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Dealing with Anismus / Puborectalis Muscle Dysfunction
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Dealing with Anismus / Puborectalis Muscle Dysfunction

1) Stay hydrated.
My physical therapist told me to drink 1 ounce of water per day for every 2 pounds of body weight.  I think that’s a little bit much, but perhaps they say that because most people will not reach their goal.  1 ounce for every 3 lbs of body weight works for me.  Signs that you’re dehydrated include a white tongue and yellow urine.  You can’t judge your hydration by how often you urinate because you may be oversensitive and urinate frequently, even though you’re not getting enough fluids.  That’s what was happening to me for 2 years before I was diagnosed.

2) Eat right.
Eat plenty of fruits and vegetables.  Eat rice, bread, and dairy only in moderation because they can lead to constipation.  I avoid ingesting too much non-soluble fiber at one time because this tends to lead to firmer stools for me.  Whole grains are good for you, but you need to get the majority of your fiber from fruits and vegetables.  I particularly like to eat a banana every day for potassium.  I find dried fruit to be a convenient addition to my diet.  More importantly, Activia yoghurt every other day helps keep me regular.

3) Be gentle.
At home I wipe myself clean with moistened toilet paper, and only use dry toilet paper to dab myself dry.  On the go, I have found a product that I like called The Final Wipe.  I keep them in my desk at work, and put one in my wallet when I’m going out.  It closely resembles a wet-nap, so it’s not particularly embarrassing to be caught with when you are forced to empty your pockets.  After removing everything I can with moist toilet paper, I wet my fingers and massage my pelvic and rectal areas for a short while.  Then I dry the area and apply a small amount of chap stick.  I haven’t found any other product that soothes as well.  (It’s another product that isn’t embarrassing to have in your pockets.  Just don’t share it with anyone.)  I barely insert the stick at all, but most of the nerves are right at the end anyway.  Then I wash my hands really well in hot water with anti-bacterial soap.  

4) Rock! Don’t push!
There’s a good chance that you aren’t voiding everything when you defecate.  You might not be able to tell one way or the other.  I stand over the toilet and relax as much as I can and let gravity help things a long for a bit.  When things are just about to come out, I sit.  After I’m mostly empty, I lean on the sink to my left while still sitting on the toilet.  After 20 seconds or so, I lean to the wall on my right.  I go back and forth like that for a little while, and most times I’ll work something out.  Sometimes I’ll only work out some gas or nothing at all.  The important thing is that I void completely without pushing.

5) Stretch.
There are a lot of stretches that can help, and I have a routine that I do at least twice a day: after defecating and before I sleep.  These include hamstring stretches, hip rotator stretches, abdominal, and lower back stretches.  The most useful of these I perform just before defecating as well.  My physical therapist told me to do Kegel exercises, but never instructed me to do them while I was stretching, which I find to be very helpful.  It’s the only time that I feel what a good relaxation of the area is supposed to feel like.

6) Massage.
Every night before bed I spend a few minutes massaging my perineum, rectum, and tailbone.  I use a Conair Touch and Tone Massager.  I don’t like to use my hand because I like to be very passive and relaxed during the massage, but you probably could use your hand.  As a man, I can give myself an extremely short perineal massage after urinating, which usually helps evacuate a few extra drops.  I’m not sure how that would work for women.  I also use a Homedics shiatsu massager for my back sometimes.  

7) Relax.
Remove as much stress from your life as you can, and make time for relaxation.  I enjoy spending time with my wife in our hammock staring at the sky and talking.

8) Exercise.
Don’t do high impact exercises like running or strenuous activity such as weight training.  Don’t ride a bike unless you’re sure it’s not hurting you.  I find swimming and inline skating to be the most tolerable.  I haven’t purchased a rowing machine, but I expect that rowing would be another tolerable exercise.  Don’t push too hard, and don’t forget to stretch a lot after any exercise.

This discussion is related to Paradoxical Puborectalis/Anismus.
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