The Pelvic Floor and the GI System: An Interview with Susan Clinton

Did you know that diarrhea is hereditary?

It runs in your genes.


Pelvic Guru Course Manager, Heather Edwards, PT, had the pleasure of interviewing Susan Clinton about work with bowel management. Not only did we get some great poo jokes (all of us here at Pelvic Guru have elementary school-age kids), but we also learned some really great information about the relationship between the gastrointestinal system and the pelvic floor… as well as some alleviation of anxiety for working with rectal balloon catheters (an internal device that inflates to simulate how the rectum and pelvic floor work together to expel feces).

PG: Let’s start with the big one… the balloon catheter lab… this is a little intimidating for some. What is the importance of using balloon catheters and is the lab as awkward as it sounds? 

Susan: The balloon catheters are the only way to recreate the full sensory experience of the rectum filling up and then the process of passing a stool.  We do not have any other modality that does this from the inside out. It is also very helpful to use with dyscoordination of defecation (again it is a real-time experience) and neuromuscular re-education/coordination.

The lab is guided and surprisingly is not painful!  The size of the tube (and balloon deflated) is about ¼ the size of the index finger used in labs for digital palpation and treatment.  I teach with condoms on the balloons – I treat this way also – never any worry of anything left behind.

PG: Nothing left behind! Good to know!

In regards to bowels, what are the primary things that pelvic PTs and other health care providers are missing when it comes to bowel management?

Susan: There are two that come to mind.  

  1. PF strength is not the number one priority with fecal incontinence – a very strong pelvic floor muscle will NEVER stop the brown river from flowing through.  This is usually a strong sign of constipation (unless it is functional diarrhea) – and patients must learn to craft a better stool.
  2. The foundational pieces of GI health are critical – you can do biofeedback all day long – but if people are not handling their stress well – including good sleep, nutrition/fiber, exercise balance (including the time of day) and hormone balance – the system will not change.  The colon is very slow to change – requires consistency to get to the other side.

PG: Have you considered renaming your course “Stop the Brown River by Crafting a Better Stool”? Because I think you’ve got some golden phrases there!

What are some of the surprising tidbits that people are so excited to learn in your class?  

Susan: How the simplest foundational changes on a consistent basis can make such a large difference – even in the complex patients.

PG: Now for the question I’ve been dying to ask you: Do you have plenty of good poop jokes that you’ll share with us so that we can score points with our elementary school aged kids?

Did you know that diarrhea is hereditary?

It runs in your genes.

I ate four cans of alphabet soup yesterday.

Then I had probably the biggest vowel movement ever.

Have you seen the movie Diarrhea?

It leaked so they had to release it early.

Did you hear about the constipated accountant?

He couldn’t budget.

You never really appreciate what you’ve got until it’s gone.

Toilet paper is a good example.

PG: Those are amazing!! I will definitely score some points with my kids with those! What’s the coolest thing you’ve learned about the digestive system that you wish all pelvic PTs understood? 

Susan: The story behind what a leaky gut really is – and how a system can become sensitized to food/pressure.  Also – how constipation actually affects the hormone balance system as well.

PG: Cliffhangers! I can’t wait to get to this course! This sounds like stuff I really need to know. When you hear feedback from course participants, what are the things that they seem to be able to take back to the clinic and implement easily with confidence? 

Susan: Most of the participants all agree that the labs, as well as the case discussions, drive home the information in a meaningful and useful way to use on Monday morning.  The clinical reasoning around the use of the balloon catheter, movement, and the complex GI system – helps each participant in finding good entry points in dealing with the complexity of Bowel/GI health.

PG: Um… Don’t you mean “exit points”… sorry… bad one. I had a better one ready, but this was my #2… and OMG I can’t stop… Thank you for joining us, Susan! And thank you so very much for teaching this amazing course through Pelvic Guru Academy! We are so fortunate to have you on our team!

Want to learn more? Join Susan Clinton for one of her Pelvic Guru Academy Ultimate Bowel Courses! You can check the list for all of our courses HERE.

Susan C. Clinton PT, DScPT, OCS, WCS, COMT, FAAOMPT received her Physical Therapy degree from Southwestern Medical Center in Dallas, Texas and a Masters of Health Sciences at LSU Health Science Center in New Orleans, Louisiana. She completed her Doctor of Science degree at Andrews University in Berrien Springs, Michigan and graduated with her NAIOMT fellowship in orthopedic manual therapy in 2013. She was accepted as a Fellow by the American Academy of Orthopedic Manual Therapists in 2014 and serves as a clinical faculty and specialty course faculty for NAIOMT. As a Board Certified Clinical Specialist in Manual Therapy, Orthopedics and Women’s Health, she has been actively treating patients with pelvic floor, urinary, bowel, reproductive, oncology, persistent pain, sports injuries and post-surgical diagnoses. She currently practices in Sewickley, Pennsylvania and is the co-owner and founder of Embody Physiotherapy and Wellness, LLC. Susan is active in teaching and research as an adjunct instructor for the University of Pittsburgh and Chatham University. Additionally, she is an international instructor and presenter of post-professional education in women’s health and orthopedic manual therapy and a certified Total Control® Instructor. Her research activities include publications on chronic pelvic pain and clinical practice guidelines for the APTA Section on Women’s Health and Orthopedic Section. Susan is active with the American Physical Therapy Association, serving in governance as a local delegate and alternate delegate, and as the Chair of the Clinical Practice Guidelines steering committee for the Section on Women’s Health. She is the past secretary on the Section on Women’s Health Board of Directors and the former President of the Performing Arts Special Interest Group of the Orthopedic Section of the APTA. She has served as an item writer and case reviewer for the WCS board certification examination and is a member of the credentialing committee with ABPTRFE. Susan is proud to serve as an inaugural board member of the Women’s Global Health Imitative (GWHI) and she concurrently serves on the board for the Association of Pelvic Organ Prolapse Support (APOPS). Susan has received awards for outstanding research in pelvic girdle by AAOMPT and Outstanding Clinical Educator by Chatham University. She is the 2016 winner of the Elizabeth Noble Award from the Section on Women’s Health.

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