By Dr. Katie Spruell, PT, DPT, CSCS, PCES | Amplify Physio | Maryville, TN
You’re in the middle of a meeting. You’re out running errands. You’re on a long drive with nowhere to stop. And suddenly – the urge hits. Not the kind you can push aside. The kind that has you scanning for the nearest restroom, quietly excusing yourself mid-sentence, or planning your entire day around where the bathrooms are.
Or maybe it’s the opposite: you’re straining, pushing, and nothing happens – or it feels like you can never fully empty, no matter how long you wait.
Whatever it looks like for you, bowel dysfunction is something millions of people quietly live with – and quietly accept as their new normal.
It doesn’t have to be.
What’s Actually Happening
Your pelvic floor is a group of muscles at the base of your pelvis – and it plays a central role in bowel function. It works in coordination with your anal sphincter, your rectum, and your abdominal and breathing muscles to manage when and how you have a bowel movement.
There are two main patterns of bowel dysfunction, and they can look very different:
Bowel (fecal) incontinence — leaking stool or gas before you can get to the bathroom, or not feeling the urge until it’s almost too late. This happens when the pelvic floor and sphincter muscles can’t generate enough pressure and coordination to hold contents in against urgency or physical demand.
Constipation and difficulty emptying — straining, hard stools, a sense of incomplete evacuation, or feeling like you have to push against resistance. This is often driven by pelvic floor muscles that are too tight, poorly coordinated, or failing to properly relax at the right time – making it physically difficult for stool to pass.
Both are real, both are common, and both have a cause – which means both can be treated.
This Isn’t Something You Just Have to Live With
One of the most common things I hear from patients is some version of: “I’ve just accepted this is my life now.” They’ve mentioned it to a doctor, been told it’s normal, and quietly stopped expecting it to change.
Bowel dysfunction is common, but common does not mean unfixable. Fecal incontinence affects roughly 1 in 3 patients presenting to primary care — and is significantly underreported because people are too embarrassed to bring it up. Constipation affects an estimated 16% of adults, rising to over 33% in adults over 60. Most of them have never been told that pelvic floor physical therapy could help.
Bowel dysfunction can stem from:
- Pregnancy, labor, and delivery – even without an obvious injury
- Colorectal or pelvic surgery, including colon resection, ostomy reversal, or procedures for cancer
- Radiation therapy to the pelvis
- Chronic straining or long-term laxative use
- Pelvic floor muscle tightness or poor coordination (dyssynergia)
- Neurological changes or connective tissue disorders
- No identifiable cause at all – but symptoms that are very real
If you’ve been avoiding the topic because you think your situation is too complicated, too embarrassing, or too far past the point of help – please don’t. Your experience is real, it has a cause, and it has a solution!
“Just Eat More Fiber” Isn’t Always the Answer
When patients mention bowel issues to their doctor, the most common responses are eat more fiber, drink more water, and try a laxative. And while those things can help in certain cases, they’re far from the full picture – and for some patients, they can actually make things worse.
Here’s why: many cases of constipation and difficult evacuation aren’t caused by what you’re eating. They’re caused by a pelvic floor that isn’t relaxing and coordinating properly during defecation. When the muscles that are supposed to release are instead contracting – a pattern called dyssynergia – pushing harder or adding bulk doesn’t solve anything. It can actually increase straining and worsen symptoms over time.
And for bowel incontinence, the problem isn’t just sphincter weakness. Timing, sensation, rectal capacity, and the coordination between multiple muscle groups all play a role. Strengthening alone – without addressing the full picture – often misses the point.
This is exactly why a thorough pelvic floor assessment matters. What’s driving your symptoms? Is it a strength deficit? Poor coordination? A muscle that can’t relax? Post-surgical changes to how your bowel functions? The answer determines the treatment -and there is no one-size-fits-all protocol.
Curious whether pelvic floor PT could help you? Book a free 15-minute discovery call — no referral needed, no commitment, just a conversation.
Why This Work Is Personal
Several years ago, my mother was diagnosed with stage 3 colorectal cancer. What followed was one of the hardest seasons our family has walked through together — radiation, surgery that removed part of the colon, an ileostomy, chemotherapy, then an ostomy reversal. She fought hard, and she came out the other side.
