Constipation; Big Picture Therapy

Author: Susannah Haarmann, PT, WCS, CLT

You made an appointment with a pelvic therapist to address urinary urgency and now they're asking you questions about your bowel function? Invasive or awkward much? We get it, but we need to know. Let me explain; there are 3 outlets sharing a tight space within your pelvis. The bowel, bladder and reproductive pathways are intimately related and a malfunction of one might cause some compromise in another. Just think about how much satisfaction is tied to your ability to poop, pee and have sex! It's our job to hear your full story, pair that with your body story (our exam findings), and connect the dots to treat the problem! Here are a few scenarios explaining how constipation relief can help solve the problem for which you seek treatment:

Urinary Urge      

Nerves relay information. When your bladder gives you a SUDDEN pang that you need to pee and you don't know if you can hold it, there is likely a neurological reason. The sacral feedback loop maintains urinary continence and makes the bladder contract when you want to urinate. The switches for that feedback loop are located inside the pelvis just in front of the sacrum, and what structure nestles nicely into the curve of that sacrum? That's right, the rectum! If the rectum is full (maybe even distended because you haven't pooped in 3 days) it could be pressing on the sacral nerves. The signals then sent to the brain can be misinterpreted as 'I have to pee,' not 'I have to poop.' So, pooping might actually be one of the keys to calming down the bladder. Tricky pelvis!   

Painful Intercourse   

When the pelvic floor contracts it lifts up and closes the openings to the vagina and rectum. We want to drop down and lengthen the pelvic floor muscles in order to receive comfortable penetration. If you are having pain with intercourse it may be because your pelvic floor muscles are short and have difficulty relaxing to open. You also want to relax these muscles to pass stool. Additionally, holding more tension in your pelvic floor throughout the day than is needed can inhibit the defecation reflex. The defecation reflex works to move stool through the bowel. A tight pelvic floor shuts the door to the anus and says 'not now.' Eventually, the defecation reflex with quiet down making you have to work much harder to have a bowel movement in the future. And let's be real, who feels their best sexy when they are constipated anyway?                                                                                                  

Back pain during pregnancy

Progesterone levels rise to maintain a pregnancy, however, this hormone can also be constipating. Many women experience intermittent back and sacroiliac joint pain during pregnancy; a pelvic health physical therapist can help you relieve these symptoms and we might ask you about your bowel health! Why? Well, one reason is when people are having difficulty pooping, some bear down or strain to nudge the stool closer to the rectum. This will increase your intra-abdominal pressure which can also put pressure on the discs of your spine. A pelvic floor physical therapist can assess what your pelvic floor muscles are doing when you simulate pooping and look at your breathing patterns with functional activities. And the best part of if all? What we teach you during therapy might even help you have an easier and more empowering labor experience!

So, there you have it; a few common scenarios explaining why your pelvic floor therapist asks seemingly unrelated questions about your bowels. We're not really an awkward lot, we just have a mind for comprehensive care and want to help you LIVE YOUR BEST LIFE! :)