Bowel Control and Constipation: The Pelvic Floor Connection - Episode 32

In this episode of the Marrón Pelvic Health Podcast, Dr. Kari Roberts delves into the connection between pelvic physical therapy and constipation. She explains how the pelvic floor plays a crucial role in bowel control and defines what normal bowel movements should look like. Listeners will learn what signs indicate constipation and how pelvic therapy can address mechanical issues that lead to irregular bowel habits. Dr. Kari also discusses the importance of diet, fiber intake, and gut health, and offers practical tips for maintaining a healthy bowel routine. The episode aims to create awareness and provide solutions for those suffering silently.

Book a call with Dr. Kari Roberts today.

• Episode Transcript

  How does pelvic physical therapy help with constipation? Stay tuned so we can get into it.

  Welcome to the Maroon Pelvic Health Podcast. Hi, I'm your host, Dr. Kari Roberts. On this show, we will be discussing a variety of things regarding your pelvic health. These conversations will be a mix of education,

  personal experiences, and a blend of tips you can apply to have a healthier pelvis. And the goal of this show is to normalize conversations around pelvic health and help women stop suffering in silence.

  Today, what I want to talk about is constipation and how that has anything to do with pelvic physical therapy.

  Now,

  basically, the pelvic floor is responsible for giving us our bowel and bladder control. And the words that we use for bowel and bladder control is fl, fecal continence or bladder continence.

  And when you don't have the control that you would like, we call it incontinence.

  So we don't talk that much about fecal incontinence, but you might hear about just incontinence or they'll even say bladder incontinence. And when people hear the term incontinence, a lot of times people are thinking about when people wet their pants or when they.

  They empty their bladder when they're not wanting to.

  So that's basically what people think of with incontinence. And what I wanted to do is focus on the bowel movement aspect.

  Incontinence is when you have trouble controlling your bowels, but when you don't go enough or when you don't go as regularly, then we call that constipation.

  And so there are a lot of people, unfortunately, walking around with constipation and they don't realize that they have constipation.

  Now, there is some conversation around what is considered normal, but what I want to do is talk about what's considered normal and then talk about what happens when things aren't normal and then talk about how pelvic physical therapy could be an avenue to help you get back normal.

  So basically what's normal is when people have a bowel movement once up to three times a day can be considered normal, depending on your activity level and the types of foods that you're eating as well as once every three days could be considered normal depending on your activity level and the foods that you're eating.

  So what's considered normal is a pretty wide range. Anywhere from once every three days to up to three times a day. Now, personally, here in my clinic, I Usually like to say you should be emptying your bowels at about the same rate that you're eating solid food.

  So if you're eating solid food relatively daily, then you should be having a bowel movement daily. Daily, if not every other day. Because if you're getting into that every three days,

  then we have to also look at the consistency of the bowel movement.

  Let me back up. Also, the consistency of your bowel movement matters.

  What you're doing when you're emptying your bowels also matter. So if you are able to sit on the toilet,

  do your due, no pun intended, and get off the toilet and go on about your manual business,

  that's considered fine. If you're gonna look at the sample that you left in the toilet, it should be kind of like sausage looking, I guess, you know, maybe like a Twix bar.

  Nothing, not super hard, not pebbles, not like rat poo poo. But it shouldn't be super wet and it shouldn't look like chicken nuggets. It should not look like soup. It should kind of look a little firm, but not too hard.

  Okay,

  so if your bowel movements are firm in that firm category, Right. It's like Goldilocks. Not too hard, not too soft, firm, just right in the middle and it's firm.

  And you're having firm bowel movements up to three times a day or as far as once every three days.

  That is what's considered normal. So the one side,

  it should be firm. The other side it can be once every three days to three times a day.

  If those two go hand in hand, then you're fine.

  Now let's get into the consistency first.

  Some people say I have a bowel movement every day, but it's very loose. It comes out kind of watery or comes out in not firm pieces. Kind of looks like.

  Not the consistency, but the look kind of like chicken nuggets or it's like small pieces that, my friends, is not firm. That's not. Not normal. That's not a normal consistency.

  That could be signs that you might need to change your intake. You might need to maybe increase your fiber. You might need to consult a registered dietitian, a plug for my very good friend Tamara Melton at La Carte Wellness, who specializes in all of this stuff.

  She's a registered dietitian,

  but you might need to look into your fiber, things like that.

  Now, if it's coming out and it's very hard,

  even if it's.

  The frequency is fine, but let's say it's very hard. Or it's coming out in small little pebbles, looks like rodent ****.

  Then that's not normal either. That could be signs of slow motility in your bowel, in your intestines. It could also be a sign of dehydration,

  or it could mean that you need to have more fiber as well. So both sides of the spectrum is considered not normal.

  Now, when we look at the frequency, if you're going more than three times a day,

  that's not normal. That's usually a sign of diarrhea because it's more frequently. And then if you're going less than once every three days, then that's definitely a sign of constipation.

  Now, let's say I get this a lot. I have regular bowel movements, but they're kind of on the firm or hard side.

