Chronic Constipation and the Pelvic Floor Muscles

Constipation is reported to affect approximately 33% of the general population. Constipation can be categorized as slow transit constipation or defecatory disorder. In slow transit constipation, the body is having difficulty or is not able to effectively move the bolus of stool through the large intestine and the rectum in order to be expelled. There can be several different reasons for this and seeing a pelvic physical therapist can be a conservative form of treatment that may help you improve your constipation issues. Slow transit constipation can result in increased bloating and abdominal distension which can adversely affect the pelvic floor muscles. The pelvic floor muscles are then subjected to increased pressure exerted upon them and can weaken over a period of time.

Defecation disorders are usually seen as an impairment in coordination of the pelvic floor muscles and the anal sphincters. For normal defecation, the pelvic floor muscles relax and have a downward movement that decreases the tension in the pelvis. This, along with the internal and external anal sphincters relaxing and opening, allows for stool to be evacuated. When someone is having difficulty defecating, there is usually high resting pressures and incomplete relaxation of the pelvic floor muscles seen on biofeedback or on a functional MRI. Patients will usually report straining when trying to have a bowel movement, thin hard stools, pebble like stools, hard stools with watery diarrhea, or feelings of incomplete emptying of the bowels.

Treatment for defecatory disorders usually focuses on increasing fluid and fiber intake, and downtraining to achieve full relaxation of the pelvic floor muscles. Positioning on the toilet is important and using a small step stool to ensure that the knees are higher than your hips may be helpful. Abdominal massage may assist with slow transit constipation and focusing on breathing may improve results. The goal is to improve coordination and relaxation to have complete evacuation without unnecessary straining.

Using the Kehel in the vagina may help with relaxation of the pelvic floor muscles including the posterior muscles. The Kehel is not meant to be used in the rectum. The manual mode and massage mode are more helpful than the strengthening games when relaxation of the pelvic floor muscles is the goal. Both the manual and massage modes can help to facilitate full relaxation of the pelvic floor muscles. While in the manual mode, the objective is to get the graph line as close to zero as possible by relaxing or performing a reverse kegel exercise.

For further instructions, please refer to these videos and articles:
How to Relax Your Pelvic Floor Muscles with the Kehel Manual Training Mode
How to Use the Massage Mode for Relaxation or Strengthening

If home treatment does not improve your constipation issues, please seek out the assistance of a pelvic physical therapist for further assessment and possible behavioral modification treatments.


Lola Rosenbaum

Doctor of Physical Therapy

Elizabeth Bell

Clinical Specialist in Women’s Health

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