Intrarectal Balloon Training: Can You Trust a Fart?
On road trips, my husband and I pass the time listening to music, true crime podcasts and of course, comedians. On our last road trip, we were listening to one who did a whole set on the idea that, “you can never trust a fart.” My husband thought this was hysterical; I thought he could benefit from intrarectal balloon training! If you are like my husband, he was very confused when I said that outloud. Naturally, he asked, what is intrarectal balloon training?
Intrarectal Balloon Training Explained
When Is Intrarectal Balloon Training Used?
A pelvic health physical therapist will use an intrarectal balloon, or an anal balloon, to retrain your rectum. Your rectum is designed to be able to differentiate between gas, liquid or hard stool. Your rectum can also be too sensitive or not sensitive enough. If it is too sensitive, you may have fecal urgency, or frequency and/or difficulty differentiating between gas and stool. If your rectum is not sensitive enough, you may have fecal incontinence or feel constipated and never get any type of sensation that you need to defecate. In an ideal world, we get the “urge” or sensation to defecate when there is enough stool to empty and it all comes out at once.
How Does Intrarectal Bloon Training Work?
When performing intrarectal balloon training, a trained pelvic PT will insert the anal balloon into the rectum via the anal canal. The balloon is then slowly filled with air or water and a protocol is applied for hyper or hypo sensation retraining. If you are a trained pelvic therapist, it is important to know the normal sensory values, so when performing the balloon test on the patient, you are able to interpret the results and respond accordingly. Here is an overview of the most updated numbers based on a study by Lee and Bharucha (2016) who reviewed 5 studies and formed this guide based on those:
Intrarectal Balloon Training & Normal Range
First Sensation
10-40mL
First Desire
40-90mL
Urgency to Defecate
60-150mL
Discomfort / Max Sensation
135-193mL
Intrarectal Balloon Training For Difficulty Pooping
Intrarectal balloon training can also be used for someone with a diagnosis of dyssynergic defecation or someone who has a hard time expelling stool. This balloon training can act as a biofeedback tool to improve someone’s awareness and ability to bear down when defecating. A trained pelvic PT will perform the same technique as mentioned above: inserting an anal balloon into the rectum via the anal canal and then slowly filling with gas or air. The pt will then be working towards their ability to bear down and expel the balloon.
I explained to my husband, this comedian would benefit from intrarectal balloon training in order to improve his rectal sensation so that he would know he could trust his fart. My husband stared at me; if he wasn’t already questioning his decision to marry me, he was when I proceeded to tell him how excited I was by anal balloons.
Resources & Care for Intrarectal Balloon Training
We have quite a bit of professional education coming up in February on this topic. On Thursday 2/9/2023, Jessica and I are presenting a continuing education webinar to other rehab providers on balloon training for bowel disorders. Then, at the end of February, we will be speaking at the APTA Combined Sections Meeting (CSM) on this topic. We are so excited to share and teach other pelvic PTs and OTs about this important and underutilized tool in our field.
Written By
Brooke David PT, DPT, PRPC
Southern Pelvic Health Is Here To Help
References:Lee, T. H., & Bharucha, A. E. (2016). How to perform and interpret a high-resolution anorectal manometry test. Journal of neurogastroenterology and motility, 22(1), 46.Rao, S. S., Coss-Adame, E., Yan, Y., Erdogan, A., Valestin, J., & Ayyala, D. N. (2021). Sensory adaptation training or escitalopram for IBS with constipation and rectal hypersensitivity: a randomized controlled trial. Clinical and translational gastroenterology, 12(7).Schey, R., Cromwell, J., & Rao, S. S. (2012). Medical and surgical management of pelvic floor disorders affecting defecation. Official journal of the American College of Gastroenterology| ACG, 107(11), 1624-1633.