For internal massage, your PT may insert a finger into the vagina or rectum and massage the muscles and connective tissue directly. A frequently used technique is “Thiele stripping,” in which your therapist finds a trigger point by feeling a twitch in the muscle underneath, exercising it using a circular motion, and then putting pressure on it to help relax it, repeating the process until the muscle starts to release. Internal massage can also help release nerves. Sometimes, anesthetics can be injected into these trigger points. PTs may do this in a few states, but in most states, a doctor or nurse must administer injections.
When mechanical, anatomic, and disease- and diet-related causes of constipation have been ruled out, clinical suspicion should be raised to the possibility that PFD is causing or contributing to constipation. A focused history and digital examination are key components in diagnosing PFD. The diagnosis can be confirmed by anorectal manometry with balloon expulsion and, in some cases, traditional proctography or dynamic magnetic resonance imaging defecography to visualize pathologic pelvic floor motion, sphincter anatomy and greater detail of surrounding structures.

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Pelvic floor exercises are specific movements that engage and strengthen your pelvic floor muscles, which can weaken due to factors such as childbirth, aging, menopause, obesity, chronic coughing, or heavy lifting. Most pelvic floor exercises don’t require specific equipment. These exercises typically rely on your body’s weight to initiate the stretch and engage the muscles. Pelvic floor exercises can increase bladder control, reduce the probability of pelvic organ prolapse, and increase sexual pleasure.
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