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Physical Therapy

The Better Bowel Blog: All About Constipation

image from psychlopaedia.org

Did you know constipation can affect up to 20% of individuals in North America? It also affects more than half of women at some point in pregnancy. Constipation accounts for more than 13 million days of restricted activity and 3 million days of bed disability each year as well as 2.5 million physician visits per year. 

Mental health is closely associated with bowel health. The prevalence of depression and anxiety disorders are much higher in those with constipation. For those that have high levels of stress, increased secretion of cortisol can cause bloating, gas, cramps, food sensitives, aches and pains. 

How often should  I go? Normal frequency ranges from a maximum of 3 x per day to a minimum of 3 x per week. Clinicians will define constipation by decreased frequency from your “norm.” It is usually associated with need to strain and hard stools.   

What can lead to this problem?

1) Pelvic floor dysfunction. The pelvic floor is made up of 3 layers of muscles that run from your pubic bone to your tailbone. These muscles aid in controlling bowel and bladder function. In order to evacuate stool, the pelvic floor muscles need to relax. The inability to do so can lead to constipation. This can also be termed as dyssenergic defecation.

2) Weakness of core muscles to aid in having a bowel movement. The deep abdominal muscles work hand in hand with the pelvic floor. The abdominal muscles need to contract as the pelvic floor relaxes to aid in evacuating stool.

3) Slow transit constipation: when there is decreased motility through the intestines due to lack of peristalsis , or muscular wall contractions, to move the substance through the intestines to be evacuated.

4) Stool withholding behavior– holding it in due to lack of privacy can lead to diminished brain processing of urge sensation. This is a conditioned behavior and can lead to decreased stool frequency, volume and transit times. This suggests that constipation can be learned

5) Lack of activity

6) Lack of fiber in diet

7) Dehydration

Suggestions on how to become more regular:

1) Toileting Posture: Proper toileting posture is important when trying to have a BM. Increased hip flexion allows the anorectal angle to become more obtuse (opens it up) to allow for ease stool evacuation. Placing your feet up on a stool while on the toilet or using a Squatty Potty can aid in this. Do not hold your breath! 

 2)Stay well hydrated. Try to drink half of your body weight in ounces, 3/4 of this should be water. Water is needed to keep stools soft and make it easier to go.

3) Increase exercise. Daily moderate exercise was associated with a 44% decrease in risk of constipation in women. Lack of activity has been associated with increased risk of constipation. It is recommended by the American Heart Association for adults to get 150 min of moderate exercise per week or 75 minutes of vigorous exercise per week, or a combination of both with the addition of 2 strength training workouts per week. Exercise helps promote motility through the intestines.

4) Going at the same time every day (the easiest time for most people is a few hours after waking up and after breakfast). Try setting aside one time that works best for you to go every day. Try to wake up and go to bed at the same time every day to keep body in routine. However, do not sit on the toilet for more than 10 minutes at a time as this can increase your risk of developing hemorrhoids.  

5) Increase fiber in diet. Adults should aim for 25-30 g per day. Increasing this should be done gradually to avoid cramping. Higher fiber foods include whole grains, beans and legumes, and fresh fruits and veggies. Foods you want to eat sparingly that tend to back up the intestines include cheese, white rice, bananas and processed foods.

6)Drinking warm liquid– This does not have to be coffee or tea. Warm water can help stimulate bowels

7) Being evaluated by a Pelvic Floor PT to assess where the problem may lie. They can provide the correct strengthening or relaxation exercises to help in conjunction with the recommendations listed above. Trained physical therapists can also provide visceral mobilization and manual massage techniques to help with these issues.