What is a Healthy Bowel Movement?

Healthy bowel movements depend on two primary factors:

• gut motility — how efficiently stool moves through the digestive system, and
• pelvic floor coordination —pelvic floor muscle relaxation at the right time to allow stool to pass through the rectum and anus.

If motility is slow, stool may become hard and difficult to pass. If pelvic floor muscles are overactive or tense, even normally formed stool can be challenging to evacuate. Both systems must work together for effective bowel function. They must relax appropriately to allow complete bowel emptying. When a person strains because stool is difficult to pass – the pelvic floor muscles often respond by tightening or spasming, which further interferes with evacuation, making symptoms worse.

Conditions such as constipation, irritable bowel syndrome (IBS), small intestine bacterial overgrowth (SIBO), and small intestinal fungal overgrowth (SIFO) all involve bowel dysfunction—and each can directly affect the pelvic floor muscles. The pelvic floor muscles form a supportive sling around the rectum and anus.

Constipation and the Pelvic Floor
Constipation is not simply a result of “not enough fiber.” It commonly involves slowed gut motility, difficulty coordinating pelvic floor muscles, or a combination of both. Irregular eating patterns, dehydration, stress, medications, and dietary factors can also contribute.

When stool moves too slowly through the colon, excess water is absorbed, making it hard and difficult to pass. Chronic straining in response to this can increase pelvic floor muscle tension that may prevent complete emptying. Over time, this may lead to symptoms such as incomplete evacuation (“never fully emptying”), rectal pain and pressure. We caution patients that repeated straining may also increase the risk of rectal prolapse or stool becoming trapped.

Effective treatment often requires bowel retraining to include:

•  breathing techniques and pelvic floor down training,
• improved toileting posture and mechanics,
•  lifestyle factors such as hydration, stress, and meal timing,
•  strengthening pelvic floor muscles appropriately.

Pelvic floor physical therapy plays a critical role in restoring normal muscle tone, coordination and the relaxation needed for healthy bowel movements.

SIBO
SIBO occurs when bacteria accumulate in the small intestine. Here, bacterial levels should normally be low. The digestive system relies on the migrating motor complex (MMC) – a cleansing wave that clears residual food and bacteria between meals. When this system slows due to stress, hormonal changes, or chronic pelvic floor bracing, bacteria can accumulate and ferment.

Fermentation produces gas, leading to bloating, abdominal pressure, and changes in bowel habits – constipation, diarrhea, or alternating patterns. Constipation commonly coexists with SIBO because slowed transit allows fermentation to increase.

Pelvic floor dysfunction can worsen SIBO symptoms:

• A tight pelvic floor can make gas difficult to pass, increasing bloating and discomfort.
•  Abdominal pressure from gas may trigger muscle guarding, further elevating pelvic floor tension.
•  Incomplete evacuation perpetuates symptoms and causes moderate to severe discomfort.

Our Treatment Approach
Managing constipation, IBS, SIBO and SIFO often require a multidisciplinary approach -coordination with other healthcare providers. At Solstice Physiotherapy, we collaborate with nutritionists, dieticians and gastroenterologists to help reduce inflammatory foods, for appropriate testing and motility-enhancing medications, if necessary.