Constipation and the Pelvic Floor

Constipation is becoming an epidemic in North America. According to WebMD you are considered constipated if you have two or more of the following for at least 3 months:

  • Straining during a bowel movement more than 25% of the timeconstipation - pelvic floor
  • Hard stools more than 25% of the time
  • Incomplete evacuation more than 25% of the time
  • Two or fewer bowel movements in a week

The fact is, constipation is one of the most common gastrointestinal problems in the United States today. Over four million people suffer from constipation in the US and roughly two million doctor visits each year are the result of constipation. Unfortunately, Canadians are not doing any better! They spend almost a billion dollars on laxatives each year and yet constipation is still on the rise.

According to Pelvic Health Solutions, chronic constipation is frequently a cause of damage to the pelvic floor muscles and fascial support (ligaments).  Chronic constipation can cause stretching of the pudendal nerve due to prolonged and repetitive straining (leading to pelvic floor weakness secondary to nerve damage). They also state that constipation creates more pressure on the bladder and urethra which may cause increased urinary frequency or retention.

Some people can even have Animus.  Known by a number of other medical names including pelvic floor dyssynergia and paradoxical puborectalis contraction. It refers to a condition in which the external anal sphincter and the puborectalis muscle contracts rather than relaxes during an attempted bowel motion. It is one of the causes of obstructed defaecation syndrome (ODS).

So what is constipation? Constipation is the slow movement of stool through the colon. According to, the two disorders limited to the colon that cause constipation are colonic inertia and pelvic floor dysfunction. Constipation is seen as somewhat benign and easily treated. However a Canadian study completed in 2002 concluded that constipation significantly impairs health-related quality of life! For those suffering from this condition, we heartily agree. Additionally, physical and psychological effects of constipation are intricately linked – as constipation can be exasperated by stress. You can read more about  stress and constipation here.

The number of bowel movements seems to decrease with age. Most adults have bowel movements between three and 21 times per week. The most common pattern is one bowel movement a day, but many people are irregular and do not have bowel movements every day or the same number of bowel movements each day. Dr. Edward Group suggests that we should have three bowel movements every day, one after each large meal. How about you? Want to learn more about “your movements?” Check out this great article from Gut Sense that will help get you moving!

What Contributes to Constipation?

To have a good bowel movement you need peristalsis, fibre, and moisture. Your colon absorbs lots of water. In fact according to Johns Hopkins Medicine, hard, dry stools are the result of the colon absorbing too much water. Normally, as food moves through the colon (also known as the large intestine) the colon absorbs water while forming stool (waste products). Muscle contractions then push the stool toward the rectum, and, by the time the stool reaches the rectum, most of the water has been absorbed, making the stool solid.

When the colon’s muscle contractions are slow or sluggish, the stool moves through the colon too slowly, resulting in too much water being absorbed. Hmm, so it’s not all about drinking more water!

Too little activity or exercise is another cause of occasional constipation. It just makes good sense. If you fail to move your body your digestive system slows down! People who are hospitalized, and/or bedridden and cannot exercise, often find themselves with constipation.

Stress can also contribute to occasional constipation. Typically when a person is stressed they don’t eat right, sleep well, forget to drink plenty of water, skip moving around or getting some exercise, and may ignore the body’s messages that it is time to “go.” All these behaviors can contribute to a lifestyle that makes a person susceptible to irregularity and constipation.

medications and constipationMany medications—both prescription and over-the-counter medications—can cause constipation. Sometimes your body will adjust to the medication and regulate itself but in other cases especially with certain pain, high blood pressure, and cholesterol medications, constipation may become an ongoing problem.

Ever consider that what you eat could be binding you up? What we eat is the most important factor in relieving and preventing constipation. Excess amounts of light, dry and astringent foods like legumes, raw greens (spinach, lettuce, alfalfa sprouts), pretzels, chips, beans, corn and corn products, pomegranate and cranberries can cause dryness in the body. This article from MindBodyGreen explains how certain foods may help with constipation.

