Constipation and Your Pelvic Floor: It’s Not Just About Fibre

Have you ever felt like you're doing everything "right,” - you are eating fibre, drinking water, exercising but you're still struggling to poo regularly and comfortably? You are not alone. Constipation affects a huge portion of the population, and for many people, the missing piece isn't just diet, it also includes the pelvic floor.

As pelvic health physiotherapists, we are regularly seeing people who've tried every laxative and supplement on the shelf. Many people are diligently eating their daily chia pudding and kiwi fruit only to find that the real issue was a coordination problem between their brain, their pelvic floor muscles, and their bowel. The good news is that is we can help you put the pieces of your poo puzzle together.

What is Constipation?

Constipation is when you are pooing infrequently and that your poo becomes hard and/or is hard to pass. It is often really uncomfortable and for some people it can be painful. It may involve:

-          Doing less than 3 poos a week

-          Regularly straining to do a poo

-          Lumpy or hard stools (think pebbles or pellets)

-          A feeling that you have not emptied your bowel completely

-          Needing to use your fingers to help get your poo out (this is often by pushing the back wall of the vagina)

If any of these sound familiar, your pelvic floor may be playing a role.

The Pelvic Floor Connection

Your pelvic floor muscles are a located at base of your pelvis and control all your openings, including your anus. They need to relax and lengthen to let a bowel movement pass. Many people with constipation actually have the opposite problem: their pelvic floor tightens or does not relax when they try to go. This is called “dyssynergic defecation” or “pelvic floor dyssynergia.”

Common contributors include:

-          Pelvic pain – often the muscles gradually get tighter over time or can get tight before and during a period

-          Chronic straining, which over time can affect muscle coordination

-          Anxiety and stress – this can increase pelvic floor tension, you can even get worried about doing a poo which can cause tension to rise in the pelvic floor

-          Pregnancy, birth, and post baby – particularly if you have had a perineal tear

-          Regularly holding or postponing the urge to go – I am looking at you teachers, nurses, doctors and busy parents

-          Poor toileting posture – see blog on optimal position to poo.

Signs Your Problem Pooing Might Involve the Pelvic Floor

-          You feel like something is "blocking" the stool from coming out, even when it's soft – think trying to squeeze out the toothpaste from a tube but the lid is on

-          You strain but nothing happens, or only a small amount passes

-          You are doing super skinny poo or alternatively a massive painful poo – you can’t achieve that sought after sausage poo everyone is talking about

-          You feel like you are never fully empty

-          Laxatives or fibre helps a bit but doesn’t solve the problem – for some people fibre can make the problem worse

What can a Pelvic Health Physio do?

Pelvic floor physiotherapy for constipation is going to be individualised to you and may include:

1.  Assessment of the position you are sitting on the toilet to do a poo
We don’t need to see you in your toilet but we can get you to replicate the position you are sitting in the treatment room. This will help us to start making changes to optimise your poo position which will enable the pelvic floor to more easily let go.

2.  Assess pelvic floor awareness and coordination
We can check whether the muscles that let out the poo can switch on and relax and whether you are aware it is happening. We have a few ways of doing this depending on how comfortable you feel, you get to choose.

3.  Breathing and bearing-down retraining
We can teach you how to do a poo without tightening your pelvic floor.

4.  Manual therapy
A physio can also teach you how to release tension in the pelvic floor and surrounding muscles.

Simple Things you can Try at Home

1. Try a foot stool
While on the toilet use a foot stool (or a few yoga blocks or toilet rolls) to bring your knees above your hips, which may make the passage of poo easier. You can get one delivered to your door here.

2.  Try making a “Moo” or and “Ohhhm” sound (either out loud at home or in your head at school or work)
This will widen your waist as you push the poo out rather than drawing in your belly breath and straining.

3. Tune into the urge
Postponing your poo regularly can make the poo bigger, harder and more difficult to pass, so prioritise the poo even if you are not near your favourite toilet.

4. Get into a bowel routine
This might involve making more time to poo. You often get the best urge 30 minutes after you eat breakfast and have a hot drink (if you don’t drink tea or coffee in the morning even just a mug of hot water might kick your bowel into gear). This might mean you need to get up earlier which might mean you need to go to bed earlier which might mean you need to set doom scrolling limits.

5. Notice how you feel as you are doing a poo
Are you tense in your belly? You will need to put your phone away to poo so you can focus on relaxing your body, especially your jaw and shoulders, as tension in your body can affect pelvic floor tension.

When to Seek Help

Persistent or worsening symptoms, blood in the stool, or unintended weight loss require a medical review to rule out other causes.

If constipation has lasted more than a few weeks, is affecting your quality of life, or comes with straining, incomplete emptying, or pain, it's worth being assessed by an experienced pelvic health physio, especially if fibre, hydration, and standard advice haven't helped.

Constipation can feel like an embarrassing problem, but it's incredibly common and very treatable. You don't have to just live with it; it is much better to get to the bottom of it (sorry I lasted the whole blog without a poo pun but couldn’t hold on).

This blog is for general educational purposes and isn't a substitute for individualised medical or physiotherapy assessment. If you're experiencing blood in your poo, severe abdominal pain or a change in your bowel habits book in to see your GP.