Understanding the Ties Between Bowel, Bladder, and Sexual Function

What is the Tie Between Bowel, Bladder, and Sexual Function?

Let’s talk more specifically about how bowel, bladder, and sexual function are interconnected. One reason these areas are tied together includes the physical location of our bladder and rectum. These structures lie in front of one another with the bladder located closer to the front of our bodies relative to the rectum. For those with female anatomy, there may be another organ present that lies in between the bladder and rectum, called the uterus. These structures are a part of our urinary, rectal, and sexual function systems and lie inside of our pelvic cavity. Issues with mobility of one structure may impact function of another organ due to closeness of proximity.

To show how there is interplay between these areas, consider this: a full rectum applying pressure towards the bladder. The rectum may be full due to constipation. As the bladder starts to fill, the rectum would be applying pressure towards the bladder. This may impact your sensation and feelings of needing to urinate or it may cause feelings of pressure or discomfort which you may sense. To help you further picture and understand this interplay, imagine two balloons in a basket. Balloon A is our bladder and lies in front of balloon B, our rectum. Both fit inside of the basket which is our pelvis. Let’s say balloon B is extra full of air, almost 2x the size of balloon A. This represents the fullness of the rectum and its pressure towards the bladder. If balloon A starts to fill with more air, it will experience pressure from balloon B. This represents the excess pressure the bladder may feel from the rectum. On top of this, consider the basket, the basket is experiencing lots of pressure now from balloon B and balloon A; this may lead to excess pressure in the abdomino-pelvic system. If our system is feeling excess pressure this may lead to pain or the urge to want to urinate prior to the bladder being able to fully fill.

Understanding Fascial Connections

We have only considered proximity of the organs leading to connected symptoms and interplay of organs but there’s more to consider. Let’s talk about a system of tissue called our fascia. Fascia is a spider web-like connection of tissue that envelops our bodies. There are many layers of fascia that lie underneath our skin and also lie at the layers of our organs. This deeper fascia around the organs is called visceral fascia and helps suspend the organs within their cavities in our bodies. If the fascia is restricted or doesn’t move well from tightness in certain areas, this can impact the mobility of the tissues and organs that lie below or connected to it. Sometimes fascial restriction in one area can impact an area that may physically lie distant from it. This is because of the connective nature of fascia.

Let’s consider this analogy to better understand fascial connections: use a spiderweb and pretend that it is our fascial network which envelops the structures in our bodies. If you pinch part of this web, the entire web pattern will change. The web pattern around the pinched region will become smaller and more narrow in size and the rest of the web will become distorted moving in the direction of the pinched area. The impact of one small change in the system affecting the wider network of the web represents our fascial system changes. If an area in our fascial network becomes shortened or narrow, this may impact other areas of the network which may lie distant from the directly impacted area. If the fascia surrounding our bladder becomes restricted in any direction or narrowed, this may lead to changes of pressure surrounding other organs such as our rectum, uterus, or intestines. This alteration can lead to changes in mobility of the organs and may impact their functionality.

Some examples of symptoms one may experience from fascial changes at the organ level include changes of pressure sensations of the bladder and rectum, and altered movement at the intestines. In specific to the bladder, one may experience pain or pressure from visceral restrictions around the bladder leading to symptoms of frequent urination, bladder pain, or bladder pressure. One specific diagnosis that can be addressed in pelvic floor physical therapy is bladder pain syndrome. For a patient with this diagnosis I would be likely to assess the bladder mobility – seeing how well the tissue that envelopes the upper portion of the bladder moves to either side and rotates. As for rectal symptoms, restrictions at the rectum may lead to symptoms of pain or pressure in the area. Lastly, at the level of the intestines, if there is fascial restriction here, this may contribute to symptoms of slowed motility, abdominal pain, and/or abdominal pressure. The idea here is that if the fascia is enveloping the intestines too tightly and is restricting it, the colon may not be able to function optimally. Our colon performs a movement called peristalsis, which is a series of contraction and relaxation. With visceral fascial restriction, this may lead to smaller movement and slowed movement to occur as the muscular layers of the colon may be put into a shortened portion making it more difficult for these patterns of movement to occur.

