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Constipation

Bowel movements are very individual and differ in frequency and quality of stool.  What is “normal” has a wide range.

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First, Let's Define "Constipation"

You may have constipation if you have at least two or more of the following (Rome II criteria)

  • Straining to eliminate stool more than 25% of the time

  • More than 25% of bowel movements produce hard, lumpy stool

  • Sensation of incomplete emptying in more than 25% of bowel movements

  • Sensation of blockage in more than 25% of bowel movements

  • Use your hands to help expel feces more than 25% of the time

  • Fewer than 3 bowel movements per week.

Causes of Constipation

  • Dietary factors: Not enough water intake and/or not enough fiber in your diet

  • Lack of physical activity

  • Certain medications and supplements

  • Out of balance gut bacteria;

  • Inability to relax the pelvic floor muscles, when needed,  to have a bowel movement

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WHY BOWEL MOVEMENTS BECOME DIFFICULT

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Bowel control relies on the muscles and nerves of the pelvic floor and anus to work  together. 

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First the puborectalis muscle has to “hold” the stool in the rectum (picture to the left). Once we get the signal that we are ready to poop, the puborectalis muscle has to “let go”  and to straighten out the pipe so the stool can flow out easily (picture to the right). 

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Constipation can happen when the puborectalis muscle does not relax to allow the feces to pass through easily.  That is why we may strain to “push” out feces.

How Can Physical Therapy Help?

Muscle retraining

​You will learn how to correctly use the muscles surrounding your anal opening in a coordinated manner; to hold when needed and more importantly to relax to allow the passage of stool.  We use gentle and  particular manual therapies to release muscle tension. 

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“Bowel” Massage

​Specific techniques for massage to “wake up a slow colon” and encourage the stool to move through your colon towards the rectum. 

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Exercise

​Specific breathing exercises to relax the pelvic floor muscles and allow the anal opening to widen during a bowel movement without straining.  Specific breathing techniques while you are having a bowel movement to minimize strain on your bottom

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Education and Resources

​Encourage creative and enjoyable exercise activity.  Advice on toileting habits, position on the toilet, what you eat and drink, what medications and/or supplements might be contributing to the problem.  Together we plan what changes you can make. 

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Small changes can have big results.

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