Constipation is something that we all experience sporadically throughout our lifetime. 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 two or more of the following features:

1. Must force to evacuate/pass stool

2. Hard or pellet-like stool consistency

3. Sensation of incomplete evacuation

4. Sensation of obstruction or ano-rectal blockage

5. Must use manual techniques (pushing on pelvic structures) in order to evacuate stool 

6. Less than 3 bowl movements/week 

Constipation can 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 bowel movement

Five Key Tips to Help with Constipation

1. 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

2. Fibre intake

• Fibre helps with the stool consistency through hydration and bulk
• It is important to consider the amount, and type:
  • Soluble fibre: Absorbs water into stool, keeping it soft. Examples: chia seeds, oats, sweet potato
  • Insoluble fibre: 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

3. 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

4. ILU Massage

• The goal is to move stool along the intestine, and help calm the intestine if it is irritated
• Use cream or soap on fingertips, and always follow the clockwise direction (right to left)
• Perform lying down or standing in shower
• Use moderate pressure
• Repeat each section 10x, 1-2x/day

Step 1: “I”: Massage from under the left ribcage, down towards the inside of the left hip bone

Step 2: “L”: Massage from under the right ribcage, to left ribcage, then complete the above step

Step 3: “U”: Massage from inside of the right hip bone, up to right rib cage, and complete the “L”

Step 4: Stimulate the small intestine by performing small circular circles in the clockwise direction 2-3 inches from the belly button x 1-2 minutes

5. 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 Physiotherapy will help with your symptoms and condition, we welcome you to contact us for a 15 minute Free Phone Consultation. One of our specialized therapists will discuss your concerns with you, and help you determine whether this is the best course of treatment for you.

Mississauga Pelvic Health is a full service Physiotherapy clinic that specializes in Pelvic Health wellness. We are a team of highly trained healthcare professionals who are dedicated to helping mothers, moms to be, women, men, and children with the diagnosis, management, and treatment of pelvic health conditions. Having provided specialized services for over 10 years, we understand the deep impact pelvic health issues can have on one’s life, and are committed to delivering evidenced-based, individualized, and holistic care.