But surviving cancer didn’t mean returning to normal. After everything her body had been through and after beating cancer, she was left with significant bowel dysfunction. Oftentimes, it impacted her ability to go out in public and there were many times she wasn’t able to go to the park with her grandkids.
We tried everything. She saw a pelvic floor PT here in Maryville. Then one in Knoxville. Progress was limited. And I watched her continue to struggle with something that I believed – deeply – didn’t have to be permanent.
That’s when I made a decision I hadn’t originally planned on: I pursued advanced Herman & Wallace training to perform internal pelvic floor examinations, specifically so I could help her. Pelvic health hadn’t been part of my original path in physical therapy. But need has a way of redirecting you.
After just a few sessions using a more comprehensive, individualized approach – combining internal pelvic floor assessment with my orthopedic background – her symptoms improved significantly. The change was meaningful enough that I knew I couldn’t stop there.
I have been pursuing pelvic health ever since. Because if my mother’s experience is any indication, there are a lot of people out there who have been told – directly or indirectly – that this is just their life now. I don’t believe that. And I want to do something about it.
Quick update on my mom: She is strength training and living her best life! She’s able to do things she struggled with even before her cancer diagnosis and feels stronger than ever. She’s able to take care of her grandchildren (a true dream of hers) and her life continues to get bigger – we’ve discussed that there are no limits on what she can achieve! As her daughter, it brings me so much joy to see her gain her life back. I’m so grateful that my kids get to grow up knowing her as the “outside Grandma” who loves the outdoors and playing. I will never take these days for granted!
The Real Fix: Meeting Your Body Where It Is
Treatment for bowel dysfunction is always individualized, but here’s the general framework we work within:
For constipation and difficult evacuation: we focus on learning how to properly coordinate the muscles involved in defecation – relaxing the pelvic floor and external sphincter while gently bearing down with the correct mechanics. We address positioning (a small footstool can make a significant difference), breathing patterns, and the physical habits that may be contributing to straining. Where appropriate, we layer in soft tissue work and mobility.
For fecal incontinence: we address strength, sphincter coordination, rectal sensation, and urgency retraining. We work on building the pelvic floor’s capacity to respond to demand – while also teaching strategies for managing urgency in daily life so you can function without constant anxiety about access to a restroom.
For post-surgical bowel changes: we take into account everything the body has been through – radiation effects, surgical anatomy changes, altered sensation, and the neuromuscular adaptations that happen after significant bowel surgery. Recovery is possible, but it requires a provider who understands the full picture.
The same principle applies across all of these presentations: meet your body where it is, build from there, and progress with intention. The goal is always function – not just symptom management.
When to Stop Waiting and Ask for Help
Bowel dysfunction is common – but it is not normal, and it is not something you should have to simply accept or push through. Continuing without addressing the underlying cause can reinforce poor patterns and make things harder to treat over time.
Signs it’s time to see a pelvic floor PT:
- You’re leaking stool or gas before reaching the bathroom
- You feel constant urgency or have to rush to the restroom with little warning
- You’re regularly straining, pushing for extended periods, or feeling incomplete after a bowel movement
- Your bowel habits changed significantly after surgery, radiation, or childbirth – and haven’t returned to normal
- You’ve tried fiber, hydration, and laxatives and nothing has helped long term
- You’ve started limiting what you eat, where you go, or what you do because of bowel symptoms
No matter how long you’ve been dealing with this – weeks, months, years, or decades – there is always hope. It’s never too late to start!
Pelvic Floor Physical Therapy in Maryville, TN and Surrounding Areas
If you’re dealing with bowel dysfunction and you’re in Maryville, Alcoa, Louisville, Knoxville, or anywhere in Blount County, we can help. At Amplify Physio, we do a thorough evaluation to understand exactly what’s driving your symptoms — and we build a plan that gets you back to living your life without planning every outing around bathroom access.
You deserve to feel confident in your own body again.
Schedule Your Free Discovery Call →
Prefer to talk first? Call or text us at 865-233-3533.
Dr. Katie Spruell is a Doctor of Physical Therapy, Certified Strength and Conditioning Specialist, and Pelvic Health specialist serving Maryville, Alcoa, Louisville, Knoxville, and Blount County, TN. To schedule an appointment at Amplify Physio, call 865-233-3533.