Rectal balloon training a needed tool for coccyx mobilization
Move is necessary to help SMA patient with comfort while sitting in wheelchair
Coccyx, or tailbone, mobilization, internal and external, has been a helpful treatment for one of my patients, reducing tailbone pain. For Michael, who has spinal muscular atrophy, treatments change as his body and other therapies evolve and as his disease progresses.
Recently, we scheduled an internal coccyx mobilization to reduce pain he has been having in his tailbone and right hip after his move to a new wheelchair. We’ve done an internal coccyx mobilization in the past and afterward seen significant reduction in pain for weeks. This time, Michael was unable to tolerate the rectal internal examination due to significant tightness and spasms in the internal anal sphincter.
While pelvic floor physical therapy is usually thought to be for women, we often forget men have pelvic floors and can benefit from specific pelvic floor treatment. Sometimes techniques can be used for different reasons than initially intended to benefit patients in a different way.
For example, rectal balloon training is designed to assist patients with difficulty emptying or holding bowels. It is performed by using a small tube with a balloon attached on the end. The tube and balloon are passed through the rectal opening into the rectum with a pump attached externally. Once this is in position, the balloon is inflated and deflated and different measurements are taken when the patient feels an urge to have a bowel movement or when no urge is felt at all. From there, we can perform different treatments and techniques to assist.
With Michael being unable to tolerate digital rectal coccyx mobilizations currently, a balloon may be more tolerable since, deflated, it is smaller in diameter than a finger. Once the balloon is in the rectum, it can be inflated, putting pressure on the coccyx without a finger being inserted into the rectal canal. Inflating the balloon slightly can assist in mobilizing the coccyx bone and reducing pain Michael feels when he sits. Using the balloon, more constant pressure can be put onto the coccyx and allow for a longer stretch hold.
Michael has had a colostomy for several years now which means he doesn’t have bowel movements through his rectum; his bowels are emptied into a colostomy bag on his stomach. Given this, it will be interesting to see what the balloon inflating feels like to him since, usually when the balloon is used, the person has a feeling of fullness which equates to the need to have a bowel movement. This is a natural stretch reflex that happens in the rectal canal to alert the person that they need to make it to a toilet soon. Since there has been no stretch reflex in Michael’s rectal canal for years, this may be an odd feeling, but should help to get a stretch in the area and assist in coccyx movement.
If this activity is tolerable and able to be done, we will reassess for any changes that may take place and change our treatment plan accordingly. This may be an activity we do every few months or we may only do it only one time; this will depend on Michael and if he has any reduction in pain afterwards.
Patient perspective
Over the past few years, Emily has been working to reposition my tailbone in hopes it will allow me to sit more comfortably throughout the day. Usually, my tailbone can be repositioned without too many issues, but there have been times it’s more of a struggle to properly align everything the way it should be.
One of the many problems that SMA patients may encounter as they get older is the tightening of their sphincter. While it’s not necessarily a topic that you would bring up in general conversation, it is definitely a topic of concern if you sit for the majority of your day.
This new balloon technique Emily plans to try should help not only stretch the sphincter muscle, it might even provide some comfort while sitting in my wheelchair. I trust Emily with my life and am never shy about trying something new because I know that she has my best interest at heart. I’m not embarrassed to talk to Emily about any topic regarding my health, and it’s important for physical therapists to remember that type of candor is necessary. I’m fortunate Emily is certified in pelvic floor therapy, and I count my blessings knowing I’ve got great people working with me.
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