Constipation Management

Although most people aren’t openly discussing their bowel habits, I can assure you that constipation is a common problem in America and one of the most common conditions I treat as a Pelvic Health Physical Therapist. Especially around times of great change - like pregnancy and postpartum. 

And why do we care?

You may be wondering how constipation is related to pelvic health? It’s actually very closely related. The pelvic floor muscles play a large role in defecation. And if there is pelvic floor dysfunction, you are more likely to suffer from constipation, and vice versa. In fact, up to 50% of people with chronic constipation also have a pelvic floor dysfunction.  It’s a chicken or the egg situation, where one can cause the other, but we don’t always need to know what starts the vicious cycle. That being said, keeping bowels regular and easy to pass is very important for protecting your pelvic floor and optimizing pelvic health. 

What causes constipation?

Constipation is such a prevalent problem because there are many causes, therefore it can be challenging to find a solution. That being said, I find it’s best to take a comprehensive approach and tackle it from all angles. It’s first helpful to know what could be contributing to your constipation. These are some of the most common causes but certainly not an exhaustive list: 

• Dehydration

• Lack of fiber or too much fiber

• Lack of physical activity 

• Stress

• Pelvic floor dysfunctions like pelvic floor tension, discoordination or prolapse

• Delaying bowel movement after getting the urge to go

• Pregnancy or breastfeeding

• Certain medications like pain killers

• Improper toileting mechanics and posture

• Medical conditions like IBS, endometriosis, celiac disease, etc. 

• Food sensitivities or allergies 

What can you do?

 Like I said, it’s best to take a comprehensive approach. But it is also helpful to try one or two things at a time so you know what’s helping. I would first make sure you are grabbing the “low-hanging fruit” and then add in additional support as needed.

The Low-Hanging Fruit:

• Hydration: You should be getting in at least half your body weight in fluid ounces of water per day. 

• Fiber: Bulk up your diet with high fiber foods including lots of fruits and veggies and foods like beans, whole grains and nuts/seeds as tolerable. Most Americans are not getting in the daily recommended amount of fiber. Women should be getting around 25 grams per day and men should be getting around 38 grams per day - ideally from food sources. You can gradually work up to this goal by increasing fiber intake by 2-3 grams per day. You want both soluble and insoluble fiber in your diet, but if you tend to run more constipated, I would focus on insoluble fiber as it can help make bowel movements easier to pass. Foods high in insoluble fiber include:

• Whole grains

• Nuts and seeds - psst chia seeds have a ton of fiber in them! 

• Most vegetables (spinach, cauliflower, celery, green beans, zucchini)

• Fruits like  tomatoes, unripe bananas, and kiwi 

• Movement: Regular exercise can help with your bowel motility. Walking is a great way to stimulate a bowel movement in the morning but any form of exercise will help.  

• Toileting habits: 

• Avoid straining! This can lead to prolapse, hemorrhoids or other pelvic floor issues like urinary leakage. 

• Use a squatty potty or step stool under your feet. This puts your pelvic floor in a more relaxed position, making stool easier to pass. Modern day toilets are not conducive for optimal pooping - think about our ancestors pooping in the woods. Getting knees above hips simulates this deep squat position. 

• Sit up straight and lean forward so hands or elbows are supported on thighs. 

• Take a few slow and deep breaths, expanding your belly as you inhale. As you exhale, keep your belly expanded.

• You can try making a “shhh” or “moo” sound as you exhale. This can further help relax your pelvic floor. 

• You can also visualize the space between your vagina and anus widening. 

• Go when you have the urge to go. Try to avoid delaying the urge. This will give your body time to reabsorb water and make the stool harder. 

• If you don’t have a bowel movement within 5-10 minutes of sitting on the toilet, leave and try again later when the urge hits again. Prolonged sitting on the toilet can lead to hemorrhoids because blood is pooling and causing veins to swell.  

Additional Supports:

• Consider adding in magnesium citrate. CALM is the brand I commonly recommend. 

• On days you are having a hard time eating enough fiber from your food, you can supplement with things like sunfiber, or psyllium husk. 

• Practice pelvic floor relaxation exercises or yoga. Diaphragm breathing, child’s pose, hip and abdominal stretches and reverse kegels would all be very helpful. 

• Try bowel massage.

• If you aren’t finding relief with the tips above, I would strongly recommend booking a virtual consult or seeking out an in-person Pelvic Floor PT.