How Pelvic Floor Physical Therapy Can Help You Poop

For how much most of us want to avoid the unpleasant experience, constipation is shockingly common. A recent survey shows that an estimated 16% of Americans, or around 52 million people, suffer from chronic constipation; that number increases to 33% in people 60 and up.

Constipation leads to millions of doctor visits each year, including around 703,000 trips to the emergency department. Fortunately, many of those struggling can find symptomatic relief in a number of lifestyle changes–and, perhaps surprisingly, pelvic floor physical therapy.

I’m a pelvic floor physical therapist, which means I focus on the pelvic floor–the muscles that control urination, defecation, penetration, and erection–and how it affects our bladder, bowel, and sexual health. Constipation can present in a number of ways, causing some to experience infrequent bowel movements and others to have a sense of difficulty emptying their bowels. I’ll frequently hear my patients describe having to push or strain to go, sometimes taking up to 60 minutes on the toilet. Some even have to use a finger to extract poop, because otherwise it feels like it will never happen.

Research has shown that upwards of 50% of people with constipation have concurrent pelvic floor dysfunction. As a pelvic floor physical therapist, the first thing I offer my patients is education. Constipation has many causes, so we need to address diet and fluid intake, activity level, and other habits. Studies have found that modifying these lifestyle factors can reduce severity and symptoms of constipation.

Drinking enough water is one important step in managing constipation. Dehydration can lead to hard, lumpy, and difficult-to-pass stool. Another topic I discuss with my patients is daily fiber intake. Fiber can help increase water absorption during the digestive process, thereby softening stool, as well as promote movement throughout the digestive tract.

Getting more physical activity is also extremely helpful. Exercise ups your heart rate and promotes blood flow throughout your body, and it encourages movement throughout your bowels, too. But sometimes these habits aren’t enough on their own. That’s where I come in. Pelvic floor physical therapy helps manage any existing tightness in your muscles even throughout your intestines and diaphragm. Restrictions in these areas can contribute to constipation or make symptoms worse.

Retraining those muscles to function the way they are meant to can keep stool moving. During bowel movements, your pelvic floor muscles are meant to relax to allow the passage of poop. In those with pelvic floor dyssynergia, a condition where the pelvic floor muscles contract instead of relax while attempting to empty your bowels, this paradoxical muscle pattern can halt the process and contribute to constipation. Pelvic floor physical therapists use a combination of internal treatment to manage muscular tension, breathing and relaxation exercises to assist in decreasing muscular tone, and cuing to teach you how to relax these muscles and improve your bowel movements.

Internal treatment, you say? Unlike at a gynecologist’s office, pelvic floor internal treatment typically does not include stirrups or speculums. We use a gloved, lubricated finger to palpate your internal muscles. We feel each muscle in your pelvic floor (there are quite a few) and determine whether that muscle is tight and spastic or whether your muscles are weak. This can be done vaginally or rectally, with each of those options allowing for a closer look at a different part of the pelvis. If muscles are tight, during the PT session, we’ll work on them. Using different techniques, we can help those muscles relax and function better to improve symptoms of constipation.

Pelvic floor physical therapists can teach you exercises and stretches to work on any tight muscles you have at home, as well. For those with tension in their pelvic floor, there are specific tools like dilators. Physical therapists can also teach you abdominal massage. This technique has been shown to help manage abdominal pain associated with constipation and increase frequency of bowel movements. It involves stroking and kneading throughout the abdomen in a consistent pattern, and it’s often used during therapy sessions. Additional stretches can include common yoga poses like happy baby and child’s pose; it all depends which muscles are tight and what you need to work on.

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I even discuss toileting habits and positioning with my patients. You might feel silly at first, but bringing your knees up on a stool has been shown to decrease the amount of time you spend on the toilet, as well as the need for all that pushing.

If after reading this you’re thinking pelvic floor physical therapy sounds like something that may help you, ask any local physicians or physical therapists you know if they have heard of anyone in your area. If that doesn’t work, visit the American Physical Therapy Association online and click on Find a PT to search for therapists who are certified in women’s health in your area.

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