Excessive Puborectalis Muscle Tension and Its Impact on Bowel Health

Is there excessive tension in the pelvic floor muscles?

Hello Dr.
Chen, on December 8th, I underwent a defecation X-ray examination at Cathay General Hospital in Taipei, and the results are as follows: http://www.imagehosting.com/photo/x-754?context=user.
I initially suspected benign prostatic hyperplasia, but I have not experienced any issues with urination; rather, I am having significant difficulties with bowel movements and have no urge to defecate at all.
I am uncertain whether the problem lies with my small intestine or pelvic floor muscles, as my comprehensive health check did not include an examination of the small intestine or pelvic floor muscles.

I mention the pelvic floor muscles because I consulted a colorectal surgeon at Tri-Service General Hospital (who performed a digital examination), and he indicated that my condition resembles excessive use of the pelvic floor muscles, leading to an inability to relax.
(I also showed him the results of the defecation X-ray examination) http://city.udn.com/54543/1832545?tpno=1285&cate_no=0.
Currently, I am receiving "functional magnetic stimulation" treatment at Taipei Veterans General Hospital http://www1.vghtpe.gov.tw/msg/%E4%BE%BF%E7%A7%98%E7%9A%84%E6%96%B0%E7%99%82%E6%B3%95931216.htm.
I am undergoing this treatment mainly because a doctor at Far Eastern Memorial Hospital informed me that my symptoms are indicative of functional constipation, and functional magnetic stimulation is specifically designed to treat functional constipation.

However, after three sessions, I have not noticed any improvement.
I asked the physical therapist, and she mentioned that functional magnetic stimulation may not be effective for everyone; some individuals may need to wait six months or even a year to see results.
Unfortunately, my symptoms have been worsening; I have not had a bowel movement for two to three days and have no urge to go.
Even when I do feel the urge, I can only pass a small amount.
I am also hesitant to eat solid foods and have only been consuming liquid soups or plant-based milk.
Therefore, I cannot afford to wait that long.
If this treatment does not prove effective, I plan to undergo further examination.

I am not dismissing the opinion of the physician at Tri-Service General Hospital, but perhaps due to his cautious tone, I feel it would be prudent to have a more thorough examination.
However, I am unsure what type of examination would be appropriate.
If it is indeed a muscular issue, should I undergo an MRI or a CT scan to investigate further?

Xiao Fan, 30~39 year old female. Ask Date: 2012/01/01

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello Mr.
Hsiao-Fan,
The examination and treatment of bowel obstruction can be quite complex.
Please cooperate with your physician and be patient with the adjustments and medications.

Dr.
Chen Shih-Dian from Changhua Hospital cares about your health.

Reply Date: 2012/01/01

More Info

Excessive tension in the puborectalis muscle can significantly impact bowel health, leading to various gastrointestinal issues, including functional constipation and difficulty in defecation. The puborectalis muscle is a key component of the pelvic floor, playing a crucial role in maintaining continence and facilitating the normal process of defecation. When this muscle is overly tense or hypertonic, it can create a functional obstruction, making it difficult for stool to pass through the anal canal.

In your case, the symptoms you describe—difficulty in defecation, lack of urge to defecate, and the need to avoid solid foods—are indicative of a potential pelvic floor dysfunction, which may be related to excessive tension in the puborectalis muscle. This condition can be exacerbated by various factors, including stress, anxiety, and previous experiences with painful bowel movements, which can lead to a cycle of avoidance and further muscle tension.

The treatment approach you are currently undergoing, functional magnetic stimulation, is designed to help relax the pelvic floor muscles and improve bowel function. However, as you mentioned, the effectiveness of this treatment can vary from person to person, and it may take time to see significant improvements. If you are not experiencing relief after several sessions, it is reasonable to consider additional evaluations or alternative treatment options.

Regarding further investigations, if there is a suspicion of pelvic floor dysfunction, a specialized evaluation by a pelvic floor physical therapist may be beneficial. They can assess the coordination and function of the pelvic floor muscles and provide targeted exercises to help improve muscle relaxation and bowel function. Additionally, imaging studies such as a pelvic MRI or dynamic MRI defecography can provide detailed information about the anatomy and function of the pelvic floor during the defecation process, helping to identify any structural or functional abnormalities.

It is also essential to consider dietary modifications and hydration, as these can significantly impact bowel health. While you are currently relying on liquid foods, gradually reintroducing fiber-rich foods, if tolerated, may help improve stool consistency and promote regular bowel movements. Consulting with a dietitian who specializes in gastrointestinal health may provide you with tailored dietary strategies to support your condition.

In summary, excessive tension in the puborectalis muscle can lead to significant bowel health issues, including functional constipation. If current treatments are not yielding results, consider seeking further evaluations from specialists in pelvic floor dysfunction and exploring additional treatment options. It is crucial to address both the physical and psychological aspects of your condition to achieve optimal bowel health.

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