Holiday treats weighing you down? December is Constipation Awareness Month!

 The Final Push to the New Year

December is the season of celebrations and holiday parties, and we’re nearing the home stretch with the New Year in sight.  It’s probably no accident that December is also Constipation Awareness Month. Most of us have enjoyed more than our share of heavy holiday food, and may have the occasional bowel discomfort.  But for many people, constipation is the rule, not the exception. If easier bowel movements is on your wish list this year, read on.


Patients often report infrequent bowel movements, straining, hard stools, and the sensation of not completely emptying during toileting attempts. 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 III 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 is normal?

Not everyone has a bowel movement daily. 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’s 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 4.

This sounds like me- now what?

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 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.

Pelvic Floor Dyssynergia: What it is and how to treat it

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 when you attempt to have a bowel movement.  Pelvic floor muscle tightening results in increased straining and may even be painful.   Trained physical therapists can teach you how to properly relax your muscles and treat muscle spasm 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.

What can I do right now?

  • Positioning: How you sit on the toilet is key to helping your pelvic floor muscle relax to fully eliminate stool.  Sometimes using a stool like a Squatty Potty can help. Check out  their website to learn more about sitting posture and effective BM’s.
  • Water:  Water is critical for forming feces and moving feces through the colon.  Drink a glass with every meal.
  • Exercise:  Movement helps stimulate peristalsis in the colon and aids in digestion by bringing blood flow to the intestines.
  • Breathe:  Regular diaphragmatic breathing will help increase the parasympathetic nervous system activity which regulates digestion.
  • 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 a pelvic floor physical therapist to schedule a pelvic floor muscle assessment. Learn coordination techniques to relax and lengthen your pelvic floor muscles to comfortably and fully eliminate your bowels.

Don’t let the holiday meals slow you down as you head into the New Year.  Resolve to get things moving in 2014 and make an appointment with your doctor or pelvic floor physical therapist today!