Understanding Gastroparesis and the Role of Pelvic Floor Physical Therapy

As the popularity of medications like semiglutides rises for weight management, many people may unknowingly exacerbate underlying conditions such as gastroparesis, making it essential to explore the interconnectedness of digestive health and pelvic function. Gastroparesis is a chronic digestive disorder characterized by delayed gastric emptying. This condition occurs when the muscles in the stomach are unable to contract properly, preventing the efficient movement of food into the small intestine. Common symptoms include nausea, vomiting, bloating, early satiety, and abdominal pain. Gastroparesis can significantly impact a person's quality of life, causing discomfort and nutritional deficiencies.

Causes and Risk Factors of Gastroparesis:

The causes of gastroparesis are varied and can include diabetes, nerve damage, connective tissue disorders, and certain medications. For instance, weight loss medications such as Ozempic (semaglutide) and Mounjaro (terzepatide) have been associated with gastrointestinal side effects, including gastroparesis. Diabetes is a major risk factor, as high blood sugar levels can damage the vagus nerve, which controls stomach muscles. Other risk factors include abdominal surgery, viral infections, hypothyroidism, and eating disorders.

Diagnosis and Conventional Treatments of Gastroparesis:

Diagnosing gastroparesis involves a combination of medical history reviews, physical exams, and specialized tests such as gastric emptying scintigraphy, gastric manometry, and breath tests. Traditional treatment options focus on managing symptoms and improving stomach emptying. These treatments often include dietary changes, medications to stimulate stomach muscle contractions, and in severe cases, surgical interventions.

Pelvic Floor Physical Therapy as a Treatment Option for Gastroparesis:

Pelvic floor physical therapy (PFPT) is an emerging treatment for managing gastroparesis symptoms. This specialized form of physical therapy targets the muscles of the pelvic floor, which support the bladder, uterus, and bowels, and play a crucial role in digestive health. Dysfunction or weakness in these muscles can exacerbate symptoms of gastroparesis by affecting the coordination and motility of the digestive tract.

To address these dysfunctions, pelvic floor physical therapy involves a variety of techniques aimed at strengthening and relaxing the pelvic floor muscles. These include exercises designed to improve muscle tone and coordination, as well as manual therapies such as myofascial release and trigger point therapy to reduce tension and improve blood flow. By working on these muscles, pelvic floor physical therapy can help restore proper function to the digestive organs, enhancing the movement of food through the stomach and intestines and reducing the severity of gastroparesis symptoms.

How Pelvic Floor Physical Therapy Helps in Gastroparesis

1. Improving Pelvic Floor and Abdominal Muscle Function:

The pelvic floor and abdominal muscles provide critical support for the digestive system. While peristalsis—the wave-like contractions that propel food through the intestines—occurs independently, the function of the pelvic floor muscles can influence gastrointestinal symptoms. Overactive pelvic floor muscles may disrupt pressure management, potentially leading to symptoms such as bloating and constipation.1 By enhancing the strength and coordination of these muscles, pelvic floor physical therapy can reduce symptoms like bloating and discomfort, and promote more regular bowel movements, ultimately improving the overall digestive process.

Pelvic floor physical therapy focuses on enhancing the strength, coordination, and relaxation of these muscles through targeted exercises. This therapy can alleviate symptoms of conditions like gastroparesis by improving gastric motility and promoting efficient bowel movements. Incorporating diaphragmatic breathing techniques can further facilitate pelvic floor muscle relaxation, supporting overall digestive health and reducing discomfort.

2. Biofeedback Techniques:

Biofeedback involves using specialized equipment to monitor and provide visual feedback on pelvic floor muscle activity. This technique helps patients become more aware of their muscle movements, improving their ability to engage and relax these muscles properly. Studies have shown that biofeedback can significantly reduce symptoms like nausea and bloating and improve gastric emptying times.2

3. Pelvic Floor Muscle Training:

Pelvic floor physical therapy includes exercises designed to strengthen the pelvic floor muscles and improve their coordination and control. These exercises can enhance digestive efficiency and symptom management. Therapists may also use visceral mobilization techniques to improve the function of internal organs.

