By Miral Patel

I’ve thought of ways to address this topic delicately, but I simply can’t. Dealing with constipation can be...well, pretty crappy ;)! It affects 14.8% of the North American adult population.  That’s approximately 63 million people!!  It’s more common than many other chronic diseases including hypertension, diabetes, and obesity.  It’s also more prevalent in women.  In fact, 40% of women in their 3rd trimester of pregnancy are reported to suffer from constipation.

Physicians often describe constipation on the basis of bowel movement frequency.  Less than 3x/week is considered abnormal. Patients usually describe constipation with a variety of symptoms including straining, passing of hard stool, unproductive urges, sensations of incomplete evacuation and abdominal bloating.

In case you are curious, and because it can help you to understand what’s going on, there are three known types of constipation:

·      Functional

·      Slow-transit

·      Outlet dysfunction

People experiencing functional constipation report difficulty or delayed voiding, hard stools, and abdominal bloating or cramping. Slow-transit constipation is the result of decreased or slow motility in the digestive tract.  Symptoms might  include low bowel movement frequency, lack of urge to defecate and abdominal distension and discomfort.  Finally, outlet dysfunction constipation can be due to a mechanical cause and includes pelvic floor dysfunction.  A tight pelvic floor can result in a decreased ability for the anal sphincter to contract and relax thereby making defecation difficult (You should see a pelvic floor physiotherapist!).  

How can pelvic floor physiotherapy help with your constipation?  

A pelvic floor physiotherapist can perform an internal exam both vaginally and rectally to evaluate the strength and tone of your floor. Based on their findings, they can use a hands-on manual therapy approach to release tight pelvic floor muscles and also to teach you how to contract them.  Whatever their findings may be, a pelvic floor physiotherapist can teach appropriate exercises to relax and lengthen the pelvic floor or to contract and strengthen the pelvic floor.    In addition to working on just the floor, a pelvic floor physiotherapist can work on abdominal massage to help with transit of stool.  They can also provide general advice and guidance on diet modifications and positions for toileting that may help with your constipation.  

Conservative treatment for constipation has traditionally consisted of an increase in the patient’s intake of dietary fibre and water, and an increase in physical activity.  Though these solutions are the cornerstone of conservative treatment, they alone may not be enough.  Two unique and very simple strategies to further assist constipation include positioning when having a bowel movement and the ILU massage.  Hope these strategies can help you!

Positioning can help with constipation

In a modern society most people sit on a raised toilet when having bowel movements.  This position maintains a kink in the colon causing you to strain or push when attempting to defecate.  Be elevating your knees and placing your feet on a stool (or the squatty potty!) you unkink the colon allowing for easy passage of stool.  This video about positioning and constipation is a great resource that can help you understand why positioning alone can make a significant difference in the passage of stool. 

ILU massage can help with constipation

ILU massage is simply massage along the length of the ascending, transverse and descending colon.  Start the massage by forming the letter I by stroking down from under your left rib cage, down to the front of the left hip bone and forwards to the pubic bone.  Do this stroke 10x.  Next form the letter L by starting under your right rib cage across to the left and down to the left hip bone.  Do this 10x.  Finally, form the letter U by starting at the right hip bone, going up under the right ribcage across under the left rib cage and down to the left hip bone.  Do this 10x.   Doing this 2-3x throughout the day can help soothe the large intestine and increase motility of food in the gut.

Try these techniques, along with the more traditional treatments of increased dietary fibre and exercise. And come see us if you feel a pelvic floor concern might be causing your constipation.

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