that someone must wait a certain period of time before attending physiotherapy, however, keep in mind that physiotherapists can assess injuries right from the moment of impact; just like when an athlete becomes injured. Coming for an appointment early in healing can give you the right tools to start with immediately. Alternatively, the body is capable of healing and change even after extended periods of time so it is also never too late to start.

If you have unfortunately sustained an ankle injury, we at Warman Physiotherapy and Wellness have trained physiotherapists who can offer a progressive rehabilitation program to help you on the road to recovery and return you to your activities/sport!

 

References:

  1. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. BJSM. Volume 52, Issue 15. August 2018. Gwendolyn Vuurberg, et. al.
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Being Backed-up: how constipation is related to the pelvic floor

Everyone dreads being constipated. It’s never fun to be backed-up to the point of difficult, often painful bowel movements. How we often think of constipation, and what constipation can look like may not always be the same!

Constipation is often described as having 2 or fewer bowel movements in a week. These bowel movements will often be difficult to evacuate or require effort. So anything outside of this (more frequent, and easy to get out) would be considered normal… right?

Not necessarily! Our ability to consistently evacuate the bowel may not mean that you aren’t constipated! Some individuals that are constipated evacuate the bowel several times a day. BUT HOW?! In this instance, usually we are getting out several smaller stools throughout the day, and not completely emptying the bowel. These stools may in fact be “easy” to pass, and for some people they will find that they will sit down to go pee, and some stool will come out as well, without any urge to go number 2 in the first place.

So beyond the “usual” signs of constipation, what else should we be watching out for?

  1. Large diameter stools: for adults and children we should not be thinking “whoa! I hope that doesn’t plug the toilet” or “I can’t believe it’s THAT BIG!”
  2. Cracked or dry stools: bowel movements that look cracked or dry, or like little bunches of small balls stuck together
  3. Urge to go with no results: if you have the urge to evacuate, get to the bathroom and just nothing seems to come out… this could be a sign
  4. You wipe and wipe and it never gets “clean”: this could mean that you aren’t fully evacuating the rectum
  5. It feels like there is still some in there: likely that the bowel is not being fully evacuated
  6. Belly aches and bloating: can be signs of constipation
  7. Itchy rear-end (or the wiggles) is common to see in children as well

Being constipated will put a strain on the pelvic floor, as often evacuating the bowel will require effort in the form of pushing of some sort. Sometimes we are spending significant amounts of time sitting on the toilet attempting to get stool out. Development of hemorrhoids, pelvic pain, and pelvic floor dysfunction can be a result of persistent or chronic constipation.

 

Constipation starts young for many people “I have always been like this for as long as I can remember”. With seeing many children with constipation, they have struggled with bowel movements often since starting solids, or when they began potty training. Often other issues start to arise such as bed wetting as well.

 

Helping people to re-educate the pelvic floor to improve coordination, improve evacuation, and go through bowel hygiene tips are all part of our pelvic health assessments. Some things you can start thinking about now:

 

are you getting enough water?

when you go are your feet well supported with knees above hips?

do you take enough time (but not too much!)?

when you get the urge to go, do you make time?

 

These can be some things to consider with your bowel hygiene to help you begin to get things sorted. Determining the abdominopelvic coordination and function, overall pelvic floor muscle strength and ability to relax, as well as a variety of other technical factors will be what we want to dive into with you.

Issues with constipation isn’t just a problem for children, but also men and women alike!

Book in Saskatoon                                                                       Book in Warman (Kendra, Maja)

Haylie has been practicing pelvic health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Officially adding to her practice pediatric pelvic floor therapy in 2017. She has been advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms ultimately brought her to open her family-friendly clinic. At Warman Physio clients are encouraged to bring their infants and children to treatment. Warman Physio has been nominated as a finalist for the 2018, 2017, & 2016 WMBEXA, is a WMBEXA award recipient of 2017 New Business Award, and a finalist in the ABEX 2018, 2017 & 2016, and Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017, and has been nominated for the 2019 SABEX and WMBEXA Awards.
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What is Incontinence and How Physio can Help

Many people are aware that physiotherapy can help with injuries from sports or car accidents, but did you know there is physio that can help with your bladder problems? Not just any physiotherapist can assist you with your leaky bladder, we need to take a little bit of extra training to become a Pelvic Health Physiotherapist (PHPT). Depending on the courses that have been taken, PHPT can treat a variety of pelvic floor disorders including urinary incontinence.

