Why Do I Still Feel Backed Up If I Poop Everyday? Here’s How Pelvic Floor Physical Therapy Can Improve Chronic Constipation

We’ve all experienced that feeling of being “backed up,” but what if you’re pooping every day and still feel uncomfortable or incomplete? If you’re dealing with chronic constipation, the issue may lie deeper than just your digestive system. Surprisingly, your pelvic floor could be playing a significant role.

What is Constipation?

Constipation is typically defined by infrequent, difficult, painful, or incomplete bowel movements (BMs), and it often comes with a variety of uncomfortable symptoms. Common reports from people suffering from constipation include:

• Abdominal pain 

• Bloating or feeling of fullness

• Irregular bowel movements, less than 3 times per week 

• Hard, small bowel movements

• Straining during evacuation 

• Pain during evacuation

What Causes Constipation?

Several factors can disrupt the functioning of your digestive system, leading to constipation. Common causes include:

• Insufficient water intake

• Medications

• Lack of physical activity

• Poor dietary choices

• Increased stress

• Changes in daily routine

In many cases, constipation resolves quickly once these triggers are addressed. However, if symptoms persist for an extended period, chronic constipation may be a sign that there’s more going on beneath the surface.

Who to See for Constipation?

Dealing with chronic constipation can be challenging and requires a multi-disciplinary approach. Key healthcare providers to consult include: 

• Primary Care Provider 

• Gastroenterologist 

• Dietician

• Pelvic Floor Physical Therapist

• Mental health counselor or psychologist 

So How Does Physical Therapy Help Constipation?

Understanding the root cause of your constipation is crucial. Two common contributors are:

1. Slow Gastrointestinal Motility

2. Poor Coordination of Evacuation (known as dyssynergic defecation)

If slow motility is a factor, a pelvic floor physical therapist can assess the abdomen for myofascial restrictions that may be affecting the function of your digestive organs. Through hands-on release techniques, visceral mobilization, breathwork, and stretching, pelvic floor therapy can help improve GI motility.

People who experience incomplete bowel emptying often report having daily bowel movements but never feel fully relieved. They may find themselves straining excessively during evacuation. For a bowel movement to be complete, the pelvic floor muscles must relax and lengthen properly to allow stool to pass through the rectum. When these muscles don’t function correctly, the necessary relaxation and lengthening may not occur, leading to incomplete emptying. A pelvic floor therapist can assess the function of these muscles and treat any dysfunction to improve bowel function.

How Does Pelvic Floor Dysfunction Lead to Incomplete Emptying?

Pelvic floor dysfunction can result in incomplete bowel emptying due to several issues with the muscles that support the pelvic region. Here are the main causes:

1. Excess Muscle Tension
   In some cases, the muscles of the pelvic floor, particularly the puborectalis and external anal sphincter (EAS), become overly tight or tense. These muscles, which encircle the rectum internally, can create pressure that makes it difficult for stool to pass through the rectum and anal canal. Pelvic floor physical therapists are trained to help release this muscle tension using manual therapy, stretching, and breathing techniques.

2. Coordination Problems
   In other cases, the pelvic floor muscles may not be too tight, but they aren't coordinating properly. A common issue is paradoxical contraction of the external anal sphincter (EAS), the muscle that controls voluntary opening and closing of the anus. During a bowel movement, instead of relaxing to allow stool to pass, the EAS may contract, making it harder to evacuate. Pelvic floor therapists can assess the coordination of this muscle and use techniques like manual feedback or biofeedback to help patients retrain the EAS to relax appropriately.

3. Muscle Weakness
   In some instances, the pelvic floor muscles may be weak, leading to dysfunctions such as pelvic organ prolapse. When pelvic organs descend or prolapse, it can cause structural changes that obstruct the passage of stool through the rectum. Pelvic floor physical therapists can assess prolapse and help manage symptoms through strengthening exercises, pressure management strategies, and techniques to reduce the impact of prolapse during bowel movements.

By addressing these dysfunctions, pelvic floor therapists can help improve bowel emptying and alleviate related symptoms.

What Does Pelvic Floor Therapy Treatment Involve?

Treatment for pelvic floor dysfunction is personalized based on an individual's specific symptoms and needs. A comprehensive treatment plan may include a combination of the following interventions:

• Pelvic Floor Muscle Release: Techniques to reduce muscle tension and restore normal muscle function.

• Biofeedback: A method to help patients improve muscle coordination and learn to control pelvic floor muscles more effectively.

• Breathwork: Breathing exercises designed to promote relaxation and proper pelvic floor muscle activation.

• Exercise Programming: Tailored exercises to strengthen or relax pelvic floor muscles, depending on the dysfunction.

• Patient Education: Guidance on understanding pelvic floor health and how to manage symptoms.

• Lifestyle Modifications: Recommendations for changes in daily habits or routines that support pelvic health, such as posture adjustments or hydration strategies.

Each treatment plan is individualized to address the specific dysfunction and goals of the patient.

What Can I Do Right Now to Improve My Constipation?

If the symptoms discussed in this article sound familiar, there are a few simple steps you can take today to help improve your constipation:

1. Prioritize Hydration
   Aim to drink about half your body weight in fluid ounces each day, with 75-80% of that being water. Staying well-hydrated helps prevent stools from becoming hard and dry, making them easier to pass.

2. Elevate Your Feet During BMs
   Use a step stool or a Squatty Potty to raise your feet while on the toilet. This helps improve the angle of your rectum and the length of the pelvic floor muscles, making it easier to fully evacuate.

3. Increase Your Fiber Intake
   Aim for around 28 grams of fiber per day, as recommended by current dietary guidelines for Americans. Fiber helps bulk up stool and promotes regular bowel movements.

4. Get Moving
   Engage in regular, moderate physical activity. Movement can stimulate your bowels and help prevent constipation.

5. Schedule an Evaluation
   If you're still struggling, consider scheduling an initial evaluation with one of our pelvic floor physical therapists at MomLife Health and Wellness in Medfield or Braintree, MA. We can assess your pelvic health and provide personalized treatment to help improve your symptoms.

Making these changes today can help you start feeling better soon!

Written by Dr. Alyssa Demeule, PT, DPT 

Alyssa is currently accepting new patients at MomLife Health and Wellness in Braintree, MA.