Constipation, dyssynergia and your pelvic floor muscles

Constipation, dyssynergia, and your pelvic floor muscles 

Your “gut reaction” might actually be telling you something about your pelvic floor muscle function.  If you do not have regular bowel movements or have pain or difficulty emptying your bowels you could be one of the 20% of folks who experience constipation. In fact, during Roman times, the health of an individual was partially based on the quality of their BM’s.  Today, we have sophisticated measures and tests to determine your total body health, but there is merit in having a daily BM’s without effort or strain.


Symptoms of Constipation

Common symptoms of constipation include infrequent bowel movements, straining, hard stools, and the sensation of incomplete emptying of fecal matter with BM’s. Some people report that they are able to go a little at a time and require multiple trips to the toilet.   Specific diagnosis requirements for constipation, the Rome IV Diagnostic Criteria for Functional GI Disorders can be found here. In some cases, pressure is applied in front of the rectum to help empty a little easier. Laxatives, stool softeners and enemas are all tools that patients report using with varied degrees of success.   


What are normal BM habits?

Not everyone has a daily bowel movement. Normal bowel habits vary from 1-3  times per day to one every 3 days. Normal stool should be soft and well-formed and easy to evacuate without straining.  If you are not sure how your stool measures up, take a look at the Bristol Stool Chart. (Yes, there is officially a poop chart- it seems a little gross but can be helpful). If you are constipated, chances are your stool looks more like Type 1 or Type 2- an ideal stool is Type 3 or Type 4.


Medical testing

If you have constipation and haven’t seen your doctor yet, now is a good time. There are different treatments for constipation depending on the cause. Your provider can work with you to rule out any underlying medical conditions that can cause constipation and get you started on necessary dietary changes and/or supplements.  One test your medical doctor might suggest is anorectal manometry. During this test, you will have a small balloon inserted into your rectum and are asked to push it out as if you are having a bowel movement.  Measurements of your pelvic floor muscle activity will be recorded and compared to normal values. With constipation, a diagnosis of pelvic floor dyssynergia is commonly found during anorectal manometry.


Role of physical therapy: neuromuscular retraining

If you are diagnosed with pelvic floor dyssynergia physical therapy can help.  Pelvic floor dyssynergia means that your pelvic muscles are contracting and closing the rectum rather than relaxing and opening the sphincter when you attempt to have a bowel movement.  Pelvic floor muscle tightening results in increased straining and may even be painful. At Carolina Pelvic Health Center, specially trained, pelvic floor physical therapists, can teach you how to properly relax your muscles and treat muscle spasms associated with poor straining technique.  Biofeedback has been shown to be effective and is like a video game for your pelvic muscles. A small sensor is placed in the rectum and is connected to a computer to allow you and your therapist to ‘see’ what your muscles do when you contract and relax them. Rectal balloon retraining may also be helpful to teach the pelvic floor muscles how to relax and eliminate stool that is similar in size and shape of real stool.  A small balloon is inserted into the rectum and inflated to the size of “normal” stool to simulate the sensation of evacuation of stool as you learn how to relax and expand your pelvic floor muscles. It is comfortable and helpful for some patients.


Tips for easier BM’s

Positioning:  How you sit on the toilet is key to help your pelvic floor muscle relax to fully eliminate stool.  Sometimes using a stool like a Squatty Potty can help.


Water:  Water is critical for forming feces and moving feces through the colon.  Aim to drink a glass with every meal and 2 or 3 more between meals.

Exercise:  Movement helps stimulate peristalsis in the colon and aids in digestion by bringing blood flow to the intestines.  A daily walk will help facilitate the movement of the colon, especially after meals. Try these exercises daily to help relax the central nervous system and promote peristalsis.


Breathe:  Regular diaphragmatic breathing will help increase the parasympathetic nervous system activity which regulates digestion. Learn how to do diaphragmatic breathing to help relax the pelvic floor muscles and facilitate parasympathetic nervous system activity.


Massage: Give your belly a gentle rub from right to left along the route of the large intestine.

Listen to your urges:  If your body tells you it’s time to go, take the time to stop what you’re doing and empty your bowels.  


Pelvic Floor Physical Therapy

Call us today to schedule your pelvic floor muscle assessment. Learn coordination techniques to relax and lengthen your pelvic floor muscles to comfortably and fully eliminate your bowels.  

J Am Board Fam Med July-August 2011 vol. 24 no. 4436-451