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Constipation: What's the Holdup?

Constipation is a common digestive issue characterized by infrequent bowel movements or difficulty passing stools. It can vary from person to person, but typically, if you have fewer than three bowel movements in a week or if passing stools is painful or difficult, you may be considered constipated. 

Pelvic floor physical therapy treats constipation alongside gastrointestinal providers such as your physician. Let’s learn about what constipation is, what factors contribute to it, and how pelvic floor physical therapy treats it.

Several factors can contribute to constipation, including:

1. Diet: Lack of fiber or fluids in the diet can make stools harder and more difficult to pass.

2. Lifestyle: Sedentary lifestyle, lack of exercise, or ignoring the urge to have a bowel movement can lead to constipation.

3. Medications: Certain medications like painkillers (opioids), antidepressants, or antacids can cause constipation as a side effect.

4. Medical Conditions: Conditions such as irritable bowel syndrome (IBS), hypothyroidism, or neurological disorders can affect bowel movements.

5. Changes in Routine: Traveling, changes in routine, or disruptions in daily activities can lead to constipation.

6. Ignoring the Urge: Ignoring the natural urge to have a bowel movement can result in constipation over time.

7. Psychological Factors: Stress, anxiety, or depression can sometimes affect bowel habits and contribute to constipation.

Symptoms of constipation may include:

- Straining during bowel movements

- Hard or lumpy stools

- Feeling like you haven't completely emptied your bowels

- Abdominal discomfort or bloating

Treatment for constipation often involves lifestyle changes such as increasing fiber intake, drinking more fluids, exercising regularly, and establishing regular bowel habits. In some cases, over-the-counter laxatives or medications may be recommended. However, chronic constipation or constipation accompanied by other concerning symptoms should be evaluated by a healthcare professional to rule out underlying medical conditions.

Pelvic floor physical therapy can be an effective treatment for constipation, particularly when it's related to issues with pelvic floor dysfunction. The pelvic floor is a group of muscles that support the organs in the pelvis, including the bladder, uterus, and rectum. Dysfunction in these muscles can contribute to difficulty with bowel movements and constipation.

Here's how pelvic floor physical therapy may help treat constipation:

1. Muscle Relaxation: Pelvic floor physical therapists can teach relaxation techniques to help release tension in the pelvic floor muscles. Tense pelvic floor muscles can make it difficult for the rectum to relax and allow for proper bowel movements.

2. Strengthening Exercises: Weak pelvic floor muscles may contribute to constipation. Pelvic floor physical therapy includes exercises to strengthen these muscles, which can improve bowel function.

3. Biofeedback: Biofeedback techniques may be used to help patients become more aware of their pelvic floor muscles and learn how to control them better. Biofeedback provides visual or tactile cues to help patients learn how to relax or contract their pelvic floor muscles effectively.

4. Manual Therapy: Physical therapists may use hands-on techniques such as massage or myofascial release to address muscle tightness and dysfunction in the pelvic floor area.

5. Education: Pelvic floor physical therapists educate patients about proper bowel habits, including techniques for effective toileting posture and strategies to avoid straining during bowel movements.

6. Dietary Recommendations: In some cases, pelvic floor physical therapists may provide dietary recommendations, such as increasing fiber intake or avoiding certain foods that can exacerbate constipation.

7. Behavioral Modification: Therapists can work with patients to identify and address behavioral factors that may contribute to constipation, such as ignoring the urge to have a bowel movement or holding in stool due to embarrassment or discomfort.

The pelvic floor plays a crucial role in controlling bowel movements through a complex interplay of muscles and nerves. Here's how it works:

1. Sphincter Control: The pelvic floor muscles include two main sphincters—the internal anal sphincter and the external anal sphincter. These muscles help control the opening and closing of the anus. When the sphincters are relaxed, stool can pass through the rectum and out of the body. When they contract, they close off the anus, preventing stool leakage.