FACT: Constipation has been indicated as one of the most common gastrointestinal disorders in patients with atopic dermatitis and food allergy.

Are you intolerant? The next possibility to explore is that you are eating something you are intolerant to. Some people don’t make the digestive enzyme lactase as adults, so can’t digest milk. Similarly, others can’t digest beans. Most beans contain a certain type of sugar called oligosaccharides that are difficult for the human digestive system to digest. Foods containing soya protein, or kidney beans, are notoriously flatulence producing. A possible solution here is to take a digestive enzyme containing alpha-galactosidase, like Renew Life’s GasStop  or here is a list of others you could try. Want to know more about digestive enzymes, read it here.

Another type of oligosaccharide that’s hard to digest is glucosides, found predominantly in cruciferous vegetables such as cabbage, kale, cauliflower, broccoli and Brussel’s sprouts. A digestive enzyme containing amyloglucosidase (also called glucoamylase) might be one to try as well! All these foods, if not digested by you, will be digested by the bacteria within you, producing gas. So give digestive enzymes a try, take them with each meal and take two. 

We also eat food that has enzyme prohibitors. Dr. Edward Howell, author of Food Enzymes for Health & Longevity and pioneer food enzyme researcher, explains:

“These enzyme inhibitors are present for the protection of the seed. Nature doesn’t want the seed to germinate prematurely and lose its life. It wants to make sure that the seed is present in soil with sufficient moisture to grow and continue the species.”

Raw peanuts, raw wheat germ, egg whites, nuts, seeds, beans, peas, potatoes & lentils are all examples of healthy raw foods that contain enzyme inhibitors. This means that they actually neutralize some of the enzymes your body produces. So another reason that digestive enzymes may work for you.

How are your toilet habits? Most people are just plain busy! Many people don’t take the time to go to the toilet properly. When we constantly ignore the need to pass a bowel movement, too much water can be absorbed from the stool and it can become dry and impacted leading to constipation. According to Konstantin Monastyrsky, author of Gut Sense, as we grow up, we learn to suppress the defecation urge by constricting our rectums with our pelvic muscles. While still young, we squint, grimace, and cross our legs to accomplish it; later in life we can suppress all but the strongest urge, completely unnoticed and wrinkle-free.

Mr. Monastyrsky goes on to explain, that this essential social skill has a downside. If you keep suppressing defecation for too long, usually over a day, retained stools gradually impact, dry out, harden up, and require straining to get expelled regardless of size. He suggests that we should should move our bowels as soon as we sense the defecation urge, usually after each major meal. In this ideal situation, stools are soft, small, and barely formed, which is perfectly normal. Who knew?

SIBO – Small intestinal bacterial overgrowth – Some people have more bacteria present in the small intestines than there should be. This can cause bloating and if the bacteria present are producing the gas methane this is known to slow down the transit time which can cause constipation. 10 Signs Of Small Intestinal Bacterial Overgrowth (SIBO)

Consider Adding Fibre

The jury is still out on whether or not increasing your fibre intake is necessary to treat constipation. But experts do agree that fibre absorbs moisture, which increases stool size, and makes the stool softer. Natural bulk laxatives provide soluble fiber to help intestinal motility and can be taken daily as necessary to create a soft, spongy stool. If you decide to add more fibre to your diet, consider pectin from fruit, flaxseed, chia seed, and oat bran. Organic ground flax seed or oil is another way to counterbalance dryness and increase fiber in the diet. Make sure you are drinking plenty of water, or it will just be dry and get stuck! Yuck! So, let’s consider fibre as a preventative method, not the treatment.

Consider Adding Magnesium 

Proper moisture in the stool is vital for easier elimination. Roughly 7 liters of fluid is dumped into the large intestine every day — this includes digestive secretions and any liquids that we consume. Our large intestine must reabsorb the proper amount so the stool moisture is just right. If the stool is dry — this can hurt! Magnesium helps draw moisture into the bowel and soften the stool. This study showed that constipation is associated with low intake of magnesium and low intake of water from foods. To get more magnesium in your diet, eat leafy green vegetables, nuts, and seeds. It’s good to note that magnesium is depleted by stress, alcohol, sugar, and sodas (high in phosphoric acid), so decrease your consumption of them if possible. Most people do well with up to about 1,200 mg of magnesium per day. I like to take 500mg before bed. We are all different, so play around with what works for you.

