Constipation is often clinically defined as having three or fewer bowel movements a week. Sometimes this is about expectations; people generally feel like they’re not “healthy” if they don’t have a bowel movement every day. But three bowel movements a week can be normal for some people, especially if that has been their pattern for a long time.
There are many other factors that affect how people perceive bowel movements. According to the Rome IV criteria of constipation often used in research, frequency alone doesn’t explain all complaints of constipation. Patients complaining of two or more of the following also qualify for a diagnosis of constipation:
- feelings of incompletely evacuating (not getting everything out)
- lumpy or hard consistency of the stool
- sensation of blockage
- using a finger to dislodge the stool.
When constipation is a problem, there are two main reasons for it: slow movement of the colon and pelvic floor dysfunction. Treatment for slowed movement of the colon is usually laxatives and drugs to move your colon. But getting your pelvic floor evaluated is worthwhile, because a diagnosis of pelvic floor dysfunction typically involves nondrug treatment.
Pelvic floor dysfunction
The pelvic floor is a muscular bowl that encompasses the rectum, bladder, and (for women) the uterus. There is a complex interaction among these different organs. In the act of defecating, or having a bowel movement, the anal sphincter (the group of muscles at the end of the rectum) has to relax, and the abdominal muscles need to contract.
A common analogy I give is that it’s like getting toothpaste out of a tube. When you want the toothpaste to come out, you loosen the cap and press on the tube. However, if you leave the cap on or even tighten it, pressing is not going to get the toothpaste out. In the same way, some people who have constipation fail to relax, or actually tighten, their anal sphincter, while using their abdominal muscles to contract the colon when they are trying to defecate. This leads to feelings of incompletely evacuating; hard, small stools; or even feeling like you have to use your finger to get the stool out.
These uncoordinated pelvic floor dynamics are usually diagnosed with a test called anorectal manometry, which uses a thin tube to measure pressures, sensations, and reflexes in the rectum and anal sphincter.
Biofeedback-based physical therapy to treat pelvic floor dysfunction
The good news is that treatment typically does not involve medications. Instead, treatment involves physical therapy in the form of biofeedback. Currently, the best way to undergo physical therapy is in a private setting, with the help of a trained physical therapist who coaches you on the dynamics of defecating. During these sessions, the physical therapist inserts a probe into your anal sphincter and places sticky pads on your abdomen, to detect the movement of your anal sphincter and abdominal wall as you simulate defecation.
By doing this, you receive feedback (either visual or verbal) on what you are doing with your abdominal wall muscles and anal sphincter during a bowel movement. The physical therapist will lead you through breathing exercises, as well as muscle strengthening and relaxation exercises, in order to help you retrain the movement and coordination of your pelvic floor.
There are currently no devices available for at-home training, but such devices are undergoing research and development.
The physical therapist will also discuss dietary recommendations including increased water and fiber consumption, positioning techniques (like using a Squatty Potty), or massaging your abdomen to stimulate the gut.
The usual time commitment is about four to eight sessions, one session a week. Like physical therapy for your shoulder or your back, learning what you have done in physical therapy takes time and also practice at home. Some people understand and incorporate these techniques right away, and others take more time and practice.
How effective is biofeedback for constipation caused by pelvic floor dysfunction?
In a study of biofeedback for pelvic floor dysfunction compared to laxatives (the usual treatment for constipation), nearly 80% of people undergoing biofeedback had improvement in constipation compared to 22% in the laxative group. The effect also seems to improve over time, up to two years.
Retraining your body to change the way you have a bowel movement takes time. But it could potentially help with all of the symptoms of constipation.
Below are spiritual recipe for health and wellness: Matthew E. McLaren
Whoever would foster love covers over an offense, but whoever repeats the matter separates close friends. Proverbs 17:9 NIV
Be kind and compassionate to one another, forgiving each other, just as in Christ God forgave you. Ephesians 4:32 NIV
For if you forgive other people when they sin against you, your heavenly Father will also forgive you. Matthew 6:14 NIV
Bear with each other and forgive one another if any of you has a grievance against someone. Forgive as the Lord forgave you. Colossians 3:13 NIV
If my people, who are called by my name, will humble themselves and pray and seek my face and turn from their wicked ways, then I will hear from heaven, and I will forgive their sin and will heal their land.
2 Chronicles 7:14 NIV
Do not judge, and you will not be judged. Do not condemn, and you will not be condemned. Forgive, and you will be forgiven. Luke 6:37 NIV
Who is a God like you, who pardons sin and forgives the transgression of the remnant of his inheritance?
You do not stay angry forever but delight to show mercy. Micah 7:18 NIV
You, Lord, are forgiving and good, abounding in love to all who call to you. Psalm 86:5 NIV
Therefore, my friends, I want you to know that through Jesus the forgiveness of sins is proclaimed to you. Through him everyone who believes is set free from every sin, a justification you were not able to obtain under the law of Moses. Acts 13:38-39 NIV
He is the atoning sacrifice for our sins, and not only for ours but also for the sins of the whole world.
1 John 2:2 NIV
Whoever conceals their sins does not prosper, but the one who confesses and renounces them finds mercy. Proverbs 28:13 NIV
In him we have redemption through his blood, the forgiveness of sins, in accordance with the riches of God’s grace. Ephesians 1:7 NIV
Rend your heart and not your garments. Return to the Lord your God, for he is gracious and compassionate, slow to anger and abounding in love, and he relents from sending calamity. Joel 2:13 NIV
Peter replied, “Repent and be baptized, every one of you, in the name of Jesus Christ for the forgiveness of your sins. And you will receive the gift of the Holy Spirit.” Acts 2:38 NIV
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