After reading about fascia, you may be wondering how is this assessed? If you choose to see a pelvic floor physical therapist, you may find that the therapist examines your abdominal tissue at some point during your visit. This type of exam involves the therapist using their hands to manually assess the tissue quality in the abdominal region to see how the fascial network moves. During this exam, the therapist usually starts with a more general exam to screen the four quadrants in the abdomen and then becomes more specific by applying more targeted pressure to smaller areas within the abdominal cavity. The pressure may also increase as the therapist starts to assess the movement of the fascia surrounding the organs. Reading this you may be wondering to yourself – is it really possible for my therapist to feel organs within my belly? This is a completely reasonable thought and question. The answer is yes! With many hours and years of training, in manual therapy based courses, a therapist can learn to listen to and feel for these delicate small structures under the many layers of fascia we have in our bodies.

Personally, during my journey as a pelvic floor physical therapist, I was trained in clinic at Beyond Basics to learn about viscera and visceral mobilization. Being a newer therapist at the time, and just learning more within the world of manual therapy, I felt that my hands were not sensitive enough to feel at the time. For me, it wasn’t until I committed to taking a multi-day course through a manual therapy based practice model, that I gained confidence in and learned how to truly palpate, listen to, and start to create change at the fascial level. If you are seeking care within this space, it’s important to ensure your provider is confident in and has experienced and trained hands to treat you with quality care.

Scar Tissue and Organ Function

Another connective tissue that may impact the interplay of our organs is scar tissue. Scar tissue may develop after surgery, injury or trauma to existing tissue in the body. When this occurs, new tissue, scar tissue, will be formed and could become restrictive in nature. Scar tissue can be taut, thickened and make underlying movement within the abdominal organs limited. For example, for an individual who undergoes a hysterectomy, or removal of the uterus, the scar tissue post surgery may contribute to feelings of tightness or pressure within the lower abdominal region. The physical nature of this newly formed tissue can also alter sensation within the abdomen and functionality of the surrounding organs by creating different pressures on the structures or altered pull or push to organs depending on where it grows and how it spreads.

Conditions Affecting Both Bowel and Bladder

Now that we have discussed some of the factors that contribute to the links between our organ systems, let’s discuss some conditions that affect both bowel and bladder. Constipation – when you hear of constipation, you likely think about bowels. However, consider this: provided the location of our bladder, sitting anterior to or relatively forward to the rectum, when there is a case of constipation or an instance of inability or incomplete bowel emptying, this could affect our urinary systems. The bowel pressure in the rectum is taking up space in the lower abdominal region and this occupied space can now impact a filling bladder. The sensation of fullness from the rectum can make an individual feel premature fullness of the bladder and lead to symptoms of frequent urine emptying. It can also lead to pressure and discomfort in the lower abdominal region that may be sensed as bladder pain or pressure. Furthermore, with a full rectum, one may also sense discomfort, pain or difficulty with penetrative intercourse or use of a tampon.

Provided the relationship of bowel and bladder issues, if you are seeing your pelvic health therapist for bladder issues it could be good to consider how your bowel health may be contributing to your symptoms. Besides your provider scanning the abdominal region for organ mobility, they may also speak to you about an external and internal pelvic floor exam. These exams are intended to assess the pelvic floor musculature from the outside and inside of the pelvis. This exam allows for understanding the muscular movement of the different layers of pelvic muscles. Think about the vaginal and rectal regions as being different halves of the inside of a basket. Sometimes restriction or tightness in one of the halves may be leading to dysfunctional movement or pressure in the other half. Your provider will be able to work with you during your history and intake at the first visit to figure out the root of your dysfunction and help lead the treatment accordingly. However, if you have been attending pelvic floor physical therapy and did not realize the connection of the systems until right this second, it is worth mentioning your symptoms or thoughts to your provider. From personal experience in clinic, sometimes despite a tried thorough intake, information can be missed or looked past – this may be due to time limitations during the session, fixed mindset from a patient going into physical therapy looking to treat something very specific, or premature narrowed thinking from the therapist. Your experience in physical therapy should be dynamic and evolving and the more information you are able to provide, the better. Work together with your provider to discuss a possible link that may have been overlooked. It is easy to take steps to assess and change treatment once something is recognized.