Constipation: Yes, there is PT for that

A little over a year ago, I discussed urinary incontinence  — by far one of the most common conditions experienced by women, and one that most assume is just a normal part of life.

Another such condition is constipation. Constipation is common in men, women and children. Constipation occurs when the food that we eat does not get expelled appropriately. This can cause a back-up in the colon and can contribute to problems like gas pain, abdominal bloating, abdominal pain, decreased appetite and even urinary incontinence or bed-wetting.

There are several possible causes of constipation and they can be treated (often without medication!).

• Medications: Certain medications, including narcotics (given for pain) and diuretics (given for high blood pressure) can cause constipation. If this is an issue, it is recommended that a person speak with their provider to discuss alternative options to manage pain or blood pressure.
• Pregnancy: Changes in hormones during pregnancy cause the colon (also called the large intestines) to slow down, which can be very uncomfortable.
• Age: As people get older, the colon processes food more slowly.
• Sitting on a tall toilet: Many people prefer tall toilets because there are easier to sit on and to stand up from. However, the muscles of the pelvic floor cannot relax to release stool when a person sits on a tall toilet. This makes it much harder to have a bowel movement.
• Dehydration: When a body does not have enough water, it will reabsorb water from the colon, making the stool hard and difficult to pass.
• Poor diet: In order to have well-formed stool, a person has to eat enough fiber. Fiber is found in fruits, vegetables, beans, nuts and whole-grain breads. If someone does not eat enough fiber, the body cannot form appropriate stools and it may be harder to have a bowel movement.
• Poor muscle coordination: Some people just have a hard time coordinating their pelvic floor muscles, which means that they don’t relax when they are supposed to (for example, when a person is trying to have a bowel movement).

So, what can be done about this?

• Eat right and stay hydrated. It is recommended that an adult eat four to five servings of fruits and vegetables and six ounces of whole-grain foods per day. It also is recommended that an adult drink eight cups of water each day. This makes sure that a person has enough fiber and water for the body to make healthy stool to pass.
• Sit on the toilet right. Sitting on a toilet with your feet on a stool (so that your knees are higher than your hips) and your knees apart helps the colon straighten out and the pelvic floor muscles relax, which makes it easier to have a bowel movement.
• Massage your belly. Colon massage can help if the colon is moving slowly. This massage uses gentle pressure and small circles to help the food move along the path of the colon, which helps speed processing of the food and can help the body have a bowel movement within one to two hours. If you are pregnant, be sure to speak with your provider or a women’s health physical therapist to make sure that it is safe to do this.
• Train your pelvic floor muscles. Specialized pelvic floor muscle training can help people learn to coordinate their muscles to improve the ease of passing bowel movements. A physical therapist can use exercises, stretches and biofeedback tools to improve a person’s ability to use the right muscles at the right time to have a bowel movement.
• Use electrical stimulation. Some people may also respond well to using electrical stimulation on the belly or the back to stimulate the colon to speed its food processing.
• Try a stool softener or a laxative. They may help empty the colon. But be careful because sometimes people can become dependent on them. Before taking a stool softener or a laxative, talk to a provider about the options available, the benefits and the risks.

If you are having trouble with constipation or any of the other issues I listed above, you may benefit from working with a physical therapist. Ask your health care provider for a referral.