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Physical Therapy Management of Pelvic Floor Dyssynergia

Bannister, Tami MSPT

Journal of Women’s Health Physical Therapy: December 2009 - Volume 33 - Issue 3 - p 16–21
Case Report

Background: Pelvic floor dyssynergia is an inability to relax the pelvic floor muscles during defecation. Successful defecation requires increased intra-abdominal pressure combined with relaxation of the pelvic floor muscles. An inability to coordinate this action often results in chronic constipation, painful bowel movements, and excessive straining. The purpose of the case report is to describe the successful physical therapy treatment of a patient with long-standing constipation caused by pelvic floor dyssynergia.

Study Design: This is a case report revealing the physical therapy interventions used to treat the patient, the outcome of the treatment, and discussion and implications for current and future physical therapy management of constipation caused by pelvic floor dyssynergia.

Case Description: The patient was a 56-year-old male complaining of chronic constipation existing greater than 10 years. The physical therapy interventions included neuromuscular re-education using electromyographic biofeedback, tactile biofeedback, and instruction regarding coordination of abdominal muscle contraction for increased intra-abdominal pressure combined with pelvic floor muscle relaxation.

Outcomes: The patient attended 5 physical therapy sessions over a 5-week time frame followed by 2 phone consultations. At time of discharge the patient was having normal bowel movements 80% of the time, was not using laxatives or enemas, reported no pain with bowel movements, improved his Obstructed Defecation Syndrome Score by 11 points and had returned to work.

Discussion: This case report discusses the physical therapy management of a man with pelvic floor dyssynergia causing chronic constipation. Interventions included biofeedback therapy and muscle retraining resulting in normal defecation.

Baylor Medical Center at Irving, Grapevine, TX

© 2009 Lippincott Williams & Wilkins, Inc.