Constipation is something that we all experience a few times during our life. It can be related to the foods we are eating or how well hydrated we are, and can hopefully be resolved quickly. However, for many, it can become a chronic issue, and become debilitating. Constipation can even be the root cause of certain symptoms and conditions, such as urinary incontinence and pelvic organ prolapse. Given that 1 in 4 Canadians are constipated, this is an important topic.
What is constipation?
According to the Rome III Diagnostic Criteria, constipation must include 2 or more of the following features:
· Must force to evacuate/pass stool
· Hard or pellet-like stool consistency
· Sensation of incomplete evacuation
· Sensation of obstruction or ano-rectal blockage
· Must use manual techniques (pushing on pelvic structures) in order to evacuate stool
· Less than 3 bowl movements/week
Constipation an also result in the following symptoms:
· Abdominal, pelvic, hip, and low back pain, discomfort
· Bloating
· Hemorrhoids
· Anal fissures
· Urinary urgency and incontinence
· Pelvic organ prolapse
How can Pelvic Health Physiotherapy help?
In Pelvic Health Physiotherapy, we treat chronic constipation by addressing all factors involved, starting from the foods/liquids we ingest, to the transit of the stool in the large intestine, to the evacuation of the stool from the ano-rectal region.
Our holistic assessment and management protocols involve the following:
· Dietary factors that may be contributing to stool consistency
· Stool motility in the large intestine
· Stool evacuation from the rectum
· Pain around the ano-rectal region
· Assessment of the pelvic floor to determine excessive tension and determine coordination during a bowel movement. This is key, as some people tighten their muscles instead of relaxing them while passing a BM!
5 Key Tips to Help with Constipation
Water intake:
Make sure to drink adequate amounts of water throughout the day to help with stool consistency/help stool move along the colon. General guidelines: 2-3L/day. This could increase if you are: physically active, breastfeeding, or taking certain medications.
Fibre intake:
Fibre helps with the stool consistency through hydration and bulk. It is important to consider the amount, and type:
Soluble fiber: absorbs water into stool, keeping it soft. Examples: chia seeds, oats, sweet potato
Insoluble fiber: adds bulk to stool, and helps food pass more quickly through stomach and intestine. Examples: Lentils, bran cereal, apples
How much? 25-35g/day, depending on the individual.
Habits:
If you have the urge to defecate, don’t hold it in for very long! It may cause the stool to dry and harden, making it more difficult to pass.
Motion is lotion! Exercise helps to stimulate intestinal muscular contractions, helping stool move along the large intestine
ILU massage:
Proper method is key!
Use a stool underneath your feet in the bathroom to help with stool evacuation. The goal is to have your knees above your hips to help with the alignment of the ano-rectal canal (think of a squatting toddler)
Do not strain! Instead, lean forward, take a big inhale, and blow into a closed fist as you are passing a bowel movement. This helps decrease the pressure going into your pelvic region
Don’t wipe aggressively around the anus after passing a bowel movement. This will help present irritation/fissures
If you are unsure of whether Pelvic Floor Physiotherapy will help with your symptoms and condition, we highly encourage you to contact us for a 15 minute Free Phone Consultation. One of our specialized Pelvic Floor Physiotherapists will discuss your concerns with you, and help you determine whether this is the best course of treatment for you.