Nerves and muscles hold in our bowels until it is time to have a bowel movement. The pelvic floor muscles and the anal sphincters must relax. And simultaneously, the diaphragm and the abdominal muscles must generate pressure to push out stool and have a normal bowel movement. If this fails to happen, the result is constipation.  

The term “constipation” is commonly used. But what is the true definition? Constipation is defined as:

• infrequent bowel movements

• hard stool

• difficult to pass stool

• incomplete emptying of bowels, and/or

• straining to have a bowel movement. 

Constipation is divided into two types, functional (primary) and secondary. Functional refers to constipation caused by an impairment in the mechanics and structures that allow bowel movements, while secondary refers to constipation related to disease or medication.

Functional constipation, commonly treated with pelvic floor physical therapy, is divided into three subcategories: 

•  Normal Transit Constipation

  • A sense of difficulty evacuating stool from the body

  • is often associated with Irritable Bowel Syndrome-Constipation (IBS-C)

•  Slow Transit

  • impaired colonic motor activity

  • abdominal pain and distension

  • reduced urge to have a bowel movement

• Defecation Disorder

  • lack of coordination or non-relaxation of pelvic floor muscles (Puborectalis/Levator Ani/External Anal Sphincter)

  • poor sensory awareness of stool entering the rectum

  • abdominal wall and diaphragm dysfunction - not generating pressure to assist in expelling stool. 

  • can occur with transit constipation or slow transit constipation

Treatment for functional constipation varies due to an individual’s medical and personal history. Diet and liquid intake, psycho-social and behavioral habits must be addressed for proper and comprehensive treatment. Treatment for functional constipation may include breathing training for bowel movements, toileting postures, anal balloon manometry, core and pelvic floor strengthening exercises, visceral and abdominal massage, as well as pelvic floor relaxation techniques, e.g., biofeedback, visualization, anal dilators and myofascial work. 

Pelvic floor physical therapy is an effective, holistic approach for treating constipation. After a few physical therapy sessions, habit-retraining and neuromuscular assessment, patients will be able to continue treatment on their own.

There are products on the market that can be used for treating constipation. Some of our favorite products are: 

Squatty Potty - this provides a simple way for you to open your pelvic floor muscles to allow stool to pass through easier

• Magnesium - can help create a smooth muscle contraction, to move the stool through the colon more quickly.

• Biofeedback - By placing sensors, either internal or external, you can see how best to relax your pelvic floor when having a bowel movement. 

If you are suffering from constipation, speak with your physician about treatment options. Pelvic floor PT can be very effective. Contact us with questions, at info@solsticept.com.

References: Freedman, Marilyn (2019). Functional constipation: A conservative first line approach. Pelviperineology 2019; 38: 130-133. http://www.pelviperineology.org - http://dx.doi.org/10.34057/PPj.2019.38.04.008