Pelvic floor disorders can cause GI symptoms – ARM testing finds answers
August 22, 2024
Pelvic floor disorders (PFD) that affect the digestive tract are widely known for causing urine leakage, pelvic pain, and sexual dysfunction due to weakened or damaged pelvic tissues. But many people don’t know that PFD also can disrupt the normal passage of stool, causing leakage and constipation due to out-of-sync contracting and relaxing of the pelvic muscles.
Gastrointestinal (GI) issues caused by PFD affect 25% of women and up to 16% of men. Over 5.5 million people in the U.S. live with fecal incontinence (stool leakage) and 30 million to 66 million have chronic constipation. Both symptoms can be embarrassing and uncomfortable, affecting patients’ personal and professional lives.
An advanced tool called anorectal manometry (ARM) can provide detailed information about your pelvic floor health, especially when it comes to GI symptoms. ARM uses a rigid catheter that has 256 sensors that measure muscle contraction or relaxation through guided squeezing and pushing, as well as how effectively you can eliminate stool.
PFD can happen due to physical trauma, such as childbirth. But often, the cause is emotional, such as anxiety or depression. Just as an anxious dog curls its tail between its legs, an anxious person might subconsciously clench his or her pelvic muscles.
However, the pelvic floor connection with GI symptoms is often overlooked. Constipation and fecal incontinence are instead attributed to a patient’s diet or acute stress. Many people see provider after provider without getting adequate answers about their health.
UT Southwestern is one of the few hospitals in North Texas with advanced ARM technology, and we treat patients referred to us from across the state. Using the data from this test, our pelvic floor disorder experts can help you decide how to move forward – and give you the answers you’ve been searching for.
GI symptoms of pelvic floor disorders
Pelvic floor disorders often are misdiagnosed as chronic infections or GI issues such as irritable bowel syndrome (IBS). ARM helps determine whether symptoms such as constipation or stool leakage are caused by a PFD or something else. Here are some of the most common GI conditions that ARM can help diagnose. It is not abnormal to have more than one GI problem such as PFD and a motility dysfunction.
Constipation can be caused by:
- Pelvic organ prolapse: This happens when the muscles and tissues that support the pelvic organs weaken. It can cause organs such as the bladder, uterus (women), small bowel, or rectum to push into the vagina (in women) or bulge toward surrounding pelvic organ structures outside the body.
"Pelvic floor disorders often are misdiagnosed as chronic infections or GI issues such as irritable bowel syndrome (IBS)."
- Rectocele: A kind of prolapse that can cause constipation, when the rectum pushes into the back wall of the vagina or more front-located organs. Stool can get trapped in the space, making bowel movements difficult.
- Dyssynergia: A condition in which the pelvic floor muscles fail to coordinate with appropriate relaxation of anal sphincters and an increase in intra-abdominal rectal pressure.
- Hirschsprung’s disease: A congenital condition in which certain nerves are missing in part of the colon, causing a lack of muscle contractions needed for bowel movement. The result is severe constipation or bowel obstruction.
Fecal incontinence can be caused by:
- Pelvic floor incompetence: Pelvic floor incompetence refers to a weakness in the pelvic floor muscles and connective tissues, which can result from damage during childbirth, such as tearing or stretching of the pelvic floor muscles; pelvic procedures such as hysterectomy, which can compromise pelvic support and muscle function; radiation therapy to the pelvis; pelvic organ prolapse; and/or prior anorectal surgeries.
- Overflow constipation: This happens when a severely constipated bowel becomes so full that liquid stool leaks around the hardened stool.
What to expect with ARM
On the day of your appointment, you’ll meet with a provider who will take your medical history and talk you through the procedure. Then you will change into an exam gown and lie on your left side on the exam table.
The provider will attach a clean catheter to the ARM and insert the device gently into your rectum. The test may be a little uncomfortable with some anal pressure, but it will not be painful. The procedure will take 5-20 minutes. You will not be sedated since we will be giving you directions during the exam.
There are three tests we can perform with ARM.
- Measuring squeezing and pushing pressure: First, you’ll be asked to squeeze around the ARM for 20-30 seconds, like you’re holding in a stool. Then we will ask you to bear down for 20 seconds like you’re having a bowel movement.
From your movements, the ARM will generate a “pressure topography.” Think of it as a map of pressure in your anus and rectum, with different pressures indicated by color. Your provider will evaluate these images to better understand your symptoms.
- Sensation test: This test is for measuring fecal urge (how much you need a bowel movement) and immediacy – how quickly you need to go to avoid leakage. We slowly inflate a small balloon inside the rectum to test for sensation of stool presence.
- Balloon expulsion test (BET): The provider will insert a catheter with a balloon on the end into the rectum and inflate it with 50ml (less than 2 ounces) of water.
You’ll then move to a private patient bathroom and attempt to pass the balloon within two minutes. If the balloon doesn’t pass, the provider will remove it – this is a sign that your constipation is likely caused by a pelvic floor disorder.
Related reading: Common causes of anal or rectal pain, and how to treat them
After the appointment
Feeling heard and acknowledged can be life-changing for patients. I’ve had patients break down in happy tears, grateful that they finally have a path forward after ARM testing.
If you are diagnosed with PFD, a physical therapist can help with:
- Pelvic floor retraining, such as Kegel exercises, to retrain and strengthen your muscles.
- Biofeedback training, which uses electrodes to better understand your muscle groups and develop a training plan.
Dietary changes, such as eating more fiber and avoiding foods that trigger symptoms, also can help with PFD.
PFD caused by emotional trauma, such as post-traumatic stress disorder (PTSD) or anxiety, can be improved with counseling or cognitive behavioral health therapy. The provider may recommend incorporating meditation and gentle movement into your routine and offer strategies to reduce your stress – which will help you regain control of your pelvic floor, in addition to pelvic floor physical therapy.
If your ARM results are inconclusive, we will help you get answers by recommending other tests, such as:
- MR defecography: An MRI test with rectal contrast that captures detailed images of the rectum and pelvic floor during a simulated bowel movement to assess their function.
- Fluoroscopic defecography: X-ray with rectal contrast imaging to see how the rectum and pelvic floor perform during defecation.
- Endorectal ultrasound: An imaging test using a probe inserted into the rectum to provide detailed pictures of the rectal wall and surrounding tissues.
Constipation and fecal incontinence can truly affect your daily life. But you don’t have to suffer in silence. ARM testing can help you get a clear diagnosis and a treatment plan that may work for you. With the right care and treatment, you can feel like yourself again.
To talk with a pelvic floor dysfunction expert, call 214-645-8300 or request an appointment online.