There are a few different types of incontinence that pelvic health physiotherapy can address including stress urinary incontinence (leaking with cough and sneeze), urge urinary incontinence (leaking when rushing to the washroom), mixed urinary incontinence (a mix of stress and urge) and functional urinary incontinence (leaking due to other limitations).

In years past incontinence was an issue associated with an elderly woman who had likely had children at some point, and now we recognize that it is an issue not only in women, but men and children as well!

In some instances the leaking starts as just a small amount and only with certain activities, and in some instances it is a large amount and seeming to be all the time!

Stress Urinary IncontinenceLaughter is one of the frequent causes of stress incontinence

Usually occurs when intraabdominal pressures exceed the ability of our internal and external urethral sphincters to counteract these pressures on the bladder. This will happen most often during laughing, sneezing, coughing, lifting, or yelling. The muscles that control keeping urine in while the pressure around the bladder increases is our external urethral sphincters, a part of our pelvic floor musculature and they are under our control. When there is weakness in these muscle, possibly a problem with timing of the contraction of these muscles, or ‘bearing down’ vs ‘lifting up’, then some leakage can occur. Pelvic floor physical therapy can help by teaching techniques and strategies to get the best recruitment of the pelvic floor muscles and timing of the contractions with these increases in intraabdominal pressure.

 

Urge Urinary Incontinence

Developing urge incontinence on the way home or upon arrival is a common "key in the door" presentation

This leaking is associated with the increased urge to void without being able to make it to the bathroom in time. This may start with “photo finishes” and just making it to the washroom in time, to having the entire bladder empty at the first urge to void. Often a higher toned pelvic floor and/or overactive bladder may be the cause.  Pelvic floor physical therapy can help by teaching strategies for retraining of the bladder reflex responsible for the urge to urinate or by helping to decrease a higher toned pelvic floor with manual therapy techniques to the lumbosacral spine or pelvic floor and breathing/relaxation exercises.

 

Mixed Incontinence

As it sounds, this is usually a combination of the first two: stress and urge urinary incontinence. Depending on what the assessment finds, various techniques and strategies can be utilized by the pelvic floor physiotherapist to help address the issues. Each individual will get their own unique program no matter what type of issue they are coming in with, but this type in particular can have some very unique features for each client!

 

Functional & Overflow Incontinence

Generally will have leaking occur when there are other factors at play. Mobility or cognitive issues that prevent a person from making it to the bathroom in time are the biggest culprits  here. Physical therapists can help address mobility issues and provide manual therapy, teach exercises to help increase mobility, strength, balance as well as recommend certain mobility aids that can assist the client to reduce incontinence secondary to functional limitations. Often associated with the more elderly client, this can also affect younger individuals as well.

Photo by Cristina Gottardi on Unsplash - demonstrating one reason for functional incontinence (mobility issues)

Urinary incontinence can also be due to overflow incontinence.  The hallmark symptoms of this type of incontinence are frequent leakage of urine without the urge to void, or the inability to have normal volumes of urine. This is when the bladder remains full due to its inability to empty, which causes the urine to leak out when the bladder capacity is overfilled.  This type of incontinence is not a form that physical therapy typically addresses and NEEDS to be medically investigated first as there are a variety of medical reasons that may be causing this type of incontinence!

 

We have talked about what to expect in a pelvic health appointment before, and with these appointments as with all our assessments we get a detailed subjective history, followed by a scan exam of the low back, as well as an internal assessment of the pelvic floor is usually required in order to fully appreciate what is causing the urinary incontinence. This will help the therapist to formulate a treatment plan that will be individual and specific to each person being assessed. If someone is experiencing urinary incontinence and wishing to have this addressed by a pelvic health physiotherapist, no physician referral is required.

 

Have you been struggling with urine leakage? Not sure if your symptoms could be part of a pelvic health issue? Please feel free to contact us and we will help chat you through what you are experiencing as best we can.

Don’t delay start your road to recovery today in Warman or Saskatoon!

Maja Stroh is a physiotherapist that has a particular interest in pelvic health and perinatal care. She graduated from the U of S MPT program in 2009 and has been working with pelvic health populations since 2013. Maja’s interest in helping her clients and spending quality time with her family has brought her to Warman Physio where she will be providing services in the Warman location.

 

 

 

 

References:

 

The Canadian Continence Foundation <www.canadiancontinence.ca>

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