You are not alone, and it is treatable.
Many women feel shy about the word constipation, but it is one of the most common conditions people deal with, especially during and after pregnancy and with aging. Research shows constipation is a prevalent condition in the United States, and typical treatment consists of diet modification, stool softeners, and laxatives, though these interventions are not always effective on their own.
Managing constipation well matters for daily comfort and function, and for avoiding complications like hemorrhoids and anal fissures. The encouraging news is that constipation can also be managed with physical therapy, not just laxatives and other medication alone.
Idiopathic versus functional constipation.
There are two broad kinds of constipation. Idiopathic constipation does not respond to standard treatments such as laxatives and requires a more extensive medical workup. Functional constipation is different: the colon itself is healthy but is not working properly, with no organic disease present. It is mostly connected to a person's lifestyle and dietary habits, and it is common among women.
Common causes include low fiber intake, lack of physical activity, dehydration, certain medications such as iron supplements, antihistamines, or narcotics, and high consumption of milk, cheese, or gluten.
Diet, hydration, and movement come first.
Your physical therapist starts with education. Teaching proper diet and lifestyle modification is always part of the treatment. Constipation is managed largely through diet, and fiber intake is a big part of that, aiming for around 35 grams a day. Hydration matters too; a common guideline is drinking half your body weight in ounces of water daily, with more needed if you consume caffeinated, carbonated, or acidic drinks, or engage in strenuous activity.
Exercise helps by increasing muscle activity, especially peristaltic movement in the intestines, the wavelike motion that pushes contents through the colon. Your provider will also advise you not to ignore the urge to have a bowel movement, and not to rush the process. Avoiding distractions and feelings of being rushed helps prevent straining, which can contribute to pelvic organ or rectal prolapse.
Biofeedback, targeted exercises, and abdominal massage.
Biofeedback training is one of the main ways a physical therapist helps manage constipation. It uses devices that help you learn to relax and tighten the muscles of the pelvis, since relaxing the pelvic floor muscles at the right time during defecation makes it easier to pass stool.
Pelvic floor physical therapists can also teach exercises and stretches to work on any tight muscles at home, along with abdominal massage. Abdominal massage is taught to help treat abdominal pain related to constipation and can increase the frequency of bowel movements; it involves stroking and kneading the abdomen in a consistent pattern. Additional stretches can include familiar yoga poses like happy baby and child's pose, depending on which muscles need work.
If medications and repeated doctor visits are not enough on their own, physical therapy is a safe, holistic option that can be combined with your existing treatment plan and can help you feel like yourself again. If you are experiencing chronic constipation, reach out to our pelvic floor specialists to learn more about how these exercises can help.