4. Relieving Pelvic Floor Dysfunction Symptoms:

Many individuals with gastroparesis also experience pelvic floor dysfunction, including constipation, urinary incontinence, or pelvic pain. Pelvic floor physical therapy addresses these symptoms, making it easier to manage gastroparesis.3

5. Breathing and Relaxation Exercises: 

Techniques that focus on diaphragmatic breathing and relaxation are used to reduce intra-abdominal pressure and promote better coordination between the stomach and intestines. These exercises can also alleviate stress, which may exacerbate gastroparesis symptoms.

Role of Pelvic Floor Muscles in Digestion:

The pelvic floor muscles form a sling-like structure at the bottom of the pelvis, supporting the pelvic organs and assisting in controlling bowel and bladder movements. Dysfunction in these muscles can disrupt the normal coordination between the stomach and intestines, contributing to gastroparesis. By improving the function of these muscles, pelvic floor physical therapy can enhance digestive health and alleviate gastroparesis symptoms.

Recent studies have highlighted the benefits of pelvic floor physical therapy for gastroparesis. For example, a study published in the Journal of Gastroenterology found that patients who underwent PFPT experienced significant improvements in their symptoms and quality of life compared to those who received standard care alone.4

Abdominal Phrenic Dyssynergia (APD) and Its Connection to Gastroparesis:

Abdominal phrenic dyssynergia (APD)3,5 is a condition characterized by a lack of coordination between the diaphragm and the abdominal muscles, leading to abnormal breathing patterns and increased intra-abdominal pressure.6,7,8  This condition can contribute to digestive disorders such as gastroparesis by disrupting normal gastrointestinal motility and function. Abdominal phrenic dyssynergia often coexists with pelvic floor dysfunction, and addressing both conditions through pelvic floor physical therapy can improve overall digestive health and reduce symptoms.6

Gastroparesis is a debilitating condition that affects the digestive system's ability to function properly. While traditional treatments focus on managing symptoms through medication and dietary changes, pelvic floor physical therapy offers a promising alternative. By addressing dysfunction in the pelvic floor muscles, PFPT can improve symptoms and overall digestive health. Individuals with gastroparesis should consult with healthcare professionals to determine the best treatment plan for their condition, potentially incorporating PFPT as a complementary approach.

At Femina Physical Therapy, we specialize in treating pelvic floor and orthopedic diagnoses, including gastroparesis and abdominal phrenic dyssynergia. Our team of experts is dedicated to improving your quality of life through personalized treatment plans and advanced therapeutic techniques. Schedule an appointment with us today to start your journey toward better pelvic health and wellness!

References

1. Hernandez, M., & Mendez, J. (2020). The relationship between pelvic floor dysfunction and gastrointestinal disorders: A narrative review. International Urogynecology Journal, 31(1), 13-20. DOI: 10.1007/s00192-019-04030-9
2. Camilleri M. Gastroparesis: Etiology, clinical manifestations, and diagnosis. Mayo Clin Proc. 2003;78(6):665-672. doi:10.4065/78.6.665.
3. Damianos JA, Tomar SK, Azpiroz F, Barba E. Abdominophrenic Dyssynergia: A Narrative Review. Am J Gastroenterol. 2023;118(1):41-45. doi:10.14309/ajg.0000000000002044
4. Hasler WL. Gastroparesis—Current concepts and considerations. Clin Gastroenterol Hepatol. 2007;5(2):207-216. doi:10.1016/j.cgh.2006.12.004.
5. Gondek, K. Treating Bloating and Abdominal Distension: a Multi-Disciplinary Team. Feminapt.com. Published July 12, 2023. Accessed August 21, 2024. https://feminapt.com/blog/treating-bloating-and-abdominal-distension-a-multi-disciplinary-team
6. Femina Physical Therapy. Abdominal Phrenic Dyssynergia and how Pelvic Floor Therapy Can Help. Feminapt.com. Published February 1, 2020. Accessed August 21, 2024. https://feminapt.com/diagnoses/abdominal-phrenic-dyssynergia
7. Shah A, Dholakia S, McClave SA. Gastroparesis: A review, current challenges, and future directions. Am J Gastroenterol. 2020;115(5):709-722. doi:10.14309/ajg.0000000000000529.
8.  Parkman HP, Hasler WL, Barnett JL, et al. Functional Gastrointestinal Disorders: Diagnosis and Treatment. Am J Gastroenterol. 2020;115(1):1-15. doi:10.1038/ajg.2020.21.