Constipation is a common digestive issue characterized by infrequent bowel movements, often fewer than three per week, and difficulty passing stools. This can involve straining, producing hard or lumpy stools, or experiencing a feeling of incomplete emptying after a bowel movement. The pelvic floor, a group of muscles and connective tissues located at the base of the pelvis, plays a significant role in various bodily functions, including bowel control. While many factors can contribute to constipation, an often-overlooked connection exists between this digestive challenge and the proper functioning of the pelvic floor muscles.
Understanding the Pelvic Floor
The pelvic floor is a sheet of muscles that spans the bottom of the pelvis, functioning like a hammock. These muscles extend from the pubic bone to the tailbone and between the sitting bones. It supports pelvic organs, including the bladder, rectum, and in females, the uterus and vagina.
The pelvic floor muscles are responsible for both contracting and relaxing, which is fundamental for controlling the release of urine and feces. For instance, the puborectalis muscle, a U-shaped component of the pelvic floor, normally maintains a “bend” in the rectum to help prevent accidental stool leakage. During a bowel movement, this muscle relaxes, allowing the rectum to straighten and facilitate stool passage.
How Pelvic Floor Dysfunction Leads to Constipation
Pelvic floor dysfunction (PFD) occurs when these muscles do not function as they should, either by becoming too weak, too tight, or failing to coordinate properly. When the pelvic floor muscles do not relax at the appropriate time or contract instead of relaxing during defecation, it can lead to significant difficulty in passing stool. This condition is referred to as dyssynergic defecation.
One common type of dysfunction is a non-relaxing, or hypertonic, pelvic floor, where the muscles are excessively tight or unable to relax. This creates an obstruction, feeling like “pushing against a closed door”. The puborectalis muscle may paradoxically contract during an attempted bowel movement, further hindering stool passage. This paradoxical contraction prevents the necessary straightening of the anorectal angle, which is required for efficient elimination.
Symptoms associated with pelvic floor dysfunction-related constipation include persistent straining during bowel movements, a sensation that stool remains in the rectum even after attempting to evacuate, or the need to use manual assistance to help pass stool. Stools may also appear narrow. The ongoing struggle to pass stool can lead to increased muscle tightness and further worsen the problem.
Addressing Pelvic Floor-Related Constipation
Managing constipation stemming from pelvic floor dysfunction involves specific therapeutic interventions aimed at retraining the muscles. Pelvic floor physical therapy is a primary approach, focusing on improving the strength, coordination, and relaxation of these muscles. This specialized therapy may include biofeedback, a technique that provides real-time feedback on muscle activity, helping individuals learn to contract and relax their pelvic floor muscles correctly.
Physical therapists also guide patients through targeted exercises and manual therapy to release muscle tension and improve coordination. Education on proper toileting posture, such as using a squatty potty or stool to elevate the knees, can also optimize the anorectal angle and facilitate easier bowel movements. This posture can help straighten the rectum, reducing the need for straining.
Beyond therapy, lifestyle adjustments play a role in managing this type of constipation. Increasing dietary fiber intake can help bulk and soften stool, making it easier to pass. Adequate hydration and regular physical activity also support healthy bowel function. Establishing consistent bowel habits, such as responding promptly to the urge to defecate and avoiding rushing, can further improve regularity. If constipation persists despite these efforts, or if symptoms like chronic straining, a feeling of blockage, or the need for manual assistance are present, consulting a doctor or a specialized pelvic floor physical therapist is advisable.