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Why Treatments for Constipation May Not Be Working For You

Hi friends!  If you suffer from constipation, you know the struggle.  You may also know that any time you tell someone, they offer advice.  Try this pill, drink water, eat fiber, have a banana every day--the list goes on and on.  Although they are trying to be helpful this advice can be overwhelming, and it can also be defeating if you try the “magic trick” and it doesn’t work for you.  Let’s talk about why these tricks may work great for some but not for others.

 

First, let’s talk about what constipation is. Many people have different definitions of what constipation may be.  For some, constipation means they can go several days without having a bowel movement.  For others, constipation simply means they have to strain or sit on the toilet for a long time to get stool out.  Functional constipation requires diagnosis of two or more of the following: (Bellini, 2021)

  • Straining more than ¼ of the time

  • Lumpy/hard stools (1-2 on the Bristol Stool Scale) more than 25% of the time

  • Sensation of incomplete popping more than 25% of the time

  • Sensation of obstruction or blockage near the anus more than 25% of the time

  • Manual maneuvers used to facilitate pooping more than 25% of the time

  • Fewer than 3 spontaneous bowel movements per week

 

Regardless of whether you fall into this diagnosis, having any difficulties with pooping can be frustrating!  The treatment approach should be based on should be the true cause of constipation, although that is sometimes hard to figure out.

 

Now you may be asking yourself, what causes constipation?  So many things!  To make sure this isn’t overwhelming, we’re going to split constipation into two broad categories: issues with getting stool out of the anus and issues with getting stool moving through the digestive tract.

 

One of our pelvic floor muscles wraps around the anus (external anal sphincter) while another wraps around the rectum (puborectalis).  These muscles work to keep stool inside our bodies and to prevent any leakage of stool.  The problem is that sometimes these muscles can do their job so well that we have a hard time getting the stool out, even when we want to.  In order to be able to poop, these muscles have to lengthen and relax to allow the stool to exit the body.  When these muscles squeeze and shorten (closing off the anus) when we try to poop it is called dyssynergic defecation. 

 

To treat dyssynergic defecation, we need to have good coordination of these muscles to do the right thing at the right time.  We need these muscles to length to allow poop to exit the body, but we don’t want them to be lengthened all day or we would have leakage of gas and stool.

 

Treatments like drinking water and eating fiber try to improve the consistency of our stool.  Ideally, our stool would be between a 3 and 5 on the Bristol Stool Scale.  This allows the stool to pass through the digestive system and out the anus easily given that all other factors normal.  When stool is dry and hard, it is physically harder to get out of the body.  However, we can have stool that is a good consistency but it can still be hard to get out if we have dyssynergic defecation.  That’s why you may find yourself drinking a gallon of water and consuming lots of fiber with no relief.



If you are experiencing constipation and it seems like nothing is working, be sure to talk with your healthcare providers.  Further testing may be needed to rule out other diseases.  If you have dyssynergic defecation, ask your provider for a referral to a pelvic floor therapist.  They can teach you how to coordinate the muscles when having a bowel movement so that you can poop easily and without any pain!  To find a PT near you, visit www.mypfm.com/find-a-pt

 

 

Ready to learn more about pelvic health? Here are some helpful resources:

For providers, join our Ambassador Program and most of our courses are included with your membership!

  • HRV as a Predictor and Intervention in IBS with Dr. Susan Clinton PT, DScPT, OCS, WCS, FAAOMPT, NBC-HWC

  • Pelvic Floor Rehabilitation for Inflammatory Bowel Disease with Dr. Amanda Olson, PT, DPT, PRPC

  • The Role of Probiotics & How to Support the Gut Microbiome for Digestive Disorders with Erin Judge, RDN, LDN

  • Gut Health Q&A with Dr. Will Bulsiewicz, MD, MSCI

 

 

Written by Emily Reul, PT, DPT

 

References

  1. Bellini M et al.  Chronic constipation: is a nutritional approach reasonable? Nutrients.  2021;13(10):3386.

  2. Sadeghi A et al.  Dyssynergic defecation: a comprehensive review on diagnosis and management.  Turk J Gastroenterol. 2023;34(3):182-195.

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