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When Your Poo Pusher Doesn’t Poo

“My Poo Pusher Doesn’t Push Poo.”  That is the best description of constipation a patient has ever given me.  Exactly right.  So, what happened and how do you fix it?

Let’s start with a more complete, scientific definition than my patient’s description above.  Constipation is defined as pