Did you know up to 50% of people with constipation have pelvic floor dysfunction?

Hopefully this blog will make the links between your pelvic health problems and constipation a bit clearer, whilst giving you some useful tips to get things moving again…

OK, so I don’t know many people that openly discuss their bowel habits with others. It is seen as taboo, kids are taught to not talk about poo and often scolded when they do. That is our culture. It is no surprise then that as adults we don’t know what is normal in the toileting department. And whilst I’m on the subject, please don’t discourage kids from talking about poo (and all things taboo). We want a generation that can go straight to the doctor with worrying bowel changes, that know when something is wrong and feel happy to discuss it.

Let’s start with “normal” , if you have no problems in the bowel department this is what I expect to hear

• Stools pass easily without straining

• No blood or mucous

• Frequency between 3 times a day to 3 times a week. There is a huge variation within the normal range, the important thing is that the number of times you open your bowels is within this range AND is normal for you. i.e. hasn’t drastically changed recently

• No need for laxatives, suppositories, enemas

• A feeling of satisfaction after emptying bowels (not a feeling that you haven’t completely emptied)

• No incontinence of faeces

• Ability to wipe yourself clean

• Ability to control wind

• No pain prior to, during or after bowel movements

• Stools are formed, smooth and sausage like

Going to the toilet should not be difficult, assess constipation not by how many times you visit the toilet but by how easy it is when you go! So many people get hung up on the idea that they have to open their bowels daily, this is not required.

So what are the links between constipation and the pelvic floor?

Constipation and pelvic floor problems often go hand in hand. Often symptoms such as pelvic pain, painful intercourse, urge incontinence and prolapse exist alongside constipation.

The pelvic bowl houses three systems in a limited amount of space 1)urinary - bladder and urethra 2) reproductive - womb, ovaries, fallopian tubes and vagina 3) GI system sigmoid colon and rectum

You can see how extra stool in the bowel can put increased pressure on the rest of the pelvic organs. Increasing pressure on the bladder and urethra can contribute to urinary frequency, urgency and sometimes retention.

The straining that happens to try to expel stools can cause further damage to the pelvic floor muscles and fascial support system. Over time it will increase your risk of incontinence and vaginal prolapse. It can also affect the pudendal nerve and cause nerve damage & pain.

It also works in reverse…

So we’ve identified that constipation can lead to pelvic floor dysfunction, but it can also work the other way around. Pelvic floor dysfunction can lead to difficulty emptying your bowels and therefore symptoms of constipation.

If you have a rectocele, which a type of vaginal prolapse, this can create a ballooning when you want and/or try to open your bowels. The stool can get trapped in the pocket and it can become difficult to empty properly. It can also then lead to further straining which causes further pelvic floor dysfunction.

Some people have pelvic floor muscles that find it difficult to relax. A nice, flexible pelvic floor which is able to “let go”, lengthen and relax is important for bowel emptying. If your pelvic floor is not relaxing properly or even contracting when it should be relaxing this leads to a type of constipation called “outlet constipation”. Basically the train is reaching the station, but it is unable to move forwards and leave.

Causes of constipation

Constipation occurs commonly through a combination of factors

• Poor eating habits such as too much processed (junk) food, excess caffeine or irregular eating patterns)

• A diet that lacks in fibre

• Low fluid intake

• A sedentary lifestyle with too little exercise

• Medications such as codeine, tranquillisers, psychiatric medications, diuretics, iron, calcium, some antacids)

• Stress

• Pregnancy

• Recent childbirth

• Recent surgery (especially pelvic or abdominal)

• Travel

• Pelvic floor dysfunction

What you can do to help your bowels

Often the most simple lifestyle changes can help. Sometimes it is far more complex, and expert opinion and investigations may be required to find out the cause. Start with lifestyle changes and if there is no improvement after a few weeks then seek further help

1) CHEW your food

This is often missed off guidance for constipation, but it is SO important. In our rushed, hectic, chaotic lives most of us have lost the art of taking our time over meals. Be mindful of what you are eating, take time to sense what you are eating and also chew it LOTS. This helps stimulate digestive enzymes and therefore aids digestion.

2) Gradually increase FIBRE in your diet

Guidelines suggest 30-40g/day, which is far more than the average person consumes. Studies have shown the average person only eats around 18g/day! Fibre is found within fruit, dried fruits, nuts, seeds, vegetables and wholegrain foods. Leafy green vegetables are very important, as they contain high levels of magnesium which is known to speed up your bowels.

Cut down on your intake of “white” and “beige” foods. Replace white rice with brown, white pasta with wholemeal, white bread with wholemeal.

Yes I’m sure you’ve heard it all before, but getting enough fibrous foods in your diet is SO important for overall health, reducing your risk of many health problems including heart disease, bowel cancer, strokes and type 2 diabetes. Make changes now and your future self will be pleased!

Have a look at the NHS website for some great tips to increase fibre in your diet https://www.nhs.uk/live-well/eat-well/how-to-get-more-fibre-into-your-diet/

3) Learn how to massage your abdomen

There are constipation massage techniques that can be really effective to help aid the transit of stool through the colon. A physiotherapist in pelvic health can teach you these techniques.

4) Respond to your bowels

Don’t put off going to the toilet, if you have the urge try your best to visit the toilet.

5) Change your toilet positioning & breathe!

Sitting on a toilet is not the way we were designed to poo! For millions of years we squatted, by sitting on toilets it changes the mechanics of how we open our bowels and it makes it more difficult for the pelvic floor to fully lengthen. By making a few simple changes we can recreate squatting, by using a small step or stool under feet and leaning forwards with arms resting on our thighs.

Try to relax, and avoid holding your breath to strain. Take deep relaxing breaths, and visualise your pelvis opening up.

6) Fluid intake

If you already drink adequate amounts of non caffeinated drinks then increasing fluids further will not make a difference to your constipation. However if you have a poor fluid intake then you may benefit from increasing it (and not just in the bowel department!). Drink plenty of hydrating fluids (water is best), making changes to your fibre intake will not help if you are not drinking enough.

7) Get help and guidance

If you are reading this and have developed recent changes to your bowel habits, start by making lifestyle changes but also you need to discuss your symptoms with your GP/healthcare provider. Constipation can sometimes be an indication of more serious health conditions, which need ruling out by a doctor.

Feel free to email me to ask further questions or book an appointment to get a full assessment and treatment for your specific concerns.

I am writing this during the covid-19 pandemic, and therefore will mention that currently we are offering virtual video consultations at a reduced price.