How pelvic floor biofeedback can help with bowel problems

If you have trouble with bowel movements, or if you’ve stopped doing things you love because you worry about getting to a bathroom in time, you may have pelvic floor dysfunction. You’re not alone. According to the American Urogynecologic Society, 25% of women 20 years or older have a pelvic floor disorder. 

The good news? Biofeedback for pelvic floor dysfunction can help.

“It breaks my heart to hear how pelvic floor dysfunction affects people’s lifestyles,” says Edyta Ruczynski, Atlantic Health RN, who specializes in biofeedback for pelvic floor dysfunction. “They’re stuck at home, afraid to go out, afraid to go swimming. They stop eating.”

Here Ruczynski shares more about what biofeedback is, how it works and how in six to eight weeks, patients can go from never leaving the house to having no accidents or worries. 

What is pelvic floor dysfunction and pelvic floor disorder?

Pelvic floor disorders affect your pelvic floor, a support system made of connective tissues, ligaments, muscles and nerves that hold your pelvic organs (bladder, rectum, vagina and uterus) in place.

Pelvic floor dysfunction is a condition in which your pelvic floor muscles are too tight (hypertonicity) or too weak (hypotonicity), making it difficult for your body to coordinate what needs to happen to poop easily or control your bowel movements. 

“Pelvic floor dysfunction isn’t something that happens overnight,” Ruczynski says. “It’s a process that has probably been happening for a long time, and can get to the point where you can’t completely evacuate or you don’t have the urge to go to the bathroom.”

Pelvic floor dysfunction symptoms

Both women and men can have pelvic floor dysfunction. Symptoms include:

• Constipation
• Fecal incontinence, or accidentally passing stool
• Difficulty completely evacuating a bowel movement
• Paradoxical sphincter contractions, when your muscles don’t relax during a bowel movement, resulting in excessive straining
• Pressure or pain in the lower back and pelvic area
• Tenesmus, a persistent urge to poop even if your bowel is empty
• Urinary frequency
• Urinary incontinence

How does pelvic floor biofeedback work?

Biofeedback for pelvic floor dysfunction helps you retrain your pelvic floor muscles by showing how they respond to guided exercises, so you can learn when to contract and relax them to have a bowel movement more effectively and easily. Biofeedback can also help with urinary issues — including incontinence, urgency, frequency and voiding issues. Biofeedback typically requires six to eight weeks, with one appointment a week.

A gastroenterologist (GI), urogynecologist or colorectal surgeon can refer you for biofeedback. Seeing a colorectal surgeon doesn’t mean you need surgery. Instead a colorectal surgeon can perform tests to determine if you have pelvic floor dysfunction. These tests may include anorectal manometry and electromyography (EMG) to evaluate how well your anal and rectal muscles and nerves function, and an anorectal ultrasound to assess the muscles’ structure. Many patients with pelvic floor dysfunction are good candidates for biofeedback. 

Rectal prolapse (a condition in which your pelvic floor muscles are so weak that your rectum slips down and protrudes through the anus) often requires surgery. You may receive a referral for biofeedback before and after surgery. 

What happens during a biofeedback session?

During your first biofeedback session, you will answer questions and discuss what you’re experiencing when you go to the bathroom. These questions may include: 

• What is your bathroom routine?
• What is the consistency of your stool?
• How often do you have a bowel movement?
• If you have the urge to poop, can you go right away?
• What bothers you the most? 

“It’s normal to be shy to speak about these things, but by the second visit, most patients are more comfortable and come with detailed notes,” Ruczynski says. “By answering these questions, we can explain what is happening and set a realistic expectation — what we plan to improve and how biofeedback can help.”

Learning is an important part of biofeedback. Using detailed pictures, Ruczynski explains how stool accumulates, how your nervous system controls your internal anal sphincter and how your brain gives you the sensation that you need to use the bathroom.

“If a patient has severe constipation, they may not have that sensation,” Ruczynski says. “They don’t have a feeling that they need to go to the bathroom.”

That could result from slow motility, when stool isn’t moving. 

“Many of my patients are schoolteachers,” Ruczynski says. “They can’t go to the bathroom whenever they want, and overcoming that urge sensation isn’t good. It gets to the point where you don’t get that urge, and without that urge, you can’t go to the bathroom.”

Other issues, such as irritable bowel syndrome or food intolerances, often go with pelvic floor dysfunction, leading to more complex issues with bowel movements.

Ruczynski also spends a lot of time talking about lifestyle, including diet (particularly fiber and drinking plenty of water), physical activity, over-the-counter medications for constipation, using a bathroom toilet stool to help with positioning, stress control, breathing to relax the pelvic floor and abdominal massage. 

“Explaining those things really helps my patients,” Ruczynski says. 

What does biofeedback feel like?

Biofeedback may feel uncomfortable at first — mainly due to nerves — but it shouldn’t hurt. You will lie on your side under a sheet. Once you are comfortable, a nurse gently inserts a small probe covered in lubricant into your rectum. 

“I ask patients to tell me if anything feels uncomfortable,” Ruczynski says. “If it does, I’ll stop right away. I’m extremely gentle. If your muscles are tight, we will do some breathing exercises to help you relax.”

Once the probe is in, your nurse will guide you through exercises, such as gently squeezing the rectum muscles for 10 seconds and then relaxing for 10 seconds. You’ll watch a monitor showing how your muscles respond in real time to your nurse’s instructions. You will learn the difference between a squeeze and a push. Electrical stimulation helps you become aware of urge, or the feeling of having to poop. 

At the end of the session, the nurse will gently remove the probe. You will receive instructions on how to continue these exercises (without the probe) at home. 

What are the benefits of biofeedback for pelvic floor dysfunction?

Patients who participate in biofeedback for pelvic floor dysfunction better understand how to contract and relax specific muscles to address bowel-movement issues. Patients typically experience less pain and constipation. They have fewer (or no) accidents. They feel an urge to poop. Many patients feel relief in having someone to talk to about their bathroom issues and getting more support than the common instruction to drink more water.

“We’re working on the muscle, but we’re also supporting the patient,” Ruczynski says. “Our patients are grateful they have someone they can speak to about these things, and they leave with hope that they can learn how to manage it.”

For many patients, biofeedback for pelvic floor dysfunction allows them to participate in the things they love doing without fear of having a bathroom incident.

“We are here,” Ruczynski says. “There is something you can do about it. The more you learn about your body and the more confident you become, you will be able to go out and enjoy your life.”