Beyond Biofeedback: Expanding Perspectives on Pelvic Floor Physical Therapy for Evacuation Disorders

Pelvic floor physical therapy (PFPT) is recommended for conditions including constipation and fecal incontinence. There is limited evidence exploring characteristics of physical therapy practices, attitudes toward treating evacuation disorders, and potential barriers to care that may influence treatment outcomes. Therefore, a better understanding of these aspects of PFPT is needed. The purpose of this study was to survey PFPT practices, using the Chicagoland area as a microcosm. We aimed to explore practice characteristics, available treatment modalities, and attitudes toward treatment of evacuation disorders.

We conducted a cross-sectional phone and email-based survey of pelvic floor physical therapists across 17 counties in the Chicagoland area. Of 149 eligible contacts, there were 48 respondents representing 58 total PFPT practices. Mixed methods were used to aggregate data quantitatively and perform mapping analysis and thematic analysis.

There were geographic disparities in PFPT provider density. Most practices served all gender identities but consisted primarily of female therapists. Levels of PFPT-specific training and certification varied. Respondents felt that education on lifestyle, including diet, was an important therapeutic goal. Biofeedback in a variety of forms was used by most respondents (81%); some suggested that biofeedback was not as effective for chronic constipation as other therapies. Themes of potential barriers to satisfactory outcomes included delayed and vague referrals from other clinicians, as well as patient misinformation and inappropriate expectations.

This study provides preliminary insights to guide further work on improving access to PFPT and improving treatment outcomes for bowel symptoms. To strengthen collaboration, we suggest that referring clinicians actively communicate and develop networks with local PFPT offices, and offer earlier, more detailed PFPT referrals to patients.