2. Rectal Sensation: Nerves in the rectum and anus send signals to the brain when stool is present, prompting the sensation of needing to have a bowel movement. The pelvic floor muscles help interpret these signals and coordinate the appropriate response.

3. Coordination with Abdominal Muscles: During a bowel movement, coordinated relaxation and contraction of the pelvic floor muscles work in conjunction with abdominal muscles to facilitate the passage of stool. When the abdominal muscles contract (such as during straining), the pelvic floor muscles should relax to allow for the downward movement of stool through the rectum and anus.

4. Support and Stability: The pelvic floor provides support and stability to the organs in the pelvis, including the rectum and anus. Proper function of these muscles helps maintain the integrity of the pelvic organs and prevents issues such as pelvic organ prolapse, which can affect bowel function.

5. Feedback Mechanism: The pelvic floor muscles provide sensory feedback to the nervous system, helping to regulate bowel function. Abnormalities in pelvic floor muscle function, such as weakness or excessive tension, can disrupt this feedback loop and lead to problems with bowel control or constipation.

Overall, the pelvic floor muscles play a vital role in regulating bowel movements by controlling the opening and closing of the anus, coordinating with abdominal muscles, providing sensory feedback, and supporting pelvic organ function. Dysfunction in these muscles can contribute to issues such as constipation, fecal incontinence, or pelvic floor disorders. Pelvic floor physical therapy is often used to address these issues by improving muscle strength, coordination, and relaxation.

A rubber duck sitting on a toilet
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Constipation can have various effects on other pelvic floor symptoms due to the interconnectedness of pelvic floor muscles and functions. Here are some ways constipation may impact other pelvic floor symptoms:

1. Pelvic Floor Dysfunction: Chronic constipation can lead to pelvic floor dysfunction, which involves abnormalities in the coordination, strength, or relaxation of the pelvic floor muscles. This dysfunction can manifest as pelvic pain, difficulty with urination, sexual dysfunction, or fecal incontinence.

2. Pelvic Organ Prolapse: Straining during constipation can increase intra-abdominal pressure, potentially contributing to pelvic organ prolapse. Prolapse occurs when pelvic organs, such as the bladder, uterus, or rectum, descend into or protrude out of the vaginal canal due to weakened pelvic floor support.

3. Fecal Incontinence: Chronic constipation followed by episodes of diarrhea or fecal impaction can stretch or weaken the anal sphincter muscles, leading to fecal incontinence—the inability to control bowel movements. Additionally, constipation-related straining can damage nerves and tissues in the pelvic floor, further exacerbating fecal incontinence.

4. Pelvic Pain: Constipation can cause increased pressure on the pelvic floor muscles and surrounding structures, leading to pelvic pain or discomfort. This pain may be experienced in the lower abdomen, pelvis, lower back, or during sexual intercourse.

5. Urinary Symptoms: Constipation can indirectly affect urinary symptoms by placing pressure on the bladder and urethra, leading to increased urgency, frequency, or difficulty with urination. Additionally, pelvic floor dysfunction associated with constipation can contribute to urinary retention or incomplete bladder emptying.

6. Sexual Dysfunction: Pelvic floor dysfunction resulting from chronic constipation can impact sexual function by causing pain during intercourse (dyspareunia), decreased sexual arousal, or difficulty achieving orgasm.

It's important to note that these symptoms can vary in severity and presentation among individuals. Addressing constipation and its underlying causes through dietary modifications, lifestyle changes, pelvic floor physical therapy, and medical interventions can help alleviate pelvic floor symptoms and improve overall pelvic health. Consulting with a healthcare provider or pelvic floor specialist is essential for accurate diagnosis and appropriate management of pelvic floor disorders associated with constipation.

Pelvic floor physical therapy is tailored to the individual needs of the patient and may involve a combination of these approaches. It can be particularly beneficial for individuals with chronic constipation or constipation that has not responded well to other treatments. 


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