Constipation or defecation dysfunctions (trouble emptying your bowels) can be caused by a multitude of things. The most common causes of are:
- Decreased water intake
- Hormonal changes from pregnancy
It is a very common complaint during pregnancy due to the hormones present that relaxes the smooth muscle of the bowel often making the movement of stool slower, but happens quite regularly in the average population as well.
Water intake and diet:
The slower the movement through the bowel, the firmer it gets and the harder it is to get it to leave the body. This occurs with people who don’t drink the recommended amount of water per day (approximately 2-3L), or in those who don’t have enough fibre in their diet. Working to decrease the amount of stool in the rectum by increasing water intake, altering diet or taking laxatives to empty the rectum can all assist.
Altering diet to include foods like:
- Green foods (vegetables in particular)
Speaking to your GP or a dietician can be beneficial if you’re concerned about your diet.
Other causes of constipation can relate to obstructions rather than the hard stool making it difficult to evacuate. Dyssynergia is the incoordination of the pelvic floor muscles when defecating, where they don’t relax as required to pass a bowel motion. When activating the pelvic floor, it creates a kinking of the anus making it quite difficult to pass a bowel motion without a lot of straining. We should naturally relax our pelvic floor when attempting to defecate, and not doing so keeps the anus kinked. It is not good for us to strain during a bowel motion, as straining results in the abdominals to contract further activating the pelvic floor. The MAYO clinic has a great video that explains how this occurs which you can watch here. Common symptoms you’ll experience with dyssynergia include the feeling of not fully emptying your bowels, needing to defecate multiple times in a day often with only small amounts of stool leaving, and the consistency of the stool can vary from normal to hard depending on how long its taken to evacuate.
The other cause of constipation can be a prolapse of the rectum onto the posterior wall of the vagina. This creates a pocket that stool can get stuck in, hardening the stool and making it harder to evacuate. If you’re not diagnosed with a prolapse, but feel the need to use a finger to increase pressure on your perineum (tissue connecting the vagina and anus) this may be what’s occurring. This can be improved upon using the correct defecating technique, more about prolapses can be read in our later blogs coming soon. Seeing a GP, gynecologist or specialised women’s health physiotherapist to assist with your diagnosis will be crucial.
We all have an internal sphincter which assists our pelvic floor and external sphincter to control emptying our bowels. This internal sphincter is not under our voluntary control, rather is an autonomic process the body does naturally without us having to think about it. Sometimes it occurs at a time which is not convenient, ie. during a meeting, while busy. Delaying this for a long period can result in the internal sphincter tightening back up again, making it almost impossible to empty your bowels even though you may feel stick us just sitting there. So when you feel the urge to defecate, going straight away can stop your symptoms related to difficulty emptying your bowels.
Correct defecation position:
Using the correct defecation position can assist with the straightening of the rectum to allow for less straining when passing a bowel motion. For most women, using a small foot stool to slightly elevate the knees above the hips, with a slight lean forward is the recommended position. Everyone will have it slightly differently. Sometimes some gentle pressure is required to assist with a bowel motion passing, and using a gentle pressure from the tummy can be beneficial. When sitting, place your hands on your waist and think about bringing your waist out into your hands. This creates some tension in your deeper abdominal muscles which should keep your pelvic floor nice and relaxed. Remember the big muscles in the front of the tummy should stay relaxed, otherwise we run the risk of increasing tension in the pelvic floor muscles and making it harder to evacuate stool.
Arana Hills Physiotherapy is excited to start offering some women’s health services soon. If you’re wanting to book in to see Rani, you can book online here.If you’re unsure if Rani can assist, feel free to call us on 3351 5639 and we will determine if we’re the right place for you to be.