Physical Therapy for Constipation

Most of us want to avoid the unpleasant experience of constipation, but it's very common. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), an estimated 16% of Americans—around 52 million people—experience chronic constipation; that number increases to 33% in people 60 and up.

In a 2020 study published in the journal Gastroenterology, researchers stated that pelvic floor dysfunction is one of the most recognized causes of constipation. Other causes include:

• Dysfunction of the nerve pathways in the gut
• Disturbances of the gut microbiome
• Side effects from certain medications
• Anatomical issues
• Reduced calorie intake

Besides being a pain in the butt, constipation can be costly. In a 2020 study published in the journal Clinical and Experimental Gastroenterology, researchers found that chronic constipation causes people to miss work, pay several thousand dollars a year in medical costs, and have a lower health-related quality of life.

Fortunately, many people living with chronic constipation can find relief by incorporating certain lifestyle changes and therapies, including pelvic floor therapy.

Symptoms of Constipation

Constipation can present in several ways, such as infrequent bowel movements or difficulty emptying the bowels.

According to the NIDDK, symptoms of constipation can include:

• Fewer than three bowel movements a week
• Stools that are dry, hard, or lumpy
• Stools that are painful or difficult to pass
• A feeling like not all the stool came out

As a pelvic floor physical therapist (PT), I've frequently heard my patients describe having to push or strain to go, sometimes taking up to 60 minutes on the toilet. Some have even had to use a finger to extract poop because otherwise, they said, it feels like it will never happen.

Treatments for Constipation

One of the first things I've offered my patients is education. Because constipation has many causes, we need to address diet and fluid intake, activity level, and other habits. According to the NIDDK, modifying these lifestyle factors has been shown to reduce the 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 stools. Another important topic is fiber intake. Fiber can help increase water absorption during the digestive process, softening stool and promoting movement throughout the digestive tract.

Getting more physical activity is also extremely helpful. Exercise increases your heart rate and promotes blood flow throughout your body; it encourages movement throughout your bowels, too.

But sometimes, changing these habits isn't enough to improve constipation. That's where pelvic floor physical therapy comes in.

Pelvic Floor Physical Therapy

Pelvic floor physical therapy helps manage existing tightness in your muscles, including throughout your intestines and diaphragm. During bowel movements, your pelvic floor muscles are supposed to relax to allow the passage of poop.

Some people have pelvic floor dyssynergia, a condition where the pelvic floor muscles are contracting instead of relaxing while attempting to empty the bowels. This paradoxical muscle pattern can halt the pooping process and contribute to constipation. Retraining the muscles involved in pooping to function the way they are meant to can help keep stool moving through the gut.

Pelvic floor PTs use a combination of internal treatment to manage muscular tension, breathing and relaxation exercises to assist in decreasing muscular tone, and cueing to teach you how to relax those muscles and improve your bowel movements.

Internal Treatment

Internal treatment can be effective for many people who are dealing with severe constipation, and it's safe when it's done by a trained professional.

Using a gloved, lubricated finger, a pelvic floor PT will feel each muscle that makes up your pelvic floor (there are quite a few) to determine which muscles are tight, spastic, or weak. This can be done vaginally or rectally, with each of those options allowing for a closer examination of a different part of the pelvis.

If muscles are tight, the PT will work on them using different techniques during the session to help those muscles relax and function better to improve symptoms of constipation.

Home Exercises

Pelvic floor PTs will also teach exercises and stretches to do at home. Some stretches include common yoga poses, like happy baby and child's pose. Which stretches and exercises will be recommended will depend on which muscles are weak or tight.

There are also tools for home use, such as rectal dilators, that can help with tension in the pelvic floor.

Abdominal Massage

Abdominal massage is a common technique that pelvic floor PTs teach people to do on themselves.

In a 2020 review of the literature published in the journal Bezmialem Science, abdominal massage was shown to help manage abdominal pain associated with constipation, increase the frequency of bowel movements, prevent constipation, decrease laxative use, and increase patients' quality of life.

The technique involves stroking and kneading the abdomen in a consistent pattern and is often used during therapy sessions.

Toilet Positioning Devices

Pelvic floor PTs also discuss toileting habits and position while pooping.

A 2019 study published in the Journal of Clinical Gastroenterology examined the use of devices—what researchers refer to as defecation postural modification devices or DPMDs—that place you into a better position to poop.

The research showed that DPMDs can help decrease the time spent pooping, produce less straining, and allow for more complete evacuation of the bowels compared to just simply sitting on the toilet. You can purchase one of these devices or use a step stool to place your feet onto.

A Quick Review

If you struggle with constipation, consider talking to a healthcare professional to learn if pelvic floor therapy might help. Consistent physical therapy with a pelvic floor physical therapist can help you avoid the discomfort and inconvenience of constipation.

You can ask your healthcare professional for a referral or try the American Physical Therapy Association's PT finder.