Constipation can be related to pelvic floor muscle tension, poor muscle coordination, and difficulty relaxing during bowel movements. Learn how pelvic floor physical therapy can help improve bowel habits, reduce straining, and address symptoms such as painful bowel movements, incomplete emptying, and rectal spasms. Discover what to expect during a pelvic floor evaluation in Forest Hills, Queens, NYC.
How Constipation Can Affect the Pelvic Floor
The pelvic floor muscles are closely linked to how we poop. Constipation can have a very significant effect on the pelvic floor, and the pelvic floor muscles, if dysfunctional, can make it harder to poop. To understand why, we must remember our pelvic floor anatomy.
The pelvic floor is a group of muscles that look like a bowl or sling going from the tailbone to the pubic bone. One of the pelvic floor’s main functions is to support the pelvic organs. These include the bladder, uterus and rectum. If we are dealing with constipation, the rectum or the colon above is full of stool, thus putting more pressure on the pelvic floor.
This pressure can contribute to many pelvic floor conditions including urinary urgency, leaking and pelvic pain. Furthermore, constipation can lead to straining which can lead to pelvic floor muscle tension over time. Chronic straining can also lead to pelvic organ prolapse.
If the pelvic floor muscles are tight, on the other hand, they can make it more difficult to poop. This can lead to pain with bowel movements, difficulty completing a bowel movement and can also lead to rectal spasms.
How the Pelvic Floor Contributes to Bowel Movements
A bowel movement involves gentle abdominal pressure and lengthening and relaxation of the pelvic floor to get the stool out of the rectum. The pelvic floor has one unique muscle for pooping called puborectalis. We call this muscle the “slingshot” muscle as it lengthens and then helps to press on the poop as it goes down the anal canal.
However, if this muscle is tight and cannot lengthen it can make it difficult to have a bowel movement. When the pelvic floor muscles are tight rectally, they can cause dyssenergic defecation. Dyssenergic defecation means that the pelvic floor muscles cannot coordinate properly to poop. Instead of lengthening, the muscles tighten instead.
Signs Pelvic Floor Dysfunction May Be Contributing to Constipation
- Pain with a bowel movement
- Difficulty completing a bowel movement
- Needing to use a hand or finger vaginally or rectally to help complete the bowel movement, also known as “splinting”
- Straining
- Rectal spasms
- Urinary symptoms such as increased urgency, frequency and leaking
- Pain with intercourse
Common Causes of Pelvic Floor Dysfunction and Constipation
- Chronic straining
- Pregnancy and childbirth
- Connective tissue disorders (such as Ehlers-Danlos syndrome)
- Abdominal and pelvic surgeries
- Hard stool consistency
- Hormonal changes (such as during menopause)
How Pelvic Floor Therapy Can Help With Constipation
Pelvic floor therapy can be very helpful for constipation. Here is a list of the many ways a pelvic floor therapist can help you improve constipation:
- Help you figure out nutrition changes or supplement support to improve stool consistency (we want an easy to pass banana like shape)
- Work on visceral mobility to improve digestion
- Teach you abdominal massage that can be performed daily at home for 5 minutes
- Go through how to have consistent meal times (the bowels love consistency)
- Go over bathroom hygiene and defecation mechanics such as the use of a squatty potty and how to use abdominal pressure to poop without straining
- Rule in or rule out pelvic floor tension and proper coordination
- Core or pelvic floor strengthening if needed
- And many more!
What to Expect During a Pelvic Floor Evaluation
During your first appointment, we will go over your personal history, concerns and goals. We will discuss your symptoms, past medical and surgical history, lifestyle and more. For constipation, it is important to go over stool consistency, how often you are using the bathroom and whether you have pain or frequently experience straining. Often a bowel and bladder diary is assigned to better understand bathroom habits and give direct feedback. We also discuss diet and possible supplements that may help to improve stool consistency.
The next part of the appointment will involve an internal or external assessment. Often, the pelvic floor physical therapist will use a pelvic model to explain anatomy. The model is also used to explain what an internal pelvic floor assessment involves and to answer any questions. Then the therapist and patient decide together if an internal assessment is appropriate for the first visit. Remember an internal assessment is never required and the choice is fully yours as the patient!
For patients with constipation or other fecal concerns, a rectal assessment is very helpful. This gives direct feedback as to whether the posterior pelvic floor muscles and puborectalis are too tight. This can cause difficulty with pooping and pain. The pelvic floor therapist will explain the exam in detail and the patient can have some time to consider if it is right for them.
The last part of the appointment will include a summary of the therapist’s findings and next steps. The therapist will outline future treatment and what will be most beneficial for the patient to reach their goals.
When to Seek Additional Medical Evaluation
If you haven’t had a bowel movement for longer than three days, please see your primary care physician. Anything over one week is considered an urgent medical situation and you should seek care at the emergency room.
Also, if you are experiencing any bleeding with pooping or wiping, please know this is not normal. Please see your primary care doctor or a colorectal specialist!
If you have any medical concerns, please know a colorectal specialist can be very helpful to consult with. Your pelvic floor physical therapist will likely have someone they can recommend.
Where to Find Pelvic Floor Physical Therapy For Constipation In Queens, NYC
If you are experiencing symptoms of a tight pelvic floor, help is available! Pelvic floor physical therapy is the gold standard treatment for this condition. If you are in the Forest Hills, Queens, NYC area and you are looking for help today, reach out to us! Give us a call or fill out our contact form today!
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