how can pelvic floor physical therapy help with my constipation?
Are you struggling with feeling like you are straining or not emptying completely when pooping?
Constipation is considered to be a problem with the passage of stool and is characterized by:
Having less than three bowel movements per week
Stools that are hard, dry, or lumpy
Bowel movements that are difficult or painful to pass
Feeling as though you have not emptied completely or still have more stool in your rectum but are unable to get everything out
Needing to use a finger on the tissue on the outside or inside to help get everything out (manual disimpaction)
Straining or pushing to try to empty completely when pooping
A deviation from what is considered “normal” for you and your bowel regularity
Constipation can feel incredibly distressing and isolating and is, unfortunately, very common. Around 16% of adults struggle with constipation while 33% of adults who are 60 years old and older deal with constipation. It is something that can be long-lasting for months or years, or can be more short term lasting for days or weeks.
We know that pregnancy, different medical conditions (like spinal cord injuries and medical conditions affecting your hormones and metabolism), and certain things we do throughout the day can impact bowel regularity and consistency and increase the chances of constipation occurring including:
A decrease in daily water intake (or not getting the recommended daily amount of water)
Not consuming enough fiber during the day (may it be through the foods we eat or fiber supplements)
Decreased daily participation in physical activity or exercise
Intake of certain medications, such as opioids, diuretics, antacids, and antidepressants
Ignoring the urge to poop
Traveling
In addition to various ongoing medical conditions or modifiable lifestyle factors that we have control of and can change that could be causing or contributing to constipation, pelvic floor muscle dysfunction can also be a major cause of constipation. The pelvic floor muscles compose the tissue surrounding the anal opening, called the “external” and “internal anal sphincters,” as well as a deeper pelvic floor muscle that serves as a natural sling around the rectum, called the “puborectalis,”which help to control the passage of stool and prevent leaking of stool or gas when we don’t want to go to the bathroom to have a bowel movement (or sneak a lil gas out when we feel like it).
But what about what happens when the pelvic floor muscles aren’t coordinating properly? Or if there is tension or pain present in the same muscles that help to allow poop to pass and also keep it back? This can be a HUGE component for folks with constipation or bowel dysfunction if the same muscles that we need to lengthen and release around the anal opening to allow poop to come out instead contract and tense up and won’t allow our stool to be expelled.
That’s where working with a skilled pelvic floor physical therapist comes in.
As a Board-Certified Women’s Health and Pelvic Floor Physical Therapist, I love working with clients with constipation or bowel/outlet dysfunction. Bowel dysfunction is honestly sooo complicated and multifactorial and it’s never a one size fits all or cookie cutter approach since we all are different. I really love spending time taking a thorough medical history intake with my clients because they frequently tell me exactly what is going on when I take the time to listen to them.
Even though constipation can be incredibly complicated to treat, it is definitely something that I see improves when working with a pelvic floor physical therapist who has the expertise to work with this client population. I have a pediatric pelvic floor client that I have been working with recently in the clinic for leaking of urine while sleeping at night and come to find out there has been underlying constipation that we now believe is triggering a lot of the ongoing symptoms. So by addressing the ongoing constipation we are seeing not only improvements in bowel movements and frequency, but also a huge decrease in the nighttime leaking of urine. Its a win-win.
Pelvic floor muscle wrapping around the anal opening (external anal sphincter)
Pelvic floor muscle that serves as a natural "sling" around the retum (puborectalis).
Alternate image showing the external anal sphincter in folks with external genitals or a penis (since everyone has a pelvic floor and can have pelvic floor dysfunction including constipation).
If you’re struggling with constipation, incomplete emptying, or straining during bowel movements, here are a few recommendations from your pelvic floor physical therapy bestie:
Make sure you’re getting the recommended daily intake of water and fiber.
For most folks, the general recommendation of drinking 48-64 ounces of water isn’t quite enough when we think about recommendations for daily levels of physical activity and movement. In general, I usually recommend for clients to be getting an equivalent to around 50% of their body weight in ounces of water that they are drinking during the day, especially for folks that are not consuming a large amount of fruits and vegetables which naturally have a high level of water in them.
