WHAT IS CONSTIPATION?
Constipation is defined as infrequent (fewer than three) bowel movements per week. Symptoms of constipation typically include hard stools, excessive straining, feeling of incomplete evacuation, use of laxatives or enemas in order to have a bowel movement, and/or prolonged time on toilet with unsuccessful defecation. Brief periods of constipation is normal when associated around travel or menses but chronic constipation can be debilitating.
WHAT CAUSES CONSTIPATION?
The cause of constipation is multifactorial and the following lifestyle habits and behaviors may contribute: limited fluid and fiber intake, imbalances in the diet (too much sugar and animal fat), sedentary lifestyle, repeatedly ignoring the urge to have a BM, lifestyle changes, such as pregnancy and travel, laxative abuse, and medication (pain medicines, antidepressants, psychiatric medications, high blood pressure medication, diuretics, iron supplements, calcium supplements, tranquilizers and antacids containing aluminum).
However, constipation can also be resultant of Pelvic Floor Dysfunction. When the pelvic floor muscles are “tight” or hypertonic they will inhibit bowel function. During defecation the pelvic floor muscles need to be relaxed in order for the sphincter to open and the stool to evacuate. You can help your pelvic floor muscles relax by having your feet on a stool in 90 degrees or greater of hip flexion (knees higher than hips while sitting). This will increase the puborectal angle allowing for easier defecation. Leaning forward and supporting your elbows on knees (or for some sitting upright is better) is also beneficial. Pay attention to the relaxation of the pelvic floor muscles while emptying your bowels. Try diaphragm breathing to help relax the pelvic floor muscles and avoid holding your breath. Be sure to take time to empty your bowels. It is not normal to have to push or strain to have a bowel movement. Chronic straining during defecation can lead to Pelvic Floor Dysfunction, as well as Pelvic Prolapse. “Heavy Bowels” or a full rectum can put pressure on the bladder leading to increased urge, frequency, and incontinence.
HOW IS CONSTIPATION TREATED?
The focus needs to be on diet and behavior modifications first. Fiber is important for good bowel health and generally most Americans do not get enough fiber in their diet. Typical diet recommendations are 25-35 grams per day, however, this needs to be spread out through each meal. If you eat 3 meals a day, then you should average about 8-11 grams per meal. If you are not drinking the appropriate amount of water then fiber cannot do its job and can even have adverse effects. Consistently sipping small amounts of water throughout the day (averaging 4-6 ounces an hour from the time you wake until 3 hours before bed) will allow for most effective use of fiber as well as keep you hydrated.
Eating breakfast is very important for overall digestion and metabolism, as well as eating a minimum of 3 meals a day (or preferably 5-6 small meals to keep your body constantly fueled and increase your metabolism). Within 30 minutes after eating a meal or drinking a hot beverage, a natural emptying reflex occurs to increase motility (movement of the stool toward the rectum). This is a natural reflex we can take advantage of to improve or resolve constipation–See Bowel Retraining.
I do not recommend fiber supplements such as Metamucil or Citracil, or “high” fiber foods such as cereals or fiber bars as they are not processed as efficiently in our body as natural resources are. It is important that you take the time to plan your meals and add fiber to your diet naturally with fruits, vegetables, nuts, and grains. If you are very low in fiber, slowly add fiber to your diet (not all at once) or you may feel bloated or gassy (another reason to not eat a high fiber supplement such as a fiber bar–too much fiber in one meal from one source is not utilized effectively). Remember, the goal of physical therapy is to restore normal bowel function without the use of supplements or medications, including laxatives and enemas.