Constipation & Bowel Problems

Bowel problems can be uncomfortable, frustrating, and sometimes difficult to talk about. Constipation, difficulty emptying your bowels, straining, bloating, or bowel leakage can affect your comfort, confidence, and quality of life.

At Core Pelvic Health & Wellness, I provide individualized pelvic health physical therapy to help identify the factors contributing to your bowel symptoms and improve the coordination of your pelvic floor, core, breathing, and digestive system.

What is constipation?

Constipation is more than simply having infrequent bowel movements. It can also involve hard or difficult-to-pass stools, excessive straining, a feeling of incomplete emptying, or needing to use specific positions or techniques to have a bowel movement.

Sometimes constipation is related to diet, hydration, medications, or gastrointestinal conditions. In other cases, the pelvic floor muscles may not relax or coordinate properly during a bowel movement.

What bowel symptoms can pelvic floor PT help with?

You may benefit from an evaluation if you experience:

  • Constipation

  • Chronic constipation

  • Difficulty passing stool

  • Straining during bowel movements

  • Feeling like you cannot completely empty your bowels

  • A sensation of blockage

  • Needing to change positions to have a bowel movement

  • Needing to press around the vagina, perineum, or rectum to help stool pass

  • Spending a long time on the toilet

  • Bloating associated with constipation

  • Abdominal or pelvic discomfort associated with bowel movements

  • Pain with bowel movements

  • Fecal or bowel leakage

  • Difficulty controlling gas

  • Urgency to have a bowel movement

  • Changes in bowel function following childbirth or pelvic surgery

Conditions associated with bowel dysfunction

Pelvic health physical therapy may be helpful for people experiencing:

  • Chronic constipation

  • Functional constipation

  • Defecatory disorders

  • Pelvic floor dyssynergia

  • Difficulty coordinating the pelvic floor during defecation

  • Fecal incontinence

  • Fecal urgency

  • Bowel leakage

  • Pelvic pain associated with bowel movements

  • Painful defecation

  • Bowel dysfunction following pregnancy or childbirth

  • Bowel symptoms associated with pelvic floor muscle dysfunction

How the pelvic floor affects bowel movements

Your pelvic floor has to relax—not just strengthen—to have a bowel movement.

When you have a bowel movement, the pelvic floor muscles need to coordinate with your abdominal muscles and breathing to allow stool to pass. Ideally, the pelvic floor relaxes while pressure from the abdomen helps move stool through the rectum.

If the pelvic floor muscles remain tense or contract at the wrong time, you may experience difficulty emptying your bowels, excessive straining, or a feeling of incomplete evacuation.

This is why “just eat more fiber” isn't always the answer.

Fiber, fluids, movement, and nutrition can all play an important role in bowel health. However, when pelvic floor coordination is part of the problem, simply increasing fiber may not fully address the underlying issue—and in some people, it may even make symptoms worse.

What can contribute to constipation and bowel problems?

Bowel symptoms may be influenced by:

  • Pelvic floor muscle tension

  • Difficulty relaxing the pelvic floor

  • Poor coordination of the pelvic floor and abdominal muscles

  • Breathing patterns

  • Chronic straining

  • Constipation

  • Low physical activity

  • Pregnancy and childbirth

  • Pelvic or abdominal surgery

  • Pelvic pain

  • Hip or low-back dysfunction

  • Changes in toileting habits

  • Certain medications

  • Dietary factors

  • Gastrointestinal conditions

  • Stress and nervous system factors

How can pelvic floor physical therapy help?

Treatment may include:

  • Education about bowel and pelvic floor function

  • Crafting a better stool

  • Pelvic floor relaxation

  • Coordination of the pelvic floor with breathing

  • Toileting position education

  • Breathing and pressure-management strategies

  • Defecation mechanics

  • Abdominal and pelvic floor coordination

  • Manual therapy when appropriate

  • Mobility and flexibility exercises

  • Hip and core assessment and strengthening

  • Scar tissue treatment

  • Strategies to reduce excessive straining

  • Home exercises and self-management strategies

What happens during your evaluation?

First, we talk.

I will ask about your bowel habits, symptoms, diet and fluid intake, medical history, medications, activity level, and how your symptoms affect your daily life.

Then, we assess.

Depending on your symptoms, I may evaluate your breathing, posture, abdomen, hips, spine, core, and pelvic floor muscle function.

Then, we create a plan.

I will explain what I find and work with you to develop an individualized treatment plan based on your symptoms and goals.

And again:

An internal pelvic floor examination is not required for every patient. If an internal examination may provide helpful information, I will explain why and discuss it with you beforehand. You are always in control of your care.

Do I have to have an internal examination?”

No. An internal examination is not automatically required. Your evaluation may be completed using external assessment techniques depending on your symptoms and goals. If an internal examination is recommended, I will explain the purpose and obtain your consent before proceeding.

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