• Emily Reul, PT, DPT

Constipation

Updated: Oct 18

Hi friends! Today we are going to talk about constipation. We know no one likes to talk about pooping, but it is so important! In fact, this month is National Gastroparesis Awareness Month. Gastroparesis is essentially when the digestive tract isn't moving food through as quickly as it should, which can cause constipation.


Constipation is having less than 3 bowel movements per week or difficulty passing stool/solid waste. Constipation is often accompanied with other symptoms such as straining when trying to have a bowel movement and abdominal cramping and bloating. (Irion, 2010)


Typically, you should have bowel movements anywhere from three times per week to three times per day. (Irion, 2010; Binford, 2013) 21% of women and 8% of men have bowel movements less frequently than this and are diagnosed with having chronic constipation. (Irion, 2010) 30% of individuals over the age of 60 suffer from constipation (Irion, 2010; Hayat 2017)


Do you ever look at your stool after you go? Yes, this may sound weird, but the type of stool you have can actually tell us a lot about how your digestive tract is working. We even have a special scale to measure the different types of poo! This is called the Bristol Stool Scale. Ideally, your stool will resemble a type 3 or type 4 stool and look like a ripe banana.




So, what causes constipation? There can be several causes:


  • The pelvic floor muscles (PFM) play a huge role in controlling defecation (the fancy word for pooping). When the pelvic floor muscles are working properly, they hold in stool when appropriate and relax to let to stool pass when we are ready to go. Sometimes, when the pelvic floor muscles are very tight and painful, it is hard to get the stool to pass through. Imagine a garden hose that is kinked—in order to get the water out, you have to unkink the hose. The same concept applies to the PFM. The PFM must “let go” in order to have a bowel movement. But there is good news: seeing a pelvic floor physical therapist can help to train those muscles to do the right thing at the right time!

  • Several medical disorders can cause or contribute to chronic constipation such as: irritable bowel syndrome (IBS), Parkinson’s disease, and thyroid disorders.


  • Many medications that are used to treat many other diseases can cause constipation as a side effect. Some of the most common are medications used to treat pain, diabetes, and depression. (Hayat, 2017)

  • Slow moving waste matter, AKA poop. The longer poop stay inside your digestive system, the harder it gets. (Binford, 2013) Skipping meals, especially breakfast, can suppress the reflex which helps to keep food moving throughout the digestive tract. (Irion, 2010)


SO WHAT IF YOU HAVE CONSTIPATION? WHAT'S THE BIG DEAL?

People with constipation often strain to have a bowel movement which increases stress on the pelvic floor muscles and can lead to dysfunction and incontinence as well as prolapse, hemorrhoids, chronic pelvic pain, and even a vasovagal response (which can actually make you pass out!) (Irion, 2010) Solid waste filling the rectum can also put pressure on the bladder making you feel a stronger urge to pee. (Irion, 2010) Constipation is often a cause of nocturnal enuresis (bed wetting) especially in children. The good news is, most children with constipation respond to education, toilet training, and laxatives. (Lu, 2018)


Okay, so you have constipation, what can we do about it? Lots, thankfully!


  • One of the biggest ways to address constipation is through the diet. Daily fiber intake for the average adult should be 20-30 grams per day. (Irion, 2010) The American Gastroenterologic Association actually recommends fiber intake as a first line treatment for constipation before medications. (Irion, 2010) When increasing the fiber in your diet, it is important to start increasing slowly to avoid abdominal cramps and bloating. (Hayat, 2017) It is recommended to get fiber from whole foods such as fruits, vegetables, and whole grains, but you can use fiber supplements as well. Supplements can include things like psyllium husk or flask seed and can be added to the food you already eat. They also are great additions to smoothies!

  • Along with increasing fiber intake, eating regular meals can help to kick start the digestive system. It is recommended that you eat breakfast and drink a hot, caffeinated beverage (like coffee or tea) within 1 hour of waking up. (Hayat, 2017) But when drinking caffeinated beverages, remember, they can be bladder irritants so you may find yourself going to the bathroom more often. If you are dealing with urinary leakage and incontinence, it may be a good idea to skip the caffeine.

  • Hydration is important for both bowel health as well as optimal bladder functioning! It is recommended that you consume 8-12 glasses of water per day. (Irion, 2010)

  • Exercise and physical activity can help to promote solid waste to move throughout the digestive system. Moving early in the morning can especially help! (Hayat, 2017)

  • A pelvic floor physical therapist can help improve your symptoms in many ways. A special treatment they may use is called biofeedback. Biofeedback measures the activity of your muscles and can help show you how to turn those muscles “on” or “off.” In research studies, biofeedback was found to be more effective than placebo, laxatives, and muscle relaxants with 70% of patients reporting symptom improvement! (Hayat, 2017) Your therapist will help you to learn to relax your PFM and coordinate them with your abdominals to successfully have a bowel movement. (Binford, 2013)

  • Try performing an abdominal massage to help move food along your digestion tract. This video will show you how.

  • Don’t ignore the urge to defecate—it can cause the signals from the rectum to get weaker and require even more stool to stimulate the urge (Binford, 2013)

  • Toileting hygiene and postures can be very beneficial to promoting bowel movements! Here are some tips:

  1. Do not sit on the toilet more than 5-10 minutes at a time. If you are unsuccessful, get up and try again when the urge comes back.

  2. Try perineal splinting. This video will show you how.

  3. Don’t strain or hold your breath.

  4. Get in a squatting position with your knees higher than hips and spread your knees apart. (Binford, 2013) Products like the “Squatty Potty” can help with this.

  5. Open your mouth, take a deep breath, and say “Grrr.”



It is important to speak with a healthcare provider about your constipation, especially if you are experiencing symptoms such as unintentional weight loss, bleeding, severe abdominal pain or rectal pain. (Irion, 2010; Hayat 2017) These symptoms can be signs of more serious conditions like infection, bowel obstruction, or malignancies.


Ready to take back control of your bowels? Here are some steps you can take now:

By Emily Reul, PT, DPT

References:

1. JM Irion, GL Irion. Women’s health in physical therapy.

2. Hayat U, Dugum M, Garg S. Chronic constipation: update on management. Cleve Clin J Med. 2017 May;84(5):397-408. doi: 10.3949/ccjm.84a.15141.

3. Lu PL, Mouse HM. Constipation: beyond the old paradigms. Gastroenterol Clin North Am. 2018 Dec;47(4):845-862. doi: 10.1016/j.gtc.2018.07.009.

4. Binford J. Physical therapy management of outlet dysfunction constipation and pelvic pain. J Womens Health Phys Therap. 2013 May;37(2):59-69. doi: 10.1097/jwh.0b013e31829df717.

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This information is for awareness purposes and not individual medical advice. You should seek your own professional counsel for any medical condition or before starting or altering any exercise or fitness program.

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