Constipation is characterised by irregular bowel movements or trouble evacuating faeces. It is linked to a number of symptoms, such as bloating, abdominal pain, incomplete evacuation, straining, hard stools, and anorectal obstruction. The overall population has a 15% prevalence of constipation, with a larger female to male ratio and a higher prevalence among the elderly, particularly those over 65.

Constipation can be either primary (such as sluggish transit or obstruction of the outflow) or secondary causes. Simple dehydration, metabolic problems, medications, neurological conditions, myopathic illnesses, and structural abnormalities are examples of secondary causes.

It should come as no surprise that constipation frequently coexists with pelvic floor dysfunction given the anatomical and functional role of the pelvic floor in defecation. The muscles supporting the bladder, intestines, and rectum are collectively referred to as the pelvic floor. Due to their ability to relax and contract during defecation, these muscles are essential for regulating bowel movements. They move smoothly when they’re working properly. Constipation results if the pelvic floor muscles are overly tight, weak, or uncoordinated.

Symptoms of Constipation

Common symptoms related to constipation include:

1. Excessive Straining: Passing faeces requires more effort than normal.
2. Incomplete Emptying: A persistent feeling that the bowel hasn’t been completely emptied
3. Painful Bowel Movements: Pain or discomfort associated with bowel movements.
4. The Need for Manual Assistance: In order to fully evacuate, some people may need to press on the perineum or use their fingers to help expel faeces.

Types of Constipation

Did you know that not all constipation is the same?

There are two types of constipation; one is functional constipation or regular constipation caused by poor diet, dehydration and sluggish or slow digestive system. It can be recovered using laxatives, or fibre supplements. The other one is pelvic floor related constipation where the muscles involved in bowel motions are not coordinated.

Tight Pelvic Floor Muscles: It becomes difficult to push stool out if these muscles are extremely tense, which causes discomfort and straining.
Pelvic floor muscle weakness can result in inadequate bowel emptying, which can provide the sensation that stool is stuck all the time.

Dyssynergia Defecation, a disorder in which the muscles do not work together correctly, can cause chronic constipation even if your pelvic floor muscles are too weak or too tight. This makes it difficult to evacuate stool easily.

How to identify whether you have regular constipation or pelvic floor related constipation?

Can exercise help relieving Constipation?

Physical activity stimulates colonic contractions and decreases colonic transit time,10 and that a high-quality diet promotes bowel regularity and improves stool consistency. If you face a functional or regular constipation then consistent physical activity and fiber rich diet is the key to resolve it. Consistency in the routine helps regulate the bowel movement patterns. Few exercise recommendations for functional or regular constipation include:

• Brisk walking/cycling/swimming – 30 minutes/day, 5 days/week improves colonic motility and reduces transit time.

• Yoga poses like Apanasana (knee to chest pose) and Supine Twist aid in bowel stimulation and gas relief. Hold for 20-30 seconds/ 3 times.

• Pelvic tilts – 2 sets of 15 reps activate abdominal muscles and promote gut movement.

• Deep squats or using a squat-like posture improves anorectal angle for easier defecation.

• Abdominal massage (clockwise) along the colon path with breathing increases peristalsis and bowel readiness.

• Cat-Cow stretch – performed slowly improves spinal mobility and stimulates digestion.

However, if these exercises do not give you significant results, understand the there is a disbalance in the pelvic floor coordination. A more holistic approach is often necessary for constipation related to pelvic floor dysfunction, taking into account posture, breath, scar tissue, fascia, and even stress levels. If you have tried traditional pelvic floor exercises, dietary changes, or even traditional physical therapy without success, you may feel frustrated and trapped in a cycle of discomfort.

The nervous system is linked to the pelvic floor muscles, which might clench involuntarily due to chronic stress or pelvic nerve dysfunction, making bowel motions more challenging. Adequate relaxation to sync the pelvic floor muscles and the nerves is needed to address the issue. This can be achieved by few techniques:

Hypopressive breathing functions by harmonising the pelvic muscles, decompressing the organs, and lowering intra-abdominal pressure. Using breath-holding techniques and deep postural activation, this method produces a natural vacuum effect.

Effective breathwork techniques such as Diaphragmatic breathing can be beneficial. Inhale by filling your rib cage (front and back) and exhale completely. This is known as lateral breathing in hypopressics.
In order to calm the body, prolonged exhalations activate the parasympathetic nervous system.
In order to maximise digestion, resonance breathing involves slowing the breath to a constant rhythm, such as five to six breaths per minute.

Many people don’t realise how important posture is for gut health. When you slouch or tilt your pelvis forward, your intestines and rectum get compressed, which makes it harder to have bowel movements. This can be improved by pelvic tilts and spinal elongation these open up the rectal passage. Being aware of your posture while sitting and standing promotes natural abdominal engagement, and using a squatty stool to mimic a natural squatting position to make elimination easier.

Not only is constipation related to your muscles and movement, but it is also closely linked to your lifestyle and stress levels. Prolonged stress activates the sympathetic nervous system (fight-or-flight), which slows down digestion and keeps the pelvic floor tense all the time. Some holistic lifestyle changes to think about include: lowering stress through mindfulness and meditation, avoiding hurried eating and making sure you chew your food thoroughly. Balancing circadian rhythms by keeping a regular sleep-wake cycle Including gentle movement exercises like yoga and tai.

Take home message

Constipation can have a substantial impact on everyday comfort, mood, and general health; it’s not just a momentary inconvenience. Consistent exercise designed to promote gastrointestinal motility can provide long-lasting relief, even though lifestyle modifications like eating a high-fiber diet, drinking enough water, and exercising frequently are essential for treating it.
Constipation, however, may be connected to more serious problems like pelvic floor dysfunction if it persists for an extended period of time or is accompanied by symptoms like pain, bloating, or straining. This condition often goes undiagnosed and may require targeted rehabilitation techniques such as pelvic floor muscle training, biofeedback, or manual therapy.

Always remember: do not self-diagnose. Consult your physiotherapist or other healthcare professional if your symptoms are complicated or persistent. To help you regain healthy bowel function, a qualified specialist can evaluate your unique needs and lead you through individualised management techniques.