Constipation plays a major role in pelvic pain. It can cause existing pain to flare or can be a contributing factor responsible for the pelvic pain to begin with. So, it’s really important to maintain regular, healthy BMs. But, for so many women and men with pelvic pain/dysfunction that can be a major challenge. If you’re in that boat, this post is a must-read!
There are two different types of constipation. And what many don’t realize is that one type, “outlet constipation” is often caused by dysfunctional pelvic floor muscles. However, because both types can negatively impact your pelvic floor, in this post I plan to give you the run down on both of them, as well as a list of strategies, including a few that your pelvic floor PT can help you with, that can get things moving in the right direction.
The first type of constipation is “general constipation,” and is caused by a lack of motility in the large intestine. The large intestine a.k.a. the colon is designed to carry out a contracting and squeezing motion that propels stool through it. This action can become impaired causing stool to move excessively slow or not much at all. A variety of things can lead to this first type of constipation such as poor diet, lack of fluid intake, lack of exercise or a sluggish colon that may or may not be associated with irritable bowel syndrome. Also, many kinds of medication, like opiates or other pain meds can cause general constipation.
The second type of constipation is what is known as “outlet constipation.” Outlet constipation occurs when stool sits in the rectum and is difficult to eliminate. In other words, the train makes it to the station, but then gets stuck there and won’t go forward! This can be due to either tight pelvic floor muscles or a situation where the “posterior wall,” the wall that separates the vaginal and rectal canals, is weak causing the stool to become stuck. We discuss this at greater length here: “What’s The Right Way To Poop?”
When it comes to outlet constipation, dysfunctional pelvic floor muscles are often the cause. When a muscle becomes tight, it becomes shortened and has too much tension when at rest—a.k.a.: a muscle spasm. When the pelvic floor muscles are in spasm, they often cannot relax sufficiently enough to allow stool to pass through the external sphincter with ease and without pain.
When stool becomes stuck, we have a tendency to want to bear down and push in an effort to pass it. But, straining only makes matters worse; the more we push, the angrier the muscles become causing the muscles to tighten even further. Over time, this can cause the posterior wall to weaken, further exacerbating constipation. Now, not only is stool having a hard time getting through the external sphincter, it’s getting stuck and pocketing in a weak posterior wall.
Whatever its cause, it is essential to put an end to constipation.
So, what can you do if you suffer with constipation?
First, work with your doctor to figure out where the problem is—is it high up in the colon or further down in the rectum or both? Is your constipation outlet constipation or general constipation, or both. Be sure and ask your doctor if any of the current medications you are taking can be the cause of your constipation. If medication you are taking for your chronic pelvic pain is the cause, discuss whether this medication can be swapped for another without a constipation side effect.
In regards to outlet constipation, physical therapy is a must when the muscles are responsible for the problem. Working with an experienced pelvic floor physical therapist who can do transvaginal and/or rectal myofascial release and trigger point release to the pelvic floor muscles can decrease or eliminate this problem altogether. Your therapist will likely also teach you techniques, such as self treatment with dilators and the “squat stretch” technique to aid in decreasing or eliminating your outlet constipation issues.
If it’s general constipation you are dealing with, getting enough exercise is important. Additionally addressing deficiencies in your diet is essential. Consuming enough fiber—adding flax seed into your diet is a good way to increase your fiber intake—and drinking lots of water can be helpful. Also, taking a Magnesium supplement combined with a Vitamin C supplement can kick start your system. (But, before you begin taking these supplements, be sure and discuss it with your doctor to make sure they will not interfere with any current treatment or medication you are on.)
If these basic steps are not enough, your doctor can work with you suggesting things such as stool softeners or fiber supplements such as Citrucel or Metamucil.
Performing a daily colon massage is another excellent way to get your colon moving. Ask your physical therapist to show you how to do this.
Also, changing the way you sit on the toilet can help get things moving. The squatting position is one of the best positions for pelvic floor relaxation, and it is WAY easier to have BM in a position similar to a squat as compared to sitting upright on the toilet. To simulate the squatting position on the toilet, you can use a small stool or a phonebook to prop your feet on. Your knees should be higher than your hips. This position helps your pelvic floor muscles that sling around your rectum relax a bit, so the stool can pass easier through the rectum.
Finally, a complementary and alternative approach to general constipation is acupuncture.
Have you had any issues with constipation that have impacted your pelvic floor impairments? If so, what were/are the strategies you deploy to break the constipation cycle?
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All the best and happy trails!
Marcy Crouch, a PT at the Pelvic Health and Rehabilitation Center, is the clinic’s Oakland location Director. Click here to read more about Marcy.
Thanks to Julie Sarton, a PT and founder of Southern California-based, Sarton Physical Therapy, for her collaboration on this blog. Click here to read more about Julie.