Constipation 101
What is Constipation?
Constipation is classified as having hard or lumpy stool that is difficult to pass. It is normal to have a bowel movement anywhere from three times per day to three times per week; as long as the stool is soft and comfortable to pass. Constipation may or may not be accompanied by abdominal pain/bloating, pain when passing a stool, anal fissures and/or hemorrhoids.
What causes it?
Constipation is more common in young children and the elderly, and it affects females more than males. There are several factors that may be contributing to this condition:
Low fibre intake
Low water intake
Low activity level
Pelvic floor dysfunction (eg. dyssynergia)
Up-regulated central nervous system (eg. stress, anxiety)
Side effects of medication (eg. narcotics, anti-depressants, iron supplements)
How can a pelvic physiotherapist help you manage constipation?
There are several strategies we can discuss with our clients who are dealing with constipation. First and foremost is lifestyle modification. We may prescribe the use of a fibre diary and/or bladder diary to obtain objective information regarding fibre/fluid intake. From there, we may make certain goals or targets in order to ensure our patients are achieving adequate amounts of fibre and/or water. We will also educate our patients on the role of exercise in promoting proper bowel function. For example, we may prescribe specific yoga-based stretches/movements that support the natural movement propulsion of waste through the digestive tract. We may also conduct a digital internal exam (vaginally and/or rectally) to determine if pelvic floor dysfunction could be contributing to your problem. For example, dyssynergia is a common, but extremely ineffective way to pass stool. Dyssynergia involves the lack of coordinated muscle function that does not allow for optimal evacuation of stool. Those that struggle with dyssynergia often will bulge/extend their abdominal muscles, but contract/tighten their pelvic floor muscles. This may result in a feeling of incomplete fecal evacuation and result in multiple small bowel movements throughout the day. The pelvic floor muscles have a sphincteric function; therefore relaxation of these muscles is necessary for both defecation and urination.
In addition to dyssynergia, we assess tightness, strength and coordination of the pelvic floor muscles and connective tissue. Based on our findings, we may elect to use a biofeedback machine for patients who are not responding to manual therapy. Your physiotherapist may also discuss postural and behavioural modifications (eg. positioning on the toilet, breathing techniques, proper straining technique). Based on our assessment of the patient, we may recommend a referral to a naturopathic doctor, nutritionist, and/or general practitioner if we expect that the patient would benefit from additional health care practitioners.
What you should avoid doing?
The main thing we don’t want clients to do is strain for prolonged periods of time. Straining transfers significant pressure from the abdominal cavity to the pelvic floor muscles, connective tissues and organs. This can result in a weakening and/or irritation of these tissues. Intense straining can result in anal fissures, hemorrhoids, rectal bleeding, pelvic organ prolapse and diverticular disease. In particular, if you have given birth (vaginally or c-section) and/or been diagnosed with pelvic organ prolapse, you are at even greater risk of negatively affecting these tissues.
What are some safe things you can start to do right now?
Drink more water!
Eat more fibre!
Get moving!
Take care of your mental health!
See a pelvic floor physiotherapist
References:
GI Society; Canadian Society of Intestinal Research (www.badgut.org)