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POOP! So what's normal anyways?


This month is dedicated to bowel health! We, as pelvic floor therapists, are nosey people - we want to know all things bowel, bladder and intimacy. WHY? Because one has everything to do with the other! Constipation and a full rectum can actually contribute to pelvic pain, urinary leakage and exacerbate prolapse symptoms. Dr. Suzanne did a stellar job going through bowel health and norms this month. Let's dive in!


For most people, normal poop habits vary from 3x per day to 3x per week. However, it’s important to note that everyone has different bowel patterns and frequency isn’t the only factor in proper bowel health. Normal stool should be soft, yet well-formed, and easy to pass. A healthy bowel should allow you to defecate within roughly a minute of sitting on the toilet, pass a stool without pain or straining, and fully empty without feeling like you need to sit back down afterwards. We typically get the urge to defecate about 30 minutes after a meal, most commonly breakfast, but this can vary from one individual to the next.


The Bristol stool chart is used to describe shapes and types of stool. Doctors can also use this tool to determine how long a stool has spent in the bowels. Ideal stool is classified as type 3-4 which is easier to pass. Type 1-2 indicates constipation since these types of stool can be hard and difficult to pass. Type 5-7 may indicate diarrhea or urgency. With type 6 and type 7, the stool is loose due to passing through the digestive system too quickly without allowing the bowel to absorb water. See below:




Constipation

Constipation affects 20% of the population and is defined as fewer than three bowel movements per week. The stools are usually hard, dry, small in size, and difficult to eliminate. People who struggle with constipation may find it painful to have a bowel movement and experience straining, bloating, or the sensation of a full bowel.


Constipation is clinically diagnosed by 2 or more of the following criteria:

  1. Straining with defecation

  2. Lumpy or hard stools

  3. Sensation of incomplete evacuation

  4. Sensation of anorectal obstruction or blockage

  5. Manual maneuvers to facilitate defecation, such as digital evacuation


As we mentioned above, constipation can also contribute to bladder control problems. When the rectum is full of stool, it can put excess pressure on the bladder. If the pelvic floor muscles are not functioning as well as they should be and the pressure from above exceeds the pressure from below, urinary leakage can occur. Constipation may also play a role in low back pain, prolapse, and painful sex.


The many potential causes of constipation:

  • Poor diet

  • Decreased water intake

  • Limited fiber intake

  • Sedentary lifestyle

  • Repeatedly ignoring the urge to have a bowel movement

  • Stress

  • Lifestyle changes, such as pregnancy and travel

  • Laxative abuse

  • Certain medications

  • Slow movement of the stool

  • Overactivity of the pelvic floor muscles

  • Abdominal weakness or issues such as diastasis recti

  • Scar tissue restrictions


How can Pelvic Floor Therapist help?

A Pelvic Floor Therapist may be the missing link in the treatment of your constipation. Below are just SOME ways Pelvic Floor Therapy can help.


  1. Treating overactive pelvic floor muscles

  2. Sometimes constipation is caused by dysfunction in your pelvic floor muscles, specifically the muscles that surround the rectum (AKA the puborectalis). When the stool reaches the rectum to be emptied, the pelvic floor muscles have to relax and lengthen to allow the stool to pass through. If these muscles are too tight or in spasm, it may be difficult to have a bowel movement and straining can occur. A pelvic floor therapist can assess the coordination, tone, and strength of the pelvic floor to address any muscular issues.

  3. Weak abdominals or scar tissue restrictions

  4. We have to generate enough force to propel stool from the rectum. However, if there is weakness in the core or a diastasis (separation between the 6-pack muscles) from childbirth it may be more difficult to have a bowel movement. A surgical scar, such as a C-section scar) on the abdomen can also cause motility restrictions of the small or large intestines leading to slower fecal transit time. A pelvic floor therapist can assess for diastasis recti, instruct in intraabdominal pressure management, and determine if any surgical scars are contributing to your constipation.


3. Food and bowel diary

  1. Your Pelvic Floor therapist may ask you to complete a bowel diary for 3-4 days to assess your eating and bowel habits. This allows the PT to see what you eat and how it correlates to your symptoms. It may also shed light on poor eating or drinking habits that are affecting your stool. When appropriate, Pelvic Floor therapists may refer out to nutritionists, allergists, or medical doctors to help assist in treating constipation.


4. Abdominal massage (ILU)

  1. Abdominal massage has been shown to stimulate peristalsis, decrease colon transit time, increase frequency of bowel movements, and decrease feelings of discomfort and pain. The massage follows the path of the large intestines. To perform abdominal massage you just have to remember the letters I, L, and U. See below:

Image used with permission from Pelvic Guru, LLC www.pelvicglobal.com


How to perform abdominal massage:

  • Lay down and bend your knees towards your chest with your feet flat on the ground.

  • Start by forming the letter “l” by stroking with mild-moderate pressure from just under the left ribcage down to the top of the left hip bone. Do this 10 times.

  • Then form the letter “L” by stroking from under the right side of the ribcage to the left ribcage, and then down to the top of the left hip bone. Do this 10 times.

  • Lastly, form the letter “U” by stroking from the top of the right hip bone up to the right ribcage, across to the left ribcage, and down to the left hip bone.


5. Toilet posture

  1. A pelvic floor therapist will also be able to advise you on optimal toilet posture. Elevating your feet using a stool puts the pelvic floor muscles, specifically the puborectalis muscle, in an optimal position for relaxation and lengthening. Think squatty potty! It may also be helpful to learn some breathing techniques and tricks such as exhaling as you try to empty the stool.


To sum it all up, Pelvic Floor therapy has been shown to be an effective treatment option for patients struggling with constipation. Since each individual is different, we will work on putting the pieces of the puzzle together to figure out the root cause of your specific problem. If you are dealing with constipation or other bowel issues, consider checking in with a therapist to see if pelvic floor therapy is the right choice for you.



Healthy & Happy Bowel Movements,

Dr. Suzanne




Sources:

Shih, David Q., and Lola Y. Kwan. “All Roads Lead to Rome: Update on Rome III Criteria and New Treatment Options.” The gastroenterology report 2007; 1(2):56–65.

Sinclair, M. “The Use of Abdominal Massage to Treat Chronic Constipation” Journal of Bodywork and Movement Therapies 2011; 15:436-45.

https://www.continence.org.au/pages/bristol-stool-chart.html. Bristol Stool Chart


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