Cleveland Clinic’s Ob/Gyn & Women’s Health Institute is committed to providing world-class care for women of all ages. We offer women's health services, obstetrics and gynecology throughout Northeast Ohio and beyond. Whether patients are referred to us or already have a Cleveland Clinic ob/gyn, we work closely with them to offer treatment recommendations and follow-up care to help you receive the best outcome.
Once patients with pelvic floor constipation have these basic tools, they can begin retraining the pelvic floor muscles with biofeedback. Based on the principle of operant conditioning, biofeedback provides auditory and visual feedback to help retrain the pelvic floor and relax the anal sphincter. Biofeedback training is the treatment of choice for medically refractory pelvic floor constipation, with some studies showing improvement in more than 70 percent of patients. Patients also learn to identify internal sensations associated with relaxation and long-term skills and exercises for use at home.

Medications: Daily medications that help to keep your bowel movements soft and regular are a very important part of treating pelvic floor dysfunction. Some of these medications are available over-the-counter at the drugstore and include stool softeners such as MiraLAX®, Colace®, Senna or generic stool softeners. Your primary care doctor or a gastroenterologist can help to advise you which medications are most helpful in keeping your stools soft.
Hip bridges: Engage your abdominals and pelvic floor before you start to bridge up, then bring the hipbones up to the sky. Then hollow out even more and really engage the pelvic floor. Then slowly lower your back to the mat, starting with your upper back, middle back, then lower back. Once you reach the mat, you can release your pelvic floor, and then re-engage as you do this move again.
To assess the degree of dysfunction, three measurements must be taken into account. First, an anatomic landmark known as the pubococcygeal line must be determined, which is a straight line connecting the inferior margin of the pubic symphysis at the midline with the junction of the first and second coccygeal elements on a sagittal image. After this, the location of the puborectalis muscle sling is assessed, and a perpendicular line between the pubococcygeal line and muscle sling is drawn. This provides a measurement of pelvic floor descent, with descent greater than 2 cm being considered mild, and 6 cm being considered severe. Lastly, a line from the pubic symphysis to the puborectalis muscle sling is drawn, which is a measurement of the pelvic floor hiatus. Measurements of greater than 6 cm are considered mild, and greater than 10 cm severe. The degree of organ prolapse is assessed relative to the hiatus. The grading of organ prolapse relative to the hiatus is more strict, with any descent being considered abnormal, and greater than 4 cm being considered severe.[2]
In order for the processes of urination and defecation to go smoothly, the various muscles within the pelvis need to act in a coordinated manner. In some cases, the muscles contract when they should be relaxing, or the muscles do not relax sufficiently to facilitate coordinated movement. Problems with the pelvic floor muscles can lead to urinary difficulties and bowel dysfunction. PFD is experienced by both men and women.
^ Masterson, Thomas A.; Masterson, John M.; Azzinaro, Jessica; Manderson, Lattoya; Swain, Sanjaya; Ramasamy, Ranjith (October 2017). "Comprehensive pelvic floor physical therapy program for men with idiopathic chronic pelvic pain syndrome: a prospective study". Translational Andrology and Urology. 6 (5): 910–915. doi:10.21037/tau.2017.08.17. PMC 5673826. PMID 29184791.
Medications: Daily medications that help to keep your bowel movements soft and regular are a very important part of treating pelvic floor dysfunction. Some of these medications are available over-the-counter at the drugstore and include stool softeners such as MiraLAX®, Colace®, Senna or generic stool softeners. Your primary care doctor or a gastroenterologist can help to advise you which medications are most helpful in keeping your stools soft.
Building and maintaining a strong pelvic floor is crucial for women of all ages. The pelvic floor is a group of muscles at the bottom of your pelvis that supports the womb, bladder, and bowels. So if these muscles become weak—whether it's due to childbirth, pregnancy, aging, or weight gain—it may be challenging to control your bladder and bowel activity. This is referred to as incontinence, a condition that affects nearly 25 million Americans, 75% to 80% of which are women.
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