Bowel Health

Pelvic Floor Therapy for Bowel Health

Optimal bowel movements depend on the coordination between the anal sphincter, pelvic floor muscles, and abdominal wall. Suboptimal toileting🚽 habits can lead to pelvic organ prolapse, reduced anorectal sensation, and the sensation of incomplete emptying. In cases of functional constipation, people may strain or use manual maneuvers to produce a bowel movement. You can be constipated and still poop every day! 

Pelvic floor physical therapy can address the root causes of suboptimal bowel movements, including poor pelvic floor muscle control and coordination, muscle spasm, and muscle weakness. By retraining proper coordination of abdominal and pelvic floor muscles, we can achieve effective push effort during bowel movements. In addition to muscle retraining, dietary recommendations, education on proper toileting techniques, and abdominal massage/visceral mobilization can also improve colonic motility and support optimal bowel movements. 

Toileting Mechanics & Breathing Techniques

▪️ Mimic squatting on the toilet with knees higher and wider than hips with feet flat on a stool, leaning forward resting forearms on thighs, and keeping a straight spine

▪️ Don’t hover over the toilet – we need our muscles to relax

▪️ Take your time to completely empty – don’t push or strain!

▪️ When you have urge for #2 don’t delay longer than 15 minutes

▪️ Drink lots of water to avoid constipation (~1⁄2 your body weight in ounces/day) 

✨This squat position helps relax the pelvic floor muscles and allows for urine and stool to pass more easily✨

This can help:

✅ Reduce the need to push/strain

✅ Improve/eliminate hemorrhoids

✅ Prevent/reduce symptoms of prolapse

Breathing techniques on the toilet to relax the pelvic floor muscles and avoid straining:

- Pretend to blow out a balloon🎈or candle🕯️

- Perform horse lips 🐴

- Say a low pitch noise like “moo”🐮 or “OM”🧘‍♀️

These techniques help to stimulate your vagus nerve/parasympathetic nervous system 😌

If you’re in a public restroom you can always do these techniques quietly 🤫

We use the bathroom every day so make sure you’re keeping your pelvic floor healthy and doing the best you can to prevent prolapse and hemorrhoids.

❌No straining

❌No pushing

❌No power peeing 

Functional Constipation

Do you feel like you do all the things to prevent constipation like drinking enough water, eating enough fiber, and staying active and still have difficulty with BMs? This may be because pelvic floor motor control, muscle spasm, and muscle weakness promote functional constipation.

Maybe you have to wipe and wipe after a BM? 

Maybe you have to strain? 

Maybe you don’t feel empty afterwards? 

Maybe you have an itchy anus?

Maybe you have to use manual maneuvers to produce a BM?

Maybe you have abdominal pain and bloating?

Functional constipation may be the culprit and I see many people with this as a pelvic floor physical therapist. The pelvic floor muscles should be able to contract, relax, and bulge. One way to improve muscle coordination during BMs is to use rectal dilators as biofeedback for push practice. 

The goal is to learn the proper muscle coordination (relaxing the anorectum while creating adequate rectal push) required to expel stool. Biofeedback can also be used to assist with poor awareness of rectal fullness which is often blunted with constipation.

Interstitial cells of Cajal (ICC) are specialized cells found in the gastrointestinal tract that play an important role in generating and coordinating the rhythmic contractions of the digestive system that move food through the intestines. When these cells are reduced or absent, functional constipation is more likely to occur. Medications such as opioids, calcium channel blockers, and some antidepressants, as well as medical conditions like diabetes, autoimmune diseases, and surgical trauma can damage these cells.

Biofeedback therapy rationale:

Other things that may help include abdominal/bowel massage, perineal acupressure, connective tissue mobilization, joint mobilization, and visceral mobilization, and defecation mechanics. Reach out to a pelvic floor PT for personalized guidance!