Q & A with Physical Therapist Emma Elton

Emma Elton, PT, DPT

After giving birth to my second child, I asked my midwife for a referral to a skilled physical therapist and she sent me to Women in Motion in Charlottesville, Virginia. During my sessions with Emma Elton, PT, DPT, I regained strength and learned a lot about pelvic floor health.

I interviewed her in order to share her wisdom about pelvic floor physical therapy for helping to heal hemorrhoids, anal fissures, and other bowel disorders.

Can pelvic floor physical therapists help with bowel disorders/pelvic health dysfunction like hemorrhoids, anal fissures, and fecal incontinence? 

YES! Many individuals (both men and women), have dysfunctional pelvic floor muscles that contribute to the underlying cause of these concerns. For example those with anal fissures and hemorrhoids commonly have tight, short and nonrelaxing pelvic floor muscles which often result in the tendency of the individual to strain when they empty which can increase risk of developing fissures and/or hemorrhoids, not to mention feeling incompletely empty or increasing risk for other pelvic floor dysfunction such as prolapse. 

In terms of fecal incontinence, also- YES! This may be a result from numerous factors such as tearing with delivery, pelvic floor weakness, lack of sensation, poor stool consistency, rectocele, etc. It takes a proper pelvic PT evaluation and individualized program to improve this function. Treatment varies depending on the cause of FI but there is strong evidence to support Pelvic PT as a first line of conservative treatment for FI. 

What types of therapies do you prescribe to your clients who have bowel disorders/dysfunction?

That looks different per individual and their concerns. This can include strengthening (in functional positions, kegel weight assistance, coordination with various exercises and activities of daily living). This may also include down-training tighter muscles so that you are better able to connect with what your pelvic floor muscles are doing during evacuation or throughout the day. This is done with internal release, biofeedback, increasing parasympathetic activity of the central nervous system, pelvic floor stretches that can be done independently at home, etc. 

If someone wants to learn more about these therapies, how do they find an experienced pelvic floor physical therapist?

Assure that your clinician is a licensed PT that has additional post doctorate education in pelvic PT. This should be stated on their website but be your own advocate and if you do not openly see this information, ASK! 

What should a new client expect during their first PT appointment?

Commonly an internal exam will be performed if the patient is comfortable with this. Vaginal exam and/or rectal exam. These exams are similar to an OB exam but do not involve a speculum (only 1 digit). These exams are aimed to look at muscular function, coordination, strength, endurance, power, tissue integrity and the surrounding muscular response. Treatments are then individualized based on these findings. These exams do not take long and your provider should be asking for consent numerous times before proceeding in addition to talking you through the results. 

Are you able to diagnose hemorrhoids versus anal fissures? How? 

Typically, yes. But so should you - ha! Hemorrhoids are usually non-painful. They can be active or latent and many times are external (meaning a visual self-exam can be performed at home and may be examined). Latent hemorrhoids may sometimes look like a skin tag. 

Anal fissures are painful with defecation. During a digital rectal exam the muscules may feel skinny and atrophied. Not always, but many times with an anal fissure there may be blood in the stool. 

What is your top tip(s) for helping clients improve their butt health?

Always use a squatty potty! 

Do not strain to empty. 

Eat a balanced diet. 

See a pelvic PT if you are experiencing any of the above concerns or pelvic pressure, unintentional loss of gas or smearing in your undies, anal pain, constipation, etc. If your MD does not automatically refer you, inquire further about a referral. However, in the state of VA you can come directly to pelvic PT without a referral for 30 days. 

Is there anything else about pelvic floor physical therapists that the world should know?

What you are experiencing may be common but is NOT NORMAL! And for those postpartum moms out there- just because you had a baby does not mean your pelvic floor should suffer because of it.