Constipation is not an easy thing to discuss amongst family and friends. But if you have it, you know that being constipated can make your life miserable! Nothing is worse than being on vacation or in a business meeting and feeling bloated and nauseated because you can’t have a bowel movement.
I have had multiple phone conversations with friends on how to fix their constipation – RIGHT NOW! The crazy part is that to really manage constipation, it takes time.
The colon is an amazing organ. It takes the liquified leftover food from the small intestine and turns it into solid stool so you can get rid of what your body doesn’t need. You may not know that 50% of the mass of your stool is actually bacteria. Eliminating what your body doesn’t need is important because as noted, if it backs up in your colon, you feel awful.
So, what is constipation anyway from a medical standpoint? You should have at least 2 of the following, at least 25% of the time, for at least 3 months. Do you:
1. Strain to have bowel movements?
2. Pass hard or lumpy stools?
3. Don’t completely evacuate when you have a bowel movement?
4. Splint or push in/on your vagina or rectum to get the stool to pass out?
5. Have bowel movements less than every 3 days?
Of course, many of us don’t have symptoms for 3 months but we still consider ourselves constipated! We say we are constipated because we don’t feel well, and we know that cause! If we could just poop, we know we would feel better!
You may know that constipation can be helped by over-the-counter supplements. There are things that make your stool softer by keeping more “water” in your stool like Miralax or Colace. There are products that gently stimulate your colon muscles to contract like Magnesium or strongly contract like Dulcolax or Exlax. These products move the stool along and take hours or overnight to usually produce a bowel movement. Then there are other products that work right now like suppositories and enemas. Whew!
Confused yet? Why do you think there are SO many products that help us poop? How is someone supposed to know what to take, when to take it and how much to take? This is something I educate my clients about every day so they can make sense of how these products work with their bodies. We also work with Nutritionists, Naturopath’s, Chiropractors, and Functional medicine doctors to collaborate on your gut health and diet!
So why come see a pelvic floor (PF) physical therapist? Well, because the only way for the stool to get out of you is through your pelvic floor muscles! These over-the-counter supplements and diet change the stool quality and the colon muscle contractions, but they do nothing for opening the “doorway” – the PF muscles!
Normal bowel movements require normal pelvic floor function. Your colon and your pelvic floor communicate with each other constantly, so they know if there is something in your colon. If something is there, the internal anal sphincter of the colon can discriminate solid, liquid, or gas. If it’s liquid stool, the colon tells the brain get to the toilet NOW! The colon is not meant to store liquid. The PF will close and lift tightly as you run to the bathroom. A perfect PF only has 3-5 minutes on average before the person will leak stool. As I said, the colon is not meant to store liquid. If the substance is gas, well, there are decisions to be made. Is it not the time and place to pass gas or would that be socially unacceptable? A perfect PF can hold gas in but you may end up with a stomach ache from the gas stretching your colon.
What if it’s solid? Again, you have a decision to make. Is now the time and place for you to have a bowel movement? Maybe the gas station bathroom is less than appealing. If it’s not time right now, your PF will close and lift tightly, stopping the colon’s contractions so that you store that stool inside your rectum and colon. You will continue to store the stool until the next wave of colon muscle contractions stimulates your urge to poop.
If now IS the time, when you sit on the toilet, your PF has to perform a lengthening type of muscle contraction so your sphincter and PF open and drop allowing the stool to pass out via colon muscle contractions! It’s normal for a mild increase in intra-abdominal pressure to help get the stool out but it is NOT normal to strain a lot. Especially if that straining is every time, you have a bowel movement.
If your pelvic floor is not opening, lengthening, and dropping well, then you will have a hard time emptying and will get constipated! I know as you read all of this you may be saying “Wow, I never knew it was so complicated!” but in reality, it’s even more complicated (and cool!) than this. This is why it is always a good idea that if you are experiencing frequent bouts of constipation, you add a PF physical therapist to your team!
We specialize in putting all of the pieces together for you that are specific to your problems. You will definitely feel better when you take back control of your colon instead of letting it rule you! If you’re constipated, call and make an appointment so we can discuss how to help you with your specific needs!