Most people are reluctant to discuss their bowel movements, but we all know having too many or too few can really have an impact on our quality of life. Also, many people don’t realize that they can have a conversation about their bowels with their physical therapist. Bowel care can fall under the purview of a physical therapist by addressing pelvic floor function (more on that below). 

What is considered “normal” bowel habits can vary between people, but the general expected range is anywhere from 3 times per week and up to 3 times per day. No matter where you fall on that spectrum, you are probably well aware of the discomfort that can come along with falling out of your “normal.” 

Constipation is generally defined as infrequent bowel movements occurring fewer than 3 times per week. More specifically, the Rome IV diagnostic criteria for constipation states having 2 or more of the following is considered to be constipation: straining 25% of the time, lumpy or hard stools, sensation of incompleteness, sensation of an obstruction or blockage, having to perform manual maneuvers to evacuate, or less than 3 spontaneous bowel movements per week. Constipation is very common with more than 2.5 million people who visit a healthcare provider reporting that they seek relief from constipation. 

Many causes can contribute to constipation, and it may be important to seek medical attention if constipation lingers or worsens. Common causes include:

• Diet
• Medications
• Inactivity
• Pelvic floor muscle tightness and paradoxical pelvic floor muscle contractions with defecation
• Dehydration
• Changes in routine
• Stress
• Resisting the urge to have a bowel movement
• Underlying medical conditions
• Abuse of laxatives 
• Low vitamin D
• And many more!

Luckily, there are simple changes and things you can try to relieve constipation. Here are some adjustments to consider: 

• Dietary changes: Increasing fiber intake to 20-35 grams/day.

• Get more activity: Exercising helps speed the bowels through the large intestine by stimulating the natural contraction and stretch of the colon known as peristalsis. 

• Improving the anorectal angle with toilet positioning: If we sit at a 90 degree angle of the hips or less (which most toilets position us in), a muscle known as the puborectalis that wraps around the rectum will constrict around the rectum even more. Being in a position with the knees closer toward the chest helps to loosen the puborectalis and improve the anorectal angle making it easier to successfully have a bowel movement. Consider elevating the feet on books, yoga blocks, or use a Squatty Potty. 

• Abdominal wall/colon massage: A massage following the tract of the colon can help to speed up the transit time of bowels or gas through the bowels. This can be performed by a practitioner or on your own. 

• Bowel habit retraining: Bowels typically thrive with routine. Establishing a regular routine specifically targeting stimulating the bowels can help to combat constipation.

• Pelvic floor muscle training: In order to successfully have a bowel movement, the pelvic floor muscles must relax. This can often be achieved through deep breathing. Unsure if you can relax your pelvic floor muscles? A pelvic floor therapist can help with releasing the muscles and teach relaxation techniques. 

Still stumped on what steps to take next? Contact one of our pelvic floor physical therapists to help address the muscles and habits of the pelvic floor to improve constipation.

At Beacon Physical Therapy, we support our patients in leading a healthy life and establishing a healthy lifestyle. And remember, if you are having an issue, make an appointment today. We’d love to meet you and get you back to doing what you love.