Recommended daily fiber intake for most adults is between 25-30 grams of fiber per day. Most clients and Americans are nowhere NEAR this recommendation for fiber. And I almost always recommend to increase fiber intake gradually (so you don’t get super bloated or more backed up) and through your diet before you try to incorporate fiber supplements. What does this look like realistically?
-1 apple with the skin left on=4.5 grams of fiber
-1 cup of oatmeal with 1 banana and 1/4 cup walnuts=9 grams of fiber
-1 cup brown rice=3.5 grams of fiber
-1/2 cup cooked black beans=7.5 grams of fiber
-1 cup sweet potato=6.3 grams of fiber
When you break it down like I did above into real life foods, it becomes a little less overwhelming and seems WAY more realistic when you’re able to see how little of something you actually have to eat to get a large amount of fiber in your food.
Make sure that you always ALWAYS keep up with your water intake when gradually increasing your fiber intake, because an increase in fiber with a decrease in your water consumption has the potential to make you more constipated.
Don’t strain when pooping (even when you really want to).
When you strain or bear down with a lot of force when trying to have a bowel movement, this actually causes an involuntary contraction of your pelvic floor muscles causing the muscles at the anal opening to squeeze shut more tightly. So you are essentially working against yourself when you strain while trying to poop. Instead, you want to gently push your belly out and keep it pushed out as you gently blow out through your mouth (as though you are trying to blow out birthday candles). This will help the muscles of the pelvic floor to stay lengthened and released while helping to generate an appropriate level of intra-abdominal pressure to allow the poop to be evacuated through the anal opening.
Try taking a magnesium supplement.
One of my favorite things to recommend to clients that are struggling with constipation is Calm, which is a form of magnesium citrate. Magnesium citrate helps to increase the amount of water absorbed by the intestines which helps to soften stool making it easier to pass. It also stimulates movement of the smooth muscles of the intestines causing stool to move.
As always, check with your physician to make sure that this recommendation is safe and appropriate for you.
See a pelvic floor therapist if you’re struggling.
Struggling with constipation and have you tried literally everything under the sun and it’s not working? I would absolutely recommend working with a pelvic floor physical therapist to get a pelvic floor assessment completed to see if there is ongoing tension or issues with muscle coordination that may be contributing to or even causing your constipation. That way we can address it so that you can poop better and get back to living your life.
Have questions or feeling on the fence about whether or not pelvic floor physical therapy is for you? If you’re looking for treatment for constipation, bowel dysfunction, or are struggling with pelvic floor issues causing constipation and you’re located in Durham, North Carolina I would love to work with you! Reach out to me here to tell me a little more about what is going on so we can chat more and get the process started. Live outside of the state of North Carolina? I also offer virtual appointment options to provide more accessible care to those seeking out pelvic floor treatment for constipation and bowel issues.
Dr. Brook Orvis is a Board-Certified Women’s Health and Pelvic Floor Physical Therapist, Duke Residency-Trained in Women’s Health, and the owner of Flora Physical Therapy. As a momma to a spirited toddler, she understands the difficulty of being a parent while prioritizing self-care, including caring for your body and pelvic floor. She believes that pelvic floor therapy is for everyone and is passionate about providing accessible treatment options for birthing people, men, women, kids, and the LGBTQIA+ community so that they can take better care of themselves and receive equitable care. She loves educating and empowering clients to take charge of their body and health and to not accept leaking of urine, prolapse, pelvic pain, pain during sex, and core weakness as a normal part of being a human.
Thinking that you may benefit from pelvic floor physical therapy treatment? Or know someone else struggling with constipation that you think may need care? Reach out here to schedule a pelvic floor physical therapy appointment with me today. At Flora Physical Therapy I am passionate about providing 1:1 accessible treatment options including in-home, in-clinic, and virtual appointment options to help meet you where you are.
