Is Poop Really That Important?!

In a word, YES! Yes I really will ask you at your evaluation how you're pooping. I like to know how often, is it satisfying (yes, pooping can be very satisfying), I'll sometimes ask what it looks like. And when you're really lucky, I'll ask you at follow-up appointments too. Because it's just that important.

Great pooping often means a few exciting things for me: you're likely getting enough fiber in your diet, your muscles have the ability to relax to let it out, your hormones likely aren't completely out of whack, you actually make a little self-care time to poop comfortably, and so much more.

So let's talk about what it means when your bowel movements aren't so great. This is a big deal. For starters, if you get regularly constipated, that's physical stuff in your rectum taking up space, and there's not really a lot of room in your low abdomen to store it for very long. So it can begin pressing on the structures around it - including the bladder, the vagina, pelvic floor muscles, and nerves. Because it can press on surrounding muscles and because storing the fecal matter doesn't feel good, the low back can also begin to ache chronically. When I was a brand-new physical therapist, my mentor encouraged me to ask my low back pain patients if they felt they were constipated. Not being a pelvic floor specialist at the time, I thought he was nuts, but I did it. I learned very quickly well over half of those patients admitted to constipation. My guess is there were probably a few more who weren't comfortable mentioning it. For this alone, I love to talk bowel function and strongly believe everyone would feel a little bit better if we all had daily bowel movements.

One job of the pelvic floor muscles is bowel and bladder control. When stool enters the rectum, we have a nerve response that tells us if it's solid, liquid, or gas. The muscles adapt to help hold it back and give us time to comfortably get to a restroom. If the stool does not come out at trips to the restroom, the pelvic floor muscles need to continue to support the extra weight and bulk of it until it can come out. This gives them chronic tension, which over time can be irritating, and eventually, the muscles don't relax or stretch well anymore. Now we have a vicious cycle - the poop didn't evacuate, the muscles tightened up to support it, but those tight muscles make it harder for the poop to evacuate, so they need to continue to support it, and around and around we go. This is one source of chronic pelvic pain. Common symptoms of this type of pelvic pain is pain with penetration during intercourse, pain with tampon insertion or use, tailbone pain, and sacroiliac joint pain.

Remember when I mentioned that a full rectum can press on surrounding structures? Particularly the bladder? A surprising symptom of constipation is bladder leakage, aka incontinence. This happens for a few reasons. The first part is by literally pressing on the bladder, there's not enough room for it to fill, and thus small amounts of urine are leaked out, like squeezing a water balloon with a tiny hole in it. Additionally, if the muscles are getting overtight, they actually lose their ability to coordinate well and become less functional. This means when you need your muscles to engage suddenly to close a sphincter, say with a sudden sneeze, they're too tense, they can't move to close the sphincter and thus, pee squeezes on out. This happens to both men AND women!

This increased pressure of constipation can have a few more serious impacts as well. If a person chronically has to push down hard to get the stool out, it can slowly weaken the muscle support or injure the pelvic floor muscles, which can contribute to, or worsen symptoms of pelvic organ prolapse. Prolapse is when an organ (the bladder, rectum, small intestines, or uterus) protrudes into the vagina. It comes with symptoms of heaviness in the pelvis, pressure sensations, feeling like you constantly have something in the vagina. Managing constipation is one of the best tools we have for improving the symptoms of prolapse.

The pelvic floor is also full of nerves. Constant pressure on nerves can create pain and burning sensations, thus keeping bowel movements on the move helps decrease pain and irritation to the nerves.

How does pelvic floor physical therapy help with constipation? We have many resources and encourage you to follow up on it: positioning and breathing techniques to help muscles relax, manual therapy to teach the muscles to let go, discussion of hydration, nutrition, discussion of medications and how to talk to your doctor about constipation symptoms, exercises that encourage good hip mobility, lumbar back support, and colon function, how to supplement if necessary, and more. The goal of pelvic floor physical therapy is to learn what contributes to your constipation and help you learn tools you can implement at home for long-term bowel health.