Pelvic Floor Physiotherapy for Managing Constipation

As a pelvic floor physical therapist, I take great interest in the details associated with a person’s experience with constipation.  Rest assured, no amount of information is “TMI” or too much information when it comes to this job.  

What does “being constipated” mean to you?

Do you feel you are not emptying your bowels often enough?  

Do you feel that the process of emptying your bowels is effortful and strenuous?  

Do you experience frequent abdominal discomfort and bloating?  

Does your stool look like rabbit pebbles as opposed to a smooth, formed banana? 

Constipation management strategies are wide ranging including discussions around diet choices, hydration/fluid goals, exercise and movement to support/enhance gut motility, and an awareness of possible constipation inducing medications.  This blog mainly focuses on the potential effect that the pelvic floor muscles may have in contributing to constipation.  

Sometimes the consistency of one’s stool can look “ideal” in that it takes on a smooth and soft appearance similar to a sausage or banana shape.  In that case, one may assume that a person is not constipated.  However, an important follow up question includes, do you have to strain or push to empty your bowels despite the consistency of your stool?  If you do, then you may be experiencing dyssynergic defecation or obstructed defecation.  Optimal bowel emptying habits rely not only on the ideal stool consistency but on the coordinated relaxation of the pelvic floor muscles during defecation.  Some of my clients have a perfect stool consistency, but the effort and straining to empty their bowels remains.  This leads one to question – what is happening or better yet, not happening in the pelvic floor muscles during defecation?  

The pelvic floor muscles are responsible for the job of retaining or expelling stool from the body.  They must coordinate full relaxation in order to facilitate expulsion of stool through the anal opening.  Soft and formed stools help support the ease with which stool is evacuated from the anus.  However, some people adopt unconscious strategies in which the pelvic floor contracts or tenses during a bowel movement, thus creating a situation called obstructive defecation or dyssynergia.  In essence, the pelvic floor muscles are not coordinating properly during defecation to allow stool to pass smoothly and without resistance.  It is similar to trying to push toothpaste through a narrowing funnel.  This situation can result in sensations of incomplete evacuation, painful bowel movements, a rectocele (laxity in the posterior vaginal wall), anal fissures or hemorrhoids.  

Pelvic physiotherapy is an excellent strategy for determining whether or not one’s difficulties with evacuation are a result of dyssynergic defecation.  We work extensively with clients to assess and identify if the pelvic floor muscles are, in fact, not coordinating properly to support optimal bowel emptying strategies.  

Some tips to help support the proper coordination of your pelvic floor muscles during a bowel movement include the following:

Empty your bowels in a semi squat position 

Using an elevated support for your feet significantly helps support pelvic floor relaxation of the puborectalis muscle.  The puborectalis is a sling-like muscle that maintains tension around the rectum to prevent stool from constantly leaking out of our bodies.  When assuming a semi squat position, this encourages relaxation or “slackening” the puborectalis, automatically reducing the effort required for evacuation.

photo source

Breathe! 

When sitting on the toilet to empty your bowels, focus on being very present in the moment.  Invite your whole body to relax.  Scan from the top of your head down to your toes for tension.  Relax your jaw and soften your lower abdomen as you breathe deeply into your lower belly.  Feel your lower belly gently rising on inhale and slightly tensioning (NOT SUCKING IN) throughout your exhale.  Continue to breathe in and out slowly and deeply focusing on the rhythmic aspect of your breath cycle.  Avoid breath holding or bearing down to empty your bowels.    

-Leeanna Maher, Pelvic Floor Physiotherapist

Click here to book an appointment with Leeanna!

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