Pelvic Floor Physical Therapy
This video was taken during a PT session. The probe is in my anus. As I squeeze my pelvic floor muscles, the green oval contracts and gets smaller. When I relax, it gets larger.
The winning treatment seems to be Pelvic Floor Physical Therapy (PF PT). I’ve been off all UC meds and am managing my disease only with better pooping. Who’da thunk it?
Who is PF PT for? You’re probably familiar with PT for a hurt back or knee replacement, but there is really a branch of PT for every part of the body (and mind). PF PT focuses on the muscles of the pelvic floor, which control bowel movements, urination, and are involved in sex. I was familiar with PF PT for people who have issues holding their urine (e.g. leaks when sneezing, laughing or coughing) or for people who have issues with sex (kegels, anyone?).
For me, PF PT was to help treat my pouchitis. My doctor suspected the inflammation in my pouch may be due to incomplete or ineffective emptying. The more he explained what might be going wrong, the more I thought, “YES. That is me!” I then had a test called pouch manometry, which measured my ability to squeeze. I apparently failed this test spectacularly, so that confirmed the diagnosis for my doctor.
When I got my pouch, I immediately had issues with using the bathroom. (Things are going to get graphic here, so read at your own risk). I couldn't leave the house for nearly a month when I first got my pouch because I had such bad sphincter control. I had daily accidents or near accidents. I worked on pouch training, but I really really struggled. The way I eventually coped was with massive amounts of anti-diarrheal medications that were focused to slow my body down. Instead of mastering my anus, I chemically stopped it. Unfortunately, the apparent repercussion of this was a persistent inflammatory process.
What is PF PT like? Every experience is probably different, dependent on your institution and therapist. I saw Jill at the Cleveland Clinic St. Vincent Charity Medical Center. She instantly made me feel comfortable and less nervous: explaining what the therapy was going to be, describing the modes by which we’d practice, and outlining our schedule.
Alright, I’ll answer your burning question now: WHAT IS IT? First, I took off my bottoms and lay down on a massage table covered with a sheet. We started with tummy massage, and Jill explained how I could loosen my strictures and scar tissue with daily kneading and pulling of my stomach. (I guess my cat was trying to help me when he’d make biscuits on my tummy!)
Then we moved south. She explained how she was going to put her fingers into my vagina and feel how my muscles reacted when I will them to squeeze and release. If I could tolerate it, we would then do the same thing with my anus. As traumatic as it sounds, I didn't feel uncomfortable. Jill explained how there were two parts to my rectal sphincter: an inner and outer sphincter. When these sphincters don't squeeze together, life gets difficult for my pouch.
After manually examining my muscles, we moved on to using the rectal probe. This was a T shaped piece of plastic covered with two strips of metal. To use it, we hooked it up to a computer, put the device into my anus, and put a sticky electrode on the outer part of my anus. The electrode and probe would work together to catch the electric impulses muscles make when they contract. If this sounds familiar, an EKG works in a very similar way. When the probe was set up, I could watch my sphincters squeeze and relax in real time. This is considered Biofeedback. Biofeedback is when we use objective visual pictures that correlate to body processes in order to help gain mastery of that process.
I did an intensive PF PT program over three weeks and retested my pouch with manometry at the end. Throughout the time I also used the UC suppository Canasa in order to help reduce inflammation. In the end, I passed the test and felt like a champ.
It has been a month and a half since my PF PT experience and I’m on my third week without Canasa. I feel amazing – better than I have in YEARS. I feel as good as my pre-diagnosis self, but now older and far wiser. I think the most important thing I learned was to trust an experienced practitioners advice. If you spend a lot of time with fellow IBDers like I do, you sometimes become jaded by failed treatments and bad patient relationships with various members of the medical community. I was VERY suspicious of PF PT being the solution to all of my problems. Admitting PF PT could help me seemed like admitting that I was actually the problem and not just my crazy immune system. I know that’s irrational, but such is life. I suspended my disbelief in this program and trusted the expertise of Dr. Shen & Jill, and the results have been fantastic! Just another reminder that I, in fact, do not know everything and it’s a good thing I don't!
