Constipation & the Pelvic Floor
Constipation & Your Pelvic Floor: Could Your Pelvic Floor Be Contributing?
Constipation isn't always as simple as not going to the toilet often enough.
You can open your bowels regularly and still experience constipation if you're straining, passing hard stools, feeling like you haven't completely emptied, spending a long time on the toilet or needing to use particular positions or techniques to help empty your bowels.
There are many possible causes of constipation. For some people, the way the pelvic floor muscles coordinate during a bowel motion may be part of the picture.
What Is Constipation?
Constipation can involve infrequent bowel movements, but frequency is only one consideration.
Symptoms may include:
Hard, dry or lumpy stools
Straining to open your bowels
Feeling like you haven't completely emptied
Difficulty starting a bowel motion
Spending a long time on the toilet
Abdominal bloating or discomfort
Feeling like something is blocking the stool from passing
Needing to change position to empty your bowels
Using your fingers or pressure around the vagina or perineum to assist emptying
If you're opening your bowels regularly but experiencing these symptoms, constipation may still be worth discussing with a healthcare professional.
How Can the Pelvic Floor Cause Difficulty Emptying Your Bowels?
To comfortably open your bowels, your pelvic floor and anal sphincter need to relax and coordinate with increases in abdominal pressure.
For some people, the pelvic floor doesn't relax adequately during a bowel motion or may contract when it needs to lengthen and relax.
This can make stool more difficult to pass and may contribute to straining, incomplete emptying or a feeling of blockage.
Pelvic floor dysfunction is only one potential contributor to constipation, which is why understanding your broader bowel habits and health history is important.
Can a Tight Pelvic Floor Cause Constipation?
It can contribute to difficulty emptying the bowels for some people.
A pelvic floor that has difficulty relaxing may make it harder to coordinate an effective bowel motion.
You might notice that you have to strain, feel unable to completely empty or find yourself repeatedly returning to the toilet.
Importantly, this means constipation associated with pelvic floor dysfunction isn't necessarily treated by simply doing more pelvic floor strengthening exercises. Some people instead need to work on relaxation, coordination and bowel-emptying strategies.
Why Do I Feel Like I Haven't Completely Emptied My Bowels?
The sensation that stool remains after you've finished a bowel motion is known as incomplete evacuation.
There can be several reasons for this, including stool consistency, constipation, pelvic floor coordination and structural changes such as a rectocele.
If incomplete emptying is happening regularly, an assessment can help determine what may be contributing rather than simply continuing to strain.
Why Do I Need to Press Around My Vagina to Poo?
Some people find they need to apply pressure around the vagina, perineum or rectum to help complete a bowel movement. This is sometimes called splinting.
For some people, vaginal splinting can help support the back wall of the vagina during a bowel motion when a posterior vaginal wall prolapse (rectocele) is present.
If you regularly need to use your fingers or pressure to help empty your bowels, it's worth discussing this with a pelvic health practitioner or medical professional.
What Is the Best Position to Poo?
Your position on the toilet can influence how easily you empty your bowels.
For many people, placing the feet on a small stool so the knees sit slightly higher than the hips can provide a more comfortable position for bowel emptying.
It may also help to:
Lean slightly forward
Rest your forearms on your thighs
Allow your abdomen to relax
Avoid holding your breath
Use gentle breathing rather than forceful straining
Give yourself time without sitting and repeatedly pushing for prolonged periods
The ideal strategy can vary depending on your individual symptoms and pelvic floor function.
Is Straining to Poo Bad for Your Pelvic Floor?
Occasional straining can happen, particularly with a hard bowel motion. However, regularly needing to strain significantly is worth addressing.
Repeated high-pressure straining may place additional load on the pelvic floor and can be particularly relevant for people experiencing pelvic organ prolapse or other pelvic floor symptoms.
Rather than simply trying to push harder, it's useful to understand why your bowel movements are difficult to pass in the first place.
Can Constipation Make Prolapse Symptoms Worse?
Constipation and repeated straining can increase downward pressure through the pelvic floor and may aggravate symptoms such as vaginal heaviness, pressure or bulging in someone with pelvic organ prolapse.
Managing bowel function is therefore often an important part of conservative prolapse management.
If you're experiencing both constipation and symptoms of prolapse, it can be useful to assess them together.
Can Constipation Cause Bladder Symptoms?
The bowel and bladder sit close together within the pelvis, and significant constipation can sometimes occur alongside changes in bladder symptoms.
Some people experiencing constipation may also report urinary urgency, frequency or difficulty emptying their bladder.
There can be multiple reasons for bladder symptoms, so persistent changes should be appropriately assessed rather than automatically attributed to constipation.
How Can Pelvic Health Care Help With Constipation?
A pelvic health assessment can explore your bowel habits, toileting technique, symptoms and pelvic floor function to determine whether pelvic floor dysfunction may be contributing.
Depending on your presentation, management may include:
Pelvic floor relaxation and coordination
Bowel-emptying strategies
Toileting position and technique
Breathing and pressure management
Education around bowel habits
Strategies to reduce unnecessary straining
Management of associated pelvic floor symptoms
Exercise and movement advice
Referral to a GP, dietitian or other healthcare professional where appropriate
Constipation can have gastrointestinal, dietary, medication-related and medical causes, so pelvic health care may form one part of a broader management approach.
When Should I Seek Help for Constipation?
If you're regularly straining, experiencing incomplete emptying, relying on splinting, having persistent hard stools or finding that constipation is affecting your pelvic floor symptoms or quality of life, it's worth seeking advice.
Seek medical assessment for new or significant changes in bowel habits, blood in your stool, black stools, unexplained weight loss, persistent abdominal pain or other concerning symptoms.
Pelvic Health Care in Healesville & the Yarra Valley
At Yarra Valley Women's Health, our pelvic health osteopaths assess bowel and pelvic floor concerns including constipation, difficulty emptying, bowel urgency and associated pelvic floor dysfunction.
Our goal is to help you better understand what may be contributing to your symptoms and provide individualised education and management strategies.