Physical Therapy for constipation,

incontinence, and general exercise

Karen Grube PT, MS

Copyright © 2009 Rehabilitation Institute of Chicago. All rights reserved.

Introduction

Research

• There is very little research available related to PT; few case reports

• Research is in the medical management

Problems PT may be able to help

• Musculoskeletal• Gastrointestinal: constipation and/or diarrhea• Bladder dysfunction

Musculoskeletal Problems

• Joint stiffness and pain• Muscle pain• Start PT and OT early to improve function and maintain activity of

daily living. (Shah and Wigley, 2014)– Individually designed for person– Exercise should not cause flair up in joint or muscle pain– Should include aerobic conditioning– Avoid “boom-bust” behavior

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General Exercises

• Before getting out of bed in the morning– Single knee to chest– Lower trunk rotations– Shoulder Flexion over head and back down to side– Neck rotation side to side– Ankle circles and pumps

• During the day– Sit to stand from a chair to strengthen legs– Buttock squeezes

• Aquatic exercise• Gentle yoga• Cardiovascular program: walking or biking

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Exercise Guidelines to Calm Nerves

• Green Light = Good– Discomfort from the exercise does not worsen with activity and generally

gets better each time performed– “No Worse” later in the day or the next morning

• Yellow Light = Cautionary – Produces pain when performing but “No Worse” after– Proceed with caution during the movement or activity so “No Worse” 2 hrs.,

12 hrs., or 24 hrs. later and maintain ROM in all directions. (“A World of Hurt A guide to Classifying Pain” Kolski, O’Connor 2015

p 205)

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Exercise Guidelines to Calm Nerves

• Red Light = Bad – Recent trauma or sensitive alarm system – Pain indicates the activity level of the tissue has exceeded its tolerance

creating a flair up of the nervous system – Tissue damage has not occurred– No motion or strength changes– Acute chemical inflammatory state momentarily dominates from doing too

much too fast– Pain worsens with each repetition– After the movement the pain continues to spike for 15 min. after stopping

and continues into the night and up to 24 hrs. – Pushing through these symptoms is unsafe and will produce a flare up.

(“A World of Hurt A guide to Classifying Pain” Kolski, O’Connor 2015, pg 209)

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Pace Activity not Boom-Bust

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Constipation and Diarrhea

• Diet• Pelvic floor relaxation• Abdominal massage• Toilet position

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Female Pelvic Floor Muscles

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Male Pelvic Floor Muscles

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Relax Pelvic Floor

• Breath training: calm, long, smooth breaths• Body awareness of tight and painful area

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Abdominal massage

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Toilet Posture

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Bladder Dysfunction

• Incontinence: urinary leakage• Urinary frequency: • Urinary Urgency: over active bladder• Urinary retention

• Cause of bladder problems– Tight pelvic floor muscles– Weak pelvic floor muscles– Poorly relaxing pelvic floor muscles– Neurogenic bladder

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Female Pelvic Floor Muscles

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Female Pelvic Floor Muscles

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Male Pelvic Floor Muscles

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Pelvic Floor Strengthening

• Lift and squeeze pelvic floor muscles as you breath• Inhale: diaphragm goes down and pelvic floor relaxes• Exhale: diaphragm goes up and pelvic floor contracts• Learn to do Long Holds: 5 sec contraction and 10 sec relaxation

for 10 repetitions in hook lying, sitting, and standing • Learn to do Quick Flicks: 1 sec contraction and 1 sec relaxation• Contract Pelvic Floor muscles during sit to stand and relax pelvic

floor from stand to sit.

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Conclusion

• Limited research on PT interventions for individuals with Scleroderma.

• PT has strategies to help with Joint and Muscle Pain, Cardiovascular deconditioning, Constipation, and Bladder Dysfunction.

• Breath Training to decrease stress and help to relax pelvic floor muscle while having a BM.

• Stretching, strengthening and CV conditioning exercise within safe guidelines.

• Constipation: diet, abdominal massage, pelvic floor relaxation, toilet posture-squat

• Urinary incontinence: relax and strengthen pelvic floor muscles both long holds and quick flicks.

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Questions?????

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Thank You

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