Article written by Pelvic Floor Physiotherapist, Joanne Ukposidolo, at One Elephant in Oakville Ontario.
I love and adore food. I think about it often. Did you know that food digestion can influence your pelvic floor? The function of your digestive system is to absorb nutrients and excrete waste. It does so through the process of ingestion, motility, mechanical digestion, chemical digestion, absorption, and defecation. Your digestive system can affect your pelvic floor through the shared function of defecation. Digestive issues that cause constipation or diarrhea can lead to fatigue, weakness, or incoordination within your pelvic floor muscles. Alternatively, poor pelvic floor muscular control can lead to constipation and symptoms of diarrhea. Let us delve into the mechanics of how and why this vicious cycle exists and ways to break it, from a pelvic floor perspective.
Your Pelvic Floor
Your pelvic floor is composed of three layers of muscles, nerves, fascia and ligaments that connect your tailbone to your pubic bone and from sitz to sitz bone. This creates a hammock or basin at the bottom of your pelvis that supports pelvic and abdominal organs such as your bladder, rectum and uterus. One important role of the pelvic floor muscles is to help control defecation and urination. A successful bowel movement requires the precise coordination of gentle deep abdominal muscle contractions while simultaneously fully relaxing the pelvic floor muscles. These pelvic floor muscles specifically are the puborectalis and external anal sphincter. It is helpful to understand their form and function a little bit more.
The puborectalis muscle is part of the inner layer of the pelvic floor. It acts as a sling that, when relaxed, increases the angle between the rectum and the anus, facilitating bowel evacuation. The external anal sphincter is part of the anus and helps keep stool safely inside the rectum until evacuation. When you make a conscious decision to have a bowel movement, the external anal sphincter along with the puborectalis relax allowing for successful elimination.
Chronic Constipation and Pelvic Floor Dyssynergia
Dyssynergia is uncoordinated pelvic floor muscular activity and it is evident with individuals who have chronic constipation. With chronic constipation you may have developed ineffective habits to bring about a bowel movement. One such habit is contracting your pelvic floor while bulging your abdominal muscles. This inadvertently futile habit results in inefficient straining to eliminate stool. It results in passing a small amount of stool, leaving you with a sense of incomplete bowel movement. Unfortunately, this forceful habit can cause further pelvic floor dysfunction such as pelvic organ prolapse which is the inability to support pelvic organs (uterus, bladder, rectum) within the pelvic cavity.
Chronic Diarrhea and Pelvic Floor Bowel Incontinence
Within your stomach and intestines, there are colonies of harmless bacteria known as microbiota. Most of these bacteria have a positive influence on your health and can contribute to your body’s natural processes. When these colonies are out of balance it can lead to dysbiosis. Gut dysbiosis can cause several negative symptoms, the most common being loose or watery stool or a frequent need to have a bowel movement. This frequent evacuation involves straining that puts consistent and persistent downward pressure on the muscles of the pelvic floor. Like any muscle, overuse can lead to fatigue and weakness. When your tired pelvic floor muscles lack strength, coordination, and functional control, this can result in the involuntary loss of stool (fecal incontinence).
Poor nutrient absorption and Pelvic floor Muscular Integrity
Our gut microbes have the important responsibility of harvesting and absorbing nutrients from the food that we eat. Poor nutrient absorption causes a dysregulation of your metabolism which can result in cravings, leading to higher caloric consumption and a higher BMI. Additionally, a lack of gut nutrient absorption also contributes to reduced muscle elasticity, tension and recovery. This lack of muscle tension and elasticity as well as increased BMI could lead to weakness and challenges with muscular coordination resulting in pelvic floor dysfunction.
Gut Brain Mood Connection and Pelvic Floor Hypertonicity
The Gut has a unique role of producing 95% of our body’s serotonin. Along with oxytocin, dopamine and various endorphins, these neurotransmitters control stress, anxiety, mood and behaviour through bidirectional gut brain communication. This means if your gut microbiome is compromised it would influence serotonin production, leading to a stress response. Your pelvic floor muscles react to stress through the sympathetic nervous system (SNS). When the SNS is activated your pelvic floor muscles contract and blood is shunted from digestive “rest and digest” organs to larger muscles for a “fight-or-flight” response. With chronic exposure to stress and anxiety this could lead to digestive issues in addition to a hypertonic, or non-relaxed, pelvic floor.
Can your Pelvic Floor influence your Digestive Health?
Yes! Over-recruiting pelvic floor muscles due to exercise or chronic stressors can cause tightness and weakness within your pelvic floor. As mentioned previously, successful bowel movement relies on the pelvic floor’s ability to relax. When the pelvic floor is overly and consistently tight it can lead to constipation which can affect the gut via the colon. The colon is where water is reabsorbed or absorbed (as needed) by the stool to create healthy, easy to eliminate stools. When stool remains in the colon for too long (constipation), toxins that were supposed to be eliminated begin to accumulate leading to leaky gut syndrome. With this digestive condition the mucosal lining of the intestines breaks down and begins to allow various bacteria and toxins to leak from the gut into the bloodstream. Leaky gut may cause or contribute to the following symptoms:
· Chronic diarrhea
· Chronic constipation
· Nutritional deficiencies
· Headaches, confusion and difficulty concentrating
· Joint pain
· Widespread inflammation
The Goal of Pelvic Floor Physiotherapy for Digestive Health
The goal of pelvic floor treatment for digestive health is to develop an ability to have successful bowel movements. This can be done by:
Stress Identification and physical management of stressors
Maintaining a diary of physical activity, fibre consumption and fluid intake
Pelvic floor physiotherapy educates you on:
· Pelvic floor anatomy and function
· Pelvic floor dysfunction including dyssynergia
Finally, pelvic floor physiotherapy facilitates treatment through:
· Pelvic floor awareness to support motor control exercises
· Abdominal massage to stimulate gut motility
· Bowel control mechanisms and healthy bowel habits
Here at One Elephant, we love working collaboratively to address any of your concerns or issues. Let us get you on the right path! Your mind and body will thank you.
To book an appointment with Joanne at One Elephant, click here!