  So that's a sign that you probably need to change something.

  And.

  Well, let me get. Before I get into what you can do, let me talk about how pelvic physical therapy can help you.

  Having bowel movements. Emptying your bowels is both a nutritional thing as well as a system in your body, as well as mechanical.

  So you might need to seek a nutritionist to make sure that you're getting the vitamins and minerals and macros and things that you need for your gut to be healthy.

  Make sure you have enough prebiotics, probiotics, all of those things that nutritionists work with.

  Let's say you check that box and you're still not normal. Then the next thing is you might want to see a GI physician because they're going to make sure the system is actually working properly.

  Everything is moving the way that it's supposed to. Everything is being absorbed the way that it's supposed to.

  They have all these tests and measures for that. Let's say you check that box. Okay, my nutrition is good. Check.

  Medically, there's no polyps or anything like that.

  Check. But I'm still having concerns.

  That's where we want to check the mechanical.

  And what can be happening is constipation.

  If you look on the inside of the pelvis,

  there is not a lot of room.

  You've got the ****** towards the back. In a woman, you have the ****** and the uterus in the middle. In a man, obviously, you don't have that. And their inside of their pelvis is a little bit more narrow.

  And then in the front, we have the ureter and the bladder.

  So those three things are down there very closely together.

  So if you've got constipation or you've got some fecal content,

  fecal matter that's building up in that intestinal tract in that ******. The ****** could actually be putting pressure on the front side, which is going to put pressure on your ureter and your bladder.

  So if you have constipation,

  it may not be presenting that you can't **** as much, but you might see it in other ways because it could be affecting your bladder, your bladder control. It could be affecting the way your bladder functions because those organs are literally running out of room.

  Something else that happens is the way that our body is shaped, the pelvic floor. There are slingshot muscles where the muscle attaches to your pubic bone and it slings and it wraps around the ******.

  And when those muscles are tight and it kind of bends the ******, and that helps reinforce our continence so that we're not leaking fecal matter or leaking fecal gas when we don't want to.

  So most of us are very happy when those muscles are doing what they're supposed to do.

  The interesting thing, though, is if those muscles stay tight or if they have a lot of tension and they don't fully relax,

  that ****** is still bent to keep things from moving.

  So if it's time to move and it's not being able to move now, it's very difficult for your ****** to empty. It's very difficult for the bowels to move.

  So that's something that could be an issue as well. So that's like a very mechanical type thing.

  Something else that can be contributing to your constipation or your changes with bowel habits. Is what you're doing when you're on the toilet, are you really bearing down? Are you really straining?

  Or do you use a squatty potty? Are you leaning forward? Are you leaning back? All of those things can change the mechanics of what's going on at your pelvic floor.

  And all of those things can have a direct impact with what's going on with your bowels.

  So where does pelvic PT come in? Well, like I said, you've checked the box with your nutrition, you've checked the box with your physician. So there's nothing medically going on, but your bowels could still be.

  Be.

  Have issues.

  There's a lot of conversation about.

  Wait, I said obs,

  ibs,

  irritable bowel syndrome, and there's IBS C, which is irritable bowel syndrome of constipation. And then there's ibsd, which is irritable bowel syndrome with diarrhea.

  So not talking about diarrhea in this conversation too much. But with the constipation,

  a lot of times what's really happening is you could be having a mechanical issue that is presenting as constipation,

  or it seems like when you do certain things,

  it flares up your ibs and what we're calling IBS sometimes is just some mechanical changes that need to be done at the pelvic floor area.

  So as a pelvic physical therapist, I do help women that have constipation. I will do just a very high level overview of the nutrition.

  Sometimes I even do a bladder diary just to make sure that the, the bladder is functioning in a normal rate as well. And then sometimes I will have you do a fecal diary so we can see how often are you having bowel movements and when you're having the bowel movements,

  what's the consistency of the bowel movement? Because knowing the consistency of the bowel movement is going to give us lots of cues. Do you need to drink more water? Are you over hydrated and you're not and you're drinking too much?

  Do you need to eat more fiber? Do you need to move more? Are there bowel massage techniques that you need to be doing? Do you have some tightness in your abdomen that needs to be worked on?

  Do you have some tightness in your pelvic floor that needs to be worked on? Do you have some looseness in the pelvic floor that needs to be worked on?

  Do you have bowels that are more or less impacted and now it's putting pressure on other structures like your bladder and things like that.

  So those are all the things that as a pelvic physical therapist, I would look at and just kind of do my assessment and see what's going on with all of those things and then what can we do to right the ship?

  So that way when the other things are dialed in, when it's time to empty your bowels, those muscles know how to relax so that, that the ****** can lose its, its bend so it can be more up and down and so that way it can empty.

  So I hope that was helpful. I hope that answered your question.

  And I will be back in about two weeks and I'll talk to you all about how long you even need to go to pelvic physical therapy. So chat with you then.

  Thank you for listening to this episode of the Marron Pelvic Health Podcast.

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