Magnesium supplements come in a variety of forms, with the most popular being citrate, chelate and sulfate. I happen to use magnesium oxide, as it just seems to work best for me. I take it before bed so it can work overnight. Some people find Natural Calm magnesium very effective – consider using a teaspoon of Natural Calm before you go to bed.  Add some warm water to it to create a fizzy tasty beverage. I find that Magnesium Oxide at 1000 mg before bed to be a great way to get the bowels moving. 

Consider Using a Castor Oil Pack

A castor oil pack involves the use of cloth soaked in castor oil which is placed on the skin. It’s been used to enhance circulation and to promote the healing of the tissues and organs underneath the skin, and to improve liver function, relieve pain, reduce inflammation and to improve digestion.

Soak unbleached wool or cotton flannel (3-4 pieces or layers about 12″ x 14″ each) in high-quality, cold-pressed castor oil. Wring off any extra to avoid a mess. Lie down in a relaxing atmosphere, placing the oily cloth directly over your liver (on your right side, stretching horizontally just below your ribcage). You may want to place some plastic between the material and the heating element, if you wish. Then place a heating element, like a hot water bottle or heating pad, on top of your belly. This keeps your vital organs supple and warms the oil, easing its penetration. Relax and let your body rest.  After 20-30 minutes, remove the heat and castor oil pack. Here are some in-depth instructions to get you going.

Consider an I Love U Abdominal Massage

i love u massageSelf-massage is used for constipation/loose bowels and generalized pelvic and abdominal pain. The I Love U massage is a great way to get you moving! These strokes follow the path of the large intestine, helping to calm it if it is irritated, and increasing the movement of food in your gut. Always do the massage from right to left using a dab of oil, to help ease the process. Start by forming the letter “I” by stroking with moderate pressure from under the left ribcage down to the front of the left hipbone, 10x. Next, form the letter “L” by stroking with moderate pressure from the right ribcage, underneath the ribcage to the left, and down to the front of the left hipbone. This should form the letter “L.” Finish with 10 strokes from the front of the right hipbone up to the right ribcage, across to the left ribcage, and down to the left hip bone, forming the letter “U.” Do this massage 1-2x daily for maximum results.
This video will help you to do an abdominal massage to help get your bowels moving. Here is a good article on the “I love U” technique you can use on an infant and of course you can use it on yourself too.

Consider Using Digestive Enzymes

As previously discussed, digestive enzymes work to help break down the food we eat at a faster rate. The faster the breakdown, the more quickly food processes through the colon. If you plan on eating a difficult-to-digest meal, I recommend taking a digestive enzyme 20 minutes before eating. Here is a very in-depth article on digestive enzymes that touches on basic dosing and what enzymes to take for what conditions.

Consider Using Probiotics

Have you taken antibiotics recently? Perhaps in the past few years? The effects of antibiotics can stick around for quite some time. Antibiotics can be brutal on the lining of the stomach and effect the digestive acids which enable us to properly digest our food. If you find yourself constipated and miserable after a course of treatment, be sure to take a high quality (refrigerated) probiotic with a high bacterial count.

Probiotics help to heal the gut and reform the body’s good bacteria. In the future, if you find you must take an antibiotic, be sure to take a probiotic along with it to prevent damage to the stomach lining. This article from Enzyme Stuff is quite detailed and will tell you what type you should try and why.

Consider Adjusting Your Posture

Another type of stress, the misalignment of the spine, can also contribute to constipation. Lumbar spinal adjustments by a chiropractor may be helpful, as may other forms of bodywork.

Consider Exercising or Moving More

One exercise to add to your stretching routine is the knee to chest stretch (sustained for 30 seconds to one minute) to stimulate bowel motility. Also consider adding squats to your daily regime. I like to try and walk 10-15 minutes after each meal. I have mats laying out in my bedroom and in the basement and I walk back and forth on them if I can’t get outdoors.

Consider Using Lemon

Lemon contains citric acid, which helps stimulate the colon. It allows your digestive system to remove toxins from the intestinal tract and it also allows undigested food matter to be detached from the intestinal wall.  I find that lemon makes me acidic, but it may work for you. Try the following to see how lemons may treat your constipation:

  • Take a regular-sized lemon and cut it in half. Squeeze the juice from one of the halves into an 8 oz. glass.
  • Add a pinch of rock salt to it. If you do not have rock salt, then try and find some sea salt.
  • Add a teaspoon or less of honey. Besides being a natural sweetener, honey has anti-inflammatory properties as well!
  • Fill the glass with filtered lukewarm water. Stir gently till all of the salt is dissolved.
  • Drink this first thing in the morning on an empty stomach.

Your condition should improve in a few days. Keep drinking this everyday to prevent the symptoms from ever showing up again!

Consider Changing How You Sit on the Toilet

Did you know that your knees should be above your hip level and your feet supported when you sit on the toilet?  This mimics the position of squatting during a bowel movement, which is how we were intended to defecate.  Toilets are considered a civilized luxury, but they are not kind to our pelvic floors because the angle between the anus and rectum is too high and makes it difficult for stool to get move freely. 

An Israeli toilet-constipationdoctor named Dov Sikirov tested this idea for a 2003 study published in Digestive Diseases and Sciences. Dr. Sikirov had several dozen patients defecate in each of three positions: sitting on a 16-inch-high toilet, sitting on a 12-inch-high toilet, and squatting over a plastic container. He asked his subjects to record how long each bowel movement took and asked them to rate the effort required on a four-point scale ranging from effortless to difficult. Sikirov found that, when squatting, subjects averaged 51 seconds to move their bowels, versus 130 seconds when sitting on the higher toilet. Interestingly enough, those who moved from a sit to a squat were more likely to rate the experience as easier!

Have you ever heard of the Squatty Potty®? It creates healthy toilet posture to relieve and prevent constipation in the following ways:

In the squatting position, it allows gravity to do most of the work. The weight of the torso presses against the thighs and compresses the colon. Squatting relaxes the puborectalis muscle, allowing the anorectal angle to straighten and the bowel to empty completely. Squatting lifts the sigmoid colon to unlock the “kink” at the entrance to the rectum. The colon has an inlet valve (the ileocecal valve) and an outlet valve (the puborectalis muscle). Squatting simultaneously closes the inlet valve, to keep the small intestine clean, and opens the outlet valve, to allow wastes to pass freely. Pretty slick eh?

Some other evacuation strategies…

  • Do not force out bowel contents. It is better to activate the bowel evacuation through movement.
  • Don’t strain; take a deep breath in, and breathe out slowly through pursed lips as you gently push. If you say the word “moo” slowly (stressing the o’s) that also seems to help things get moving. Don’t laugh, give it a try!
  • You can lean forwards – try and push your feet against something – use a stool, a stack of books or yoga blocks, or even the edge of the bathtub if it is close enough. You need a posterior force through the abdomen to help direct the passage of stool down the colon. 
  • Don’t stay on the toilet for more than five minutes; get up and get moving, maybe do an abdominal massage or some stretching, or try again when the urge returns or after your next meal.
  • Here is an excellent article by Jessica Reale, DPT on bathroom help for your child. If your child struggles with constipation I would take the time to read it.

This article by Michelle Kenway is a must read if you have constipation. 4 Essential Steps to Overcoming Bowel Incontinence & Bowel Leakage

Another great article is by Karen Reed – How To Get Rid Of Constipation Immediately and Naturally – She discuss natural remedies to get rid of constipation.

Consider following me on Twitter @MyPelvicHealth

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