As a pelvic floor therapist, I spend a lot of my day talking to people about changes they can make in their lives to improve their pelvic health. One recommendation I make to all my patients, friends, family, and, if warranted, strangers, is to prioritize pooping! Many people shy away from talking about poop, but that children’s book said it best: everybody poops (yes, everybody includes Beyoncé). I can’t speak for Queen Bey, but I can say most people have also suffered from constipation at one point or another. It’s extremely common, and it can impact more than just your rectum — constipation is a frequent cause of pelvic floor dysfunction.

To understand why, it’s important to know the function of your pelvic floor. If you were assigned female at birth, your floor is structured to support your bladder, uterus, and colon. When a pelvic floor is classified as dysfunctional, that means it has become restricted, overactive, weakened, or injured — this can lead to things like pelvic pain, pain during penetrative sex, urinary urgency or frequency, and incontinence.

Criteria for constipation

Most people know when they’re constipated, but if you’re unsure, having two of the following symptoms over three months is a pretty clear indicator:

1. Fewer than three bowel movements per week

2. Straining to go when you’re in the bathroom

3. Lumpy or hard stools

4. Sensation of anorectal obstruction (meaning it feels like something is stuck in your rear end)

5. Sensation of incomplete defecation

6. Manual maneuvering required to poop (yes, that means using your fingers)

Basically, if pooping feels like a struggle in any way: you’re constipated. Symptoms are often triggered by prescription pain relievers and other medications or bodily events like childbirth; sometimes symptoms arise simply because a person has gotten into the (bad) habit of ignoring the urge to poop. No one likes being ghosted, especially your colon. So if you feel the urge to go, you should listen to your body and make a trip to the nearest restroom. 

When poop stays in your rectum for longer than your body intends, it can add more weight than your pelvic floor muscles want to support. More work for the pelvic floor means it can fatigue (the same way a bicep—or any muscle, really—can fatigue if it’s being flexed for an extended period of time). If your bladder is full on top of that, it means your pelvic floor might not be able to keep up with all its’ responsibilities (such as controlling the urethra), which can lead to leaking.  

If your pelvic floor muscles are hypertonic (too tight) or your vaginal wall loses some of its stability, fecal matter can get stuck on its way out, which is why you feel the need to push or strain to have a bowel movement. Because everything in your body is interconnected, straining can also put more pressure on the pelvic floor muscles, which can make symptoms even more intense. 

How to prevent constipation

Patients are usually surprised when I ask them detailed questions about their bathroom habits, but it’s because I know there are tons of actionable ways to make sure you’re regularly clearing out your colon and helping your pelvic floor help *you*. If you have any symptoms of pelvic floor dysfunction, try supporting your body’s natural functions in a few simple ways:

Stay hydrated

The amount of water your body needs is dependent on several factors, including your weight, diet, and daily activity level. That said, no matter what your day-to-day looks like, upping your water intake will help keep things moving in your body. Making sure you’re properly hydrated can also help reduce leaking, because a hydrated bladder is less likely to spasm.

Eat bladder-friendly foods

If you experience bladder leaks, it’s handy to know that a bladder-friendly diet is also high-fiber and good for your colon. Lack of fiber or food sensitivities are a major contributor to constipation, so sometimes easing symptoms is just a matter of working with a healthcare provider or dietician to refine what you eat and drink.

Tweak your toilet positioning

Our bodies are actually built to squat when we poop — it’s a position that puts our pelvic floor muscles in perfect alignment to make everything go smoothly, but it’s much different from how most people go about their business. To give it a try, you can put a step stool under your feet to get your knees higher than your hips.

If you’re struggling with constipation or any of the symptoms I mentioned, consult a healthcare provider—preferably a pelvic floor physical therapist—to determine if your muscles need some TLC. Getting your bowel movements back on track can help reduce leaking and help the whole ecosystem of your pelvis function smoothly.

Have you experienced constipation? How did you ease your symptoms? Share in the comments.

Dr. Rachel Gelman practices as a clinical specialist at the Pelvic Health and Rehabilitation Center in San Francisco, where she is also the branch director. She specializes in the physical therapy management of numerous pelvic pain disorders, including bowel, bladder, and sexual dysfunction. Rachel is passionate about healthcare and strives to promote quality education regarding pelvic and sexual health.

Posted: July 30, 2019