Constipation is a common gastrointestinal problem with an estimated prevalence of 1% to 80%, worldwide.
What is constipation?
Constipation is often clinically defined as having three or fewer bowel movements a week. Often, this is about expectations. People generally feel like they’re not “healthy” if they don’t have a bowel movement every day. But three bowel movements a week can be normal for some people, especially if that has been their pattern for a long time.
There are many other factors that affect how people perceive bowel movements. According to the Rome IV criteria of constipation often used in research, frequency alone doesn’t explain all complaints of constipation. Patients complaining of two or more of the following for more than three months also qualify for a diagnosis of constipation:
- feelings of incompletely evacuating (not getting everything out)
- straining
- lumpy or hard stools
- sensation of blockage
- using a finger to dislodge the stools
Causes of constipation
When constipation is a problem, there are two main reasons for it:
slow movement of the colon and pelvic floor dysfunction (pelvic floor dyssynergia, and prolapse)
Other causes may be:
- physiological (eg. pregnancy, age)
- psychological (eg. eating disorders, depression, anxiety)
- behavioural (avoiding use of public toilets, deferring defecation when feeling the urge)
- lifestyle (eg. stress, poor diet and fluid intake, lack of exercise)
- side effect of medications (eg. morphine, codeine, antidepressants, food supplements containing iron and calcium, overuse of laxatives)
- colonic (eg. diverticular disease)
- anal (fissure, polyp, hemorrhoids, tumor)
- genetic predisposition
- functional (IBS)
- endocrine (eg. diabetes mellitis, hormonal imbalance)
- idiopathic (no obvious cause)
Pelvic floor dysfunction
The pelvic floor is a muscular bowl that encompasses the rectum, bladder, and (for women) the uterus. There is a complex interaction among these different organs. When having a bowel movement, the anal sphincter (the group of muscles at the end of the rectum) has to relax, and the abdominal muscles need to contract.
A common analogy I give is that it’s like getting toothpaste out of a tube. When you want the toothpaste to come out, you loosen the cap and press on the tube. However, if you leave the cap on or even tighten it, pressing is not going to get the toothpaste out. In the same way, some people who have constipation fail to relax, or actually tighten, their anal sphincter, while using their abdominal muscles to contract the colon when they are trying to defecate. This leads to feelings of incompletely emptying or even feeling like you have to use your finger to get the stool out.
It is not unusual to have constipation when you also have a prolapse. Constipation associated with prolapse may result from the bunching up of the rectum, creating a blockage that is made worse with straining, generalized coordination problems with the entire pelvic floor, and problems with the ability of the colon to move stool forward at a normal rate.
You can read more about prolapse here: https://mnaphysiotherapy.com/pelvic-organ-prolapse-and-how-physiotherapy-can-help/
Physiotherapy treatment
Physiotherapy is a very effective, nondrug treatment for constipation. Treatment may include:
- thorough assessment
- ano-rectal examination
- manual therapy (internal and/or external)
- pelvic floor muscle re-training program to lear muscle coordination and relaxation
- learning proper toileting techniques
- rectal sensation training
- biofeedback
- advice on appropriate movement, fluid and fibre intake
- keeping food and bowel diary
- colon/abdominal massage
- abdominal muscle and thoraco-lumbar exercise program
- breathing pattern re-education
As you can see, there is so much that can be done to improved constipation. If you want to learn more about what to expect on your first visit, click the link: What happens at the first women’s health physiotherapy appointment? – mnaphysiotherapy.com
To book an appointment click here https://mnaphysiotherapy.com/contact/
References:
https://pubmed.ncbi.nlm.nih.gov/17079751/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5976340/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206560/
https://pubmed.ncbi.nlm.nih.gov/32772745/
https://pubmed.ncbi.nlm.nih.gov/17079751