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The Role of Pelvic Floor Therapy in Constipation Management

By Dr. Sarah Ellison, PT

What is constipation? Are you wondering if what you are experiencing is considered constipation? The definition of constipation can be vague when it is simply described as “having difficulty emptying bowels.”

To help break it down, constipation can be defined in several different ways:

  • Frequency: Normal bowel frequency is typically considered less than 3 times a day and more than 3 times a week. However, each individual has their own normal frequency which should be used as a point of comparison (ie-if a person typically goes daily but has not had a bowel movement in 2 days).

  • Consistency: The Bristol Stool Scale is the standard way to measure stool consistency. A 3 to 4 on this scale (middle of the range) is considered normal stool consistency. 1 and 2 are stool consistencies associated with constipation.

  • Amount of straining: Bowel movements should be easy and comfortable to pass without straining. Both stool consistency and the ability for the pelvic floor muscles to relax can affect the degree of straining with bowel emptying.

Nutrient absorption and waste elimination, gastrointestinal functioning, and muscular functioning can all play a role in affecting constipation. For this reason, constipation responds well to an interdisciplinary approach, including a team with registered dietitians, gastroenterologists, and pelvic floor therapists, each of whom bring their expertise to identify the root cause of constipation symptoms.

Pelvic floor therapists focus on the musculoskeletal contributions to constipation. These providers can improve constipation by:

  1. Reviewing bowel habits and providing recommendations on daily habits that can help improve stool consistency to make it easier to have a bowel movement with less straining.

  2. Analyzing and retraining the pelvic floor muscles to ensure that the muscles are contracting and lengthening at the right time to maintain continence and help with bowel emptying. Pelvic floor therapists can also address tight pelvic floor muscles that can be affecting a person’s ability to completely empty their bowels.

  3. Examining and improving posture to improve muscle tightness or weakness around the pelvic floor that may be affecting pelvic floor functioning.

  4. Reviewing bowel evacuation mechanics and adjusting positioning and breathing strategies to make bowel emptying more mechanically efficient with less straining.

  5. Developing an individualized home program, including exercises and stretches, that enable the body and pelvic floor to relax and improve mobility and strength in surrounding musculature to help support the pelvic floor and make bowel emptying easier.

These strategies can have a significant impact on improving constipation symptoms, and in a way that the body is healing itself! For further questions, please feel free to contact us to speak to one of our pelvic health therapists!


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