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Pelvic Floor Dysfunction with Constipation in Males

Posted by @hew in Digestive Health, Aug 7, 2011

Anybody dealing with this malady? It's been a life-long zinger for me. I work with the motility team at Rochester. Been through many treatment regimens with them. Anyone having any success with other methods? I've taken or tried every medication on the planet to no avail. I've been through the 3 week physical therapy at Rochester with all the monitors and techniques. Now THAT process will help you lose your modesty in about the first 2 days.
Guess I'm just searching for anyone with the same...
Thanks, Hew


Posted by @mm92599, Aug 22, 2011

I have had pelvic floor dysfunction since 1999, but it took a very long time to get an actual diagnosis. I have been told that I have chronic levator spasm (levator ani syndrome), pudendal neuralgia, pelvic floor dyssynergia, and chronic pelvic pain syndrome. This condition has led to repeated episodes of anal fissures and hemorrhoids. I'm not sure I would describe my condition as "constipation" since I do get the urge to have a bm every single morning, my stool is generally soft (I take miralax daily and eat loads of fiber), and I am able to go every day, but I usually need to strain quite a bit to have a bm as my pelvic floor does not function properly to allow for an easy bm and my muscles are generally too tight and spastic to allow things to move easily. I've been to Mayo in Phoenix and I spent 3 weeks at a pelvic floor dysfunction clinic in San Francisco in 2010. I have also seen many colorectal surgeons and GI doctors, but I have found no relief for this condition. I have also taken many medications, but have not found one that helps much. I have heard of the bowel retraining program at Mayo, but I do not believe I can afford it. Did you find it helpful? Do you have typical constipation such as hard stools or is it similar to what I describe?


Posted by @hew, Aug 24, 2011

I went for the 3 week session in Rochester, MN, under Dr. Adil Bharucha's direction, led by the physical therapist Pat Olson. Yes, it's expensive. My insurance and Mayo are still going back and forth for 6 months now. My brother and my mother have helped me some financially, but the total still outstanding for me is still around $6600. After fighting this for 53 years (I'm now 54) my wife said that I had to go and try it. Because of the health issues I dropped 20% of my full time job a year ago which helped me to get ahead of some of the body stresses that worsen my condition. My wife and I live pretty simply in a small house near Louisville, KY. Apparently the PFD with constipation is not as common as the one you describe for yourself. I eat a limited diet to prevent my gut from reacting to foods that my gut can not process.

I too went through years and years of mis-diagnoses and it wasn't until Rochester that I got the main problem with the PFD plus constipation.

I also had years of anal fissures for which Bharucha prescribed niphedipine (sp?) which is in a plasticote base which I apply sparing and topically. Mayo compounds it for me which is much cheaper, like $16/vial as opposed to a "compounding pharmacy" which wanted to charge me $150 for the same size. It gives near instant pain relief by relaxing the constricture band of muscles at the pubo-rectalis that wrap around the sphincter. It is an anti-spasmodic heart drug. I also use generic valium (5mg, then 5mg more if no relief) which usually works well for me.

One of the additional approaches I have used is through a yoga teacher who practices a yoga-asana discipline and works with me to loosen and open my pelvic floor. The combination of the digital meter from the physical therapy, and the continuing opening of the pelvic floor has helped me get 50% improvement over February when I was in the training in Rochester. Yeah, February in MN. Hey, at 50 below zero F. it's all the same, right? I went to sessions three times each day with Pat. She's very good, patient, and helpful.


Posted by @heidiren, Jan 19, 2012

Hi, I was just diagnosed with PFD. I also have a very prolonged colonic transit time. Are there excerises I can do at home to help? Is there a yoga video I can purchase to help with my colon issues? I read somewhere that because I have PFD that I won't be able to have colon surgery. So not only can't I have a BM normally, It stays up in my colon for days. I feel very bloated. My colon isn't functioning very little. Any help would be appreciated.


Posted by @hew, Jan 21, 2012

Hi Heidiren,
I feel your pain, man. I've got the same long transit time. Pelvic floor dysfunction with constipation. My body adapts and "holds" stool no matter what I work through for solutions. Different methods work at different times for me. A 1/2 cup of whole psyllium husk for a couple days usually resolves the impaction I experience. I try not to eat any carbohydrates since any of the "oses" (lactose, fructose, sucrose, glucose) cause my system to "shut down" and hold stool. I have dolichocolon which prevents the transit from even occurring through the extremely long, over-extended colon. I take 600 mg of docusate sodium per day to ease the impaction. Once impaction occurs, Valium usually resolves the anal fissures that appear from constipation.

Yoga osina (created and designed by John Freind) is the practice I study. The "bindng" and core hyper-extension really helps keep the center of my core stretched out. Also keeping my cardio-vascular pulmonary efficiency up to par helps a bit. Friend's practice works to "ground" the pelvic floor to the Earth which is really helpful. It teaches me to open up the pelvic floor and keep spreading and opening it.

The PFD, slow transit, and dolicholon completely preclude surgery. Since the 1920s surgery is found to be completely ineffective. Once you cut, there is no going back, and you become much worse. Dr. Adil Bharucha is the foremost authority on planet Earth. I'd encourage you to meet with him at Mayo Rochester if you haven't already.

I took the PF Retraining at Mayo with the special physical therapist Patricia Olson. She instructed me in how to Redirect the shape of my PF to enable better "release" of the counter-acting PF muscle structure. The PFD actually causes the muscles to work the opposite of how they're supposed to which causes spasming and formation of anal fissures. I took what I learned in the two intense weeks of PF Retraining and took it into the Yoga Osina practice. My condition has improved at least 30% overall. A great relief to me.

I use a couple of standard fleet enemas even a couple times a week to prevent the hardening of a "plug" of stool forming above the "inside" sphincter. Pat Olsen says that with all the complications around the PFD and dolicholon that it's not harming anything. And it beats the pants off of impaction. Hope this helps you. Good luck.


Posted by @heidiren, Jan 21, 2012

Thanks for the info and quick response Hew! I will try cutting down on the carbs and try Yoga. I was in great pain Thurs night. I took mirlax, milk of mag, drank a bottle of mag. citrate. when they all failed I did the fleet. So you are saying that surgery is no good? Can I email you again if I have more questions as I figure this out? I will recommend Adil Bharucha to my Dr. Thank You. Heidi


Posted by @hew, Jan 22, 2012

Sure, feel free to email. I'm glad to give away any of the things I've learned that have helped me in case I can help another person.

Many of the patients I've run across over my 9 years of going in and out of Mayo Rochester with Dr. Bharucha were there because of "botched" surgeries. There is no effective surgery for Pelvic Floor Dysfunction.

Unless you have one of the really clearly diagnosable diseases (sprue, crohn's, colitis, celiac, gastroparesis, hirschsprung's) the treatments are pretty vague or non-specific. For hirschsprung's, the soave or pull through works because a part of the colon is actually dead.

Do not be tempted to undergo a "full fix" surgery since there is none.

For dolichocholon, which I also have, intestinal "shortening" surgery was proven ineffective in the 1920s.

After any surgical attempt to fix pelvic floor dysfunction with constipation, the problem then becomes the surgery, rather than the dysfunction.

The blocking or constipation occurs from the body's tendency to work the opposite way it is designed. Most folks have a natural release of fecal. Those with pelvic floor dysfunction w/ constipation have a paradoxical movement (upward) when an attempt is made to defecate. The body actually shuts itself down.

Mag Cit is like the 'atomic bomb' of relief. For me, it causes anal fissures and more problems than it's worth. I have worked with Pat Olsen, the physical therapist at Rochester who helped teach me exactly "how" to make the muscles relax during the process, rather than work paradoxically. That's where the yoga Oshina continues to teach me how to "open" or "spread" the pelvic floor.

My body tends to adapt to whatever technique I use to promote BMs. So I vary between using 2c of whole psyllium husk in water (lots of water afterward, like two cups at least), and/or the fleet enemas when I've developed a type of hard "plug" of feces that is usually the "start" of my constipation. With PFD w/ constipation, and dolichocolon, the use of fleets, according to the physical therapist at Mayo Rochester, no more often than 1x each week is not harming me.

I do the best I can with the techniques I've learned, then after a week of constipation I resort to the fleet if all else fails (limited diet, exercise, yoga, protein).

And of course the cutting back on carbohydrates that I am unable to digest. I tend to live on fish protein, little if any carbs, and canned peas. These are the highest in carbs, and the lowest in sugars.

Also, for me anyway, I'm unable to digest the "oses" which I think I mentioned. (sucrose, lactose, fructose, glucose) So staying away from any of those eliminates much of the world of food with the exception of fish protein since it's easier to digest than beef, or other hoofed animals. I eat about 60g of fish protein (mostly salmon packages), and some tuna. I had the test years ago and am not one of those who stores heavy metals, so the amount of tuna I eat a year is more than most folks.

Hope this helps some. I'm a medic in my spare time and a medical writer and technical writer for my regular job, so apologies if I get long-winded..
Take care...


Posted by @hew, Jan 22, 2012

I've had both types of stools (actually I've even classified them into about 10 distinct types, but I'm a little detail oriented). The bowel retraining program was about $8000 but I went directly to the therapy area and did not go through finance since I was an established patient. After 5 appeals to my insurance, the last appeal on the ground of patient medical necessity (rather than plan coverage) the insurance paid! So I'm doubly rich.

The techniques I learned from Pat Olsen in Rochester really helped, though I must keep practicing even now, nearly a year later. One's body tends to be a fickle adapter. It seems to forget what it's been taught. When I'm on my game, the results are really, really positive. I've improved my colonic life by 50% overall.

Truly, the "hands on" one-on-one work I did with Pat Olsen over 3 weeks, 3x each day is the only training that has worked for me. She really knows what she's doing.
She works with Dr. Adil Bharucha at Rochester. Try getting qualified through your insurance using "medical necessity." The approach through the standard summary of benefits will fail every time because they use the word "biofeedback." But the method they use is mostly digitial (fingers of the PT). The meter is for you to practice outside of the daily sessions and to "get a feel" for how to regulate the pubo-rectalis muscles and pelvic floor.

The only topical aid that has worked for anal/rectal fissures for me is niphedepine in the plasticoat base. Mayo Rochester sells a vial for $16 including shipping. It stopped the spasming and helps heal my fissures. I don't know if it works that well for everyone.

The chemicals don't work for me either. The latest was Amitizia. There was absolutely zero effect. The only approach that works for me is self control... and not putting anything down the chow lock (mouth) that I know I can't digest and process. The 60g of fish protein per day keeps me from starving.
Good luck! I hope this helps.

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