Signs Your Constipation May Be a Pelvic Floor Problem
"I've Tried Everything. Why Am I Still Constipated?"
Many people assume constipation is caused by not eating enough fiber or drinking enough water. While those factors matter, they aren't the whole story. Some people do everything "right" and still struggle to have regular bowel movements. In these cases, the problem may not be what is in the bowel—it may be how the pelvic floor muscles are functioning. If you're straining, spending a long time on the toilet, or feeling like you can never fully empty, your pelvic floor may be contributing to the problem.
What Is Constipation?
The first myth we need to debunk is that constipation means the absence of bowel movements. In fact, you can poop every day and still be constipated. Frequency of bowel movements varies a lot among individuals. Anywhere from 3 times a week to 3 times a day may be considered “normal.” In terms of frequency, fewer than 3 times a week or a change from your normal frequency warrants looking into what’s going on. Frequency aside, constipation can be defined as any or all of the following:
Hard or difficult-to-pass stools
Excessive straining
Feeling incompletely emptied
Needing to use your fingers or change positions to help a bowel movement pass
Spending excessive time on the toilet
So as you can see, constipation isn't just about how often you go—it's also about how easily you go..
What Does the Pelvic Floor Have to Do With Bowel Movements?
The pelvic floor is a group of muscles that sits below the pelvis like a hammock. These muscles span between the pubic bone and the tailbone and play a role in bladder, bowel, and sexual function, as well as contribute to your body’s support system. During a bowel movement, these muscles must relax and stretch to allow stool to pass through. If the muscles don’t relax properly, bowel movements become difficult regardless of the diet. Just imagine trying to push toothpaste out of a tube while someone pinches the opening closed.
The pelvic floor muscles can become dysfunctional for a number of reasons including nerve conditions, injury or trauma to the tissue, muscle weakness, poor coordination, or excessive muscle tension.
7 Signs Your Constipation May Be a Pelvic Floor Problem
You strain frequently - Constant pushing isn’t normal. Repeated straining may indicate difficulty relaxing your pelvic floor. Those who continue to push may end up straining to the pelvic floor muscles or contribute to confusion and poor coordination of these muscles, which perpetuate the need to strain.
You feel you can’t fully empty - If you find yourself saying, “there’s more in there” or “I never feel done.”
Bowel movements take a long time - Taking 10-20+ minutes to have a bowel movement or needing multiple attempts to empty are not normal and a sign that something needs to be addressed.
You feel blocked - A sensation that stool is “stuck” or that something won’t let it come out are common signs of pelvic floor dyssynergia
You need to change positions to go - Leaning to the side, rocking, lifting your feet, pushing on your abdomen, or even standing and squatting on top of the toilet seat are common strategies that may suggest pelvic floor issues.
You have pelvic pain, tailbone pain, or pain with sitting - Constipation and pelvic floor dysfunction commonly coexist. Pelvic pain is often associated with increased muscle tension and excessive muscle tension makes it difficult for relaxation to happen.
You also have bladder symptoms - Urgency, frequency, and difficulty emptying the bladder is also a sign of dysfunction and both the bladder and bowel share the same pelvic floor muscles.
Common Mistakes People Make When Trying to Fix Constipation
Increasing fiber indefinitely - Adding fiber to one’s diet can be a helpful starting point to consider. However, if you’re continuing to add more and more and not seeing any improvement (or you’re seeing a worsening of symptoms), you may be missing the mark.
Drinking excessive water - Water is important but too much a good thing can have negative consequences. Constipation can create bladder urgency and overloading your bladder with water can contribute to this as well. You may find that excessive water intake doesn’t improve your bowels AND worsens bladder symptoms.
Overuse of laxatives - Laxatives are often someone’s first self-treatment approach. While these may help in some cases, many times people need to add more and more to their regiment and still struggle to poop. This is because when the pelvic floor muscles are the problem, the struggle to go still exists, regardless of how soft the stool is. As a side note to consider, chronically liquid stool will negatively affect how your brain receives the signal that it’s time to get to the toilet.
Ignoring the urge - A lot of people prefer to poop at home in their own bathroom, I get it. But ignoring the urge to go will train the bowel to become less responsive to stool. This means you may notice fewer urges and less of a signal when it’s time to go. This worsens the issue all together.
Pushing harder - Straining or trying to force stool to come out often worsens symptoms of constipation by creating more strain on the pelvic floor muscles. It’s also very common for people to feel they are pushing out when really their muscles are contracting. This is a coordination problem that often develops as a result of chronic constipation.
How Pelvic Floor Therapy Can Help
Pelvic Floor Therapy is often what Gastroenterologists and Colorectal Surgeons refer patients to as an effective treatment option. Pelvic floor therapists help treat constipation in the following ways:
Assessment and treatment of pelvic floor coordination
Breathing and pressure management techniques
Toilet posture education
Bowel retraining strategies
Relaxation techniques for muscle tension and guarding
Addressing contributing factors such as:
Hips
Core function
Rib cage mobility
Nervous system regulation
It’s important to note that constipation can be multifactorial. There may be an issue in the gut itself such as IBS, IBD, or slow motility. There may be no issue with the digestive system at all and constipation maybe due to purely a mechanical issue at the pelvic floor. And finally, there may be a combination of these factors that need to be addressed.
Sometimes the Problem Isn't the Stool—It's the Exit Strategy
Many people focus exclusively on what they're eating when trying to improve constipation. But having a bowel movement requires more than healthy stool—it also requires the pelvic floor muscles to coordinate and relax appropriately.
If you've tried fiber, water, supplements, and dietary changes without lasting relief, it may be time to look beyond the bowel itself and consider whether your pelvic floor is part of the picture.
✨If you’ve been struggling with any symptoms of pelvic floor dysfunction, I’d love for you to consider working with us and getting you relief. We have both in-person and virtual options available, for your convenience.
