Unclogged: How Pelvic Health Can Get Things Moving
It often results in discomfort, bloating and feelings of incomplete evacuation. While many individuals turn to dietary changes or over-the-counter medications (e.g. Fybogel), a pelvic health physiotherapist can offer valuable insights into addressing constipation, particularly when it becomes chronic or resistant to traditional treatments. By focusing on pelvic floor function, posture, and movement patterns, physiotherapy can play a key role in both preventing and managing constipation.
The Pelvic Floor’s Role in Constipation
The pelvic floor muscles play an essential role in bowel function. These muscles surround the rectum and anus, providing support and controlling the release of stool. When these muscles are weak, tense or uncoordinated, they can contribute to constipation. For example, pelvic floor dysfunction may hinder the relaxation of muscles required for a smooth bowel movement, leading to straining and incomplete evacuation.
In some cases, people with constipation may develop a condition called ‘pelvic floor dyssynergia’, where there is a lack of coordination between the pelvic floor muscles and the abdominal muscles during defecation. This can lead to prolonged straining, pain and difficulty emptying the bowels, often exacerbating the condition.
How Pelvic Health Physiotherapy Can Help
As a pelvic health physiotherapist, I assess and treat disorders related to the pelvic floor. My approach to constipation is multifaceted. One key component of treatment involves pelvic floor exercises. For those with weak pelvic muscles, strengthening these muscles can improve bowel control and reduce constipation symptoms. Conversely, individuals with tight or hypertonic pelvic floor muscles may benefit from relaxation techniques, including diaphragmatic breathing exercises and specific stretches.
I can also provide education on optimal toileting positions. The traditional seated position on a toilet may not be the most effective for complete bowel evacuation. For example, a better position may be adopting a squatting posture or using a footstool to raise the knees above hip level, mimicking a squatting position. This has been shown to increase intra-abdominal pressure, help align the rectum and make it easier to pass stool.
There are effective abdominal massage techniques and exercises that can encourage bowel movement. Abdominal massage can stimulate peristalsis (a series of automatic, wave-like muscle contractions that move food, urine, and bile through the body) and promote regular bowel movements, while exercises that engage the core can help facilitate optimal digestive function.
Beyond direct pelvic floor interventions, I can assess your general posture and movement patterns. Poor posture – such as slouching or sitting for prolonged periods – can increase pressure on the abdomen, which in turn can disrupt normal bowel function. I can help you improve your posture through individualised exercises, and advise you on general movement. You should be getting up and moving at least every hour!
Constipation may seem like a straightforward issue, but it often involves complex interactions between the digestive system, the pelvic floor and movement patterns. Pelvic health physiotherapy offers a holistic approach to addressing these underlying factors, helping individuals regain control over their bowel function. If you are struggling with chronic constipation, a consultation with a pelvic health physiotherapist could provide the tools and strategies needed to improve your quality of life and restore regular bowel movements.
At Head2Toe Physio, we can expertly assess your pelvic floor function.
If you or anyone you know, would like to have a Women’s Health Physiotherapy assessment with Evie or Anna at Dorking or Leatherhead, book online here or contact us here.
Blog post guest written by Evie Spreadbury, Women’s Health Specialist Physiotherapist, member of Pelvic, Obstetric & Gynacological Physiotherapists (POGP), Dorking, & Leatherhead Clinics.
References
Brennen, S. (2020). Pelvic Health Physiotherapy in the Management of Constipation: A Practical Guide. Physiotherapy Theory and Practice, 36(5), 585-595. https://doi.org/10.1080/09593985.2020.1767361
Buppert, C. (2022). Prevalence of constipation in adults. British Journal of General Practice, 72(731), 334-339.
Ciccone, M. (2017). The Role of Pelvic Floor Physiotherapy in the Treatment of Functional Constipation: A Systematic Review. Journal of Gastrointestinal and Liver Diseases, 26(3), 277-284. https://doi.org/10.15403/jgld.2017.1121.263.ssr
Shafik, A., El-Sherbiny, M., & Shafik, I. (2000). Role of the Pelvic Floor Muscles in the Physiology of Defecation. Neurourology and Urodynamics, 19(3), 287-294. https://doi.org/10.1002/1520-6777(2000)19:3<287::AID-NUU9>3.0.CO;2-N
Ternent, C., McKernan, T., & Farina, S. (2017). The Effect of Posture on Bowel Movements: Implications for Physiotherapy Intervention. Journal of Clinical and Diagnostic Research, 11(4), 1-5. https://doi.org/10.7860/JCDR/2017/26267.9482
