Can Constipation Cause Pelvic Pain?
According to the National Institutes of Health (NIH), about 16 out of 100 adults have symptoms of constipation. This number grows as people get older and the prevalence can rise to 50% in nursing home residents.
What is important to understand is every person’s bowel movement frequency can be different and not everyone has a bowel movement every day.
What is your “normal”?
Have things changed after a surgery, delivery of baby, or after starting new medications?
And could my pelvic pain be coming from being constipated?
How does the pelvic floor affect bowel emptying?
Our pelvic floor muscles are the “gates” that aid in keeping contents in and allowing stool and urine to exit when appropriate. If these “gates” are affected because stool has been stored for prolonged periods of time, hard in consistency, or affected by hemorrhoids, they could become tense, irritated, and this affects their ability to lengthen and allow bowels to fully empty. Thus, starting the cycle of functional constipation.
What are the symptoms of constipation?
It is important to question ‘how do I know if I am experiencing symptoms of constipation?’
According to the Rome IV criteria, functional constipation can be predicted if you experience two or more of the following criteria over a six-month period:
Fewer than three spontaneous bowel movements per week
Straining for more than 25% of defecation attempts
Lumpy or hard stools for at least 25% of defecation attempts
Feeling of anorectal obstruction or blockage for at least 25% of defecation attempts
Feeling of incomplete defecation for at least 25% of defecation attempts
Needing to manually maneuver to defecate for at least 25% of defecation attempts
These symptoms can arise from various factors such as stress, medications, changes in routine or diet, traveling, lack of fiber or physical activity, and from gastrointestinal disorders such as IBS, GERD, etc.
How do constipation and pelvic health relate to each other?
Constipation and pelvic floor dysfunction often go hand in hand.
The symptoms of pelvic pain from constipation can include:
groin pain
painful intercourse
urge incontinence
pain with defecation
inability to fully empty bowel or bladder
and tailbone pain
As a result, people often find themselves straining and “purple pushing” really hard to get any relief. The straining that happens to try to expel stools can cause further damage to the pelvic floor muscles as well as the local fascial support system.
Over time it will increase your risk of incontinence and prolapse. It can also affect the pudendal nerve and cause nerve damage & pain.
This cycle can also get started due to pelvic pain arising first and leading to constipation and its related symptoms. Pelvic floor dysfunction can lead to difficulty emptying your bowels by tensing up with constant activity and creating a “kink in the hose” by not allowing the pelvic floor muscles to lengthen completely and allow a straight passage for stool to exit.
So what can you start doing if you are constipated?
Sometimes the most simple lifestyle changes can make all the difference! Other times, the problem can be far more complex, and expert opinion and investigations may be required to find out the cause. Start with lifestyle changes and if there is no improvement after a few weeks then seek further help from your pelvic PT and or gastroenterologist.
Perform a colon/abdominal massage daily
There are constipation massage techniques that can be really effective to help aid the transit of stool through the colon by getting the movement of the intestines going more frequently. Ideally done in the morning and in a relaxed position 30 minutes prior to getting that “call to stool”. Perform the massage 2x around the abdomen and then continue with your normal morning routine (water, breakfast, coffee).
**Do not sit on the toilet and wait to get stool out without having the sensation to go***
Check your fiber and water intake
It is recommended to intake 25-35g of fiber daily! Research has found that most people only get about 18g/day! Don’t jump into consuming a lot of fiber all at once, but instead keep track for a day and then slowly increase in the span of 1-2 weeks if needed (2-3g more per day).
Liquid (especially water) is very important to maintain a healthy gut and for stool consistency! If your stool looks like little pellets and your urine is a dark yellow/orange color, then it might be time to increase water. Similar to fiber, slowly increase your water intake per day so that the body has time to adapt and you are not rushing to the bathroom every 30 minutes. It is recommended to have at least half of your body weight in ounces but again, check your hydration identification such as the consistency and urine color!
Change your toilet positioning & breathe!
We are meant to pass stool in a squatted position, by sitting on toilets it changes the mechanics of how we pass stool and it makes it more difficult for the pelvic floor to fully lengthen. We can recreate the squatting position by using a small step or stool under feet and leaning forwards with arms resting on our thighs. Try to relax, and do not hold your breath! Take deep relaxing breaths and exhale slowly while recruiting abdominal muscles to simulate a better “push” that does not put the pelvic muscles under too much strain.
How pelvic floor physical therapy can help
Get help if you need it! If you are reading this and have developed recent changes to your bowel habits, start by making lifestyle changes but also you need to discuss your symptoms with your healthcare team.
Constipation can sometimes be an indication of more serious health conditions, which need ruling out so don’t ignore these symptoms!
At Samson Strength and Performance Physical Therapy, we offer pelvic health physical therapy services that include a full evaluation and treatment as well as one-on-one sessions in Jacksonville Beach. We can help you determine exactly what will help you alleviate constipation symptoms and address any other concerns you may have.
Get started by booking a discovery call with one of our pelvic health physical therapists.