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Physical Therapy Management of Outlet Dysfunction Constipation and Pelvic Pain

Binford, Joyce PT

Journal of Women’s Health Physical Therapy: May/August 2013 - Volume 37 - Issue 2 - p 59–69
doi: 10.1097/JWH.0b013e31829df717
Case Reports

Background and Purpose: Constipation is a common complaint and, when severe, can greatly impair quality of life. It is often caused by pelvic floor dysfunction, which is amenable to physical therapy interventions. The purpose of this case study is to present the broad range of interventions that may need to be incorporated to treat this condition.

Study Design: This study is a case report, looking at the many factors and the interrelationship of these factors involved in the presenting complaint of constipation.

Case Description: This client is a 48-year-old woman with a 9-year history of pelvic pain and severe constipation. Interventions included education on pain and pain management, bowel retraining, a home exercise program, manual therapy, and pelvic floor retraining with surface electromyography (sEMG) biofeedback.

Outcomes: This client attended 16 sessions over 7 months. Upon discharge, her pain had decreased from 8 to 4 on a scale of 1 to 10. She used warm water enemas 2 to 3 days a week instead of stimulant enemas daily. She required 10 to 30 minutes to have a bowel movement instead of 2 to 3 hours.

Discussion: This case study discusses the physical therapy interventions for a woman with long-term pelvic pain and outlet dysfunction constipation. She had complicating factors, including medical and psychological issues, which is common in women with these complaints. This study shows the importance of specialized education in managing pelvic floor problems and the need to evaluate and treat multiple systems.

Department of Physical Therapy, Providence Holy Family Hospital, Spokane, Washington.

The author declares no conflicts of interest.

Copyright © 2013 by the Section on Women's Health, American Physical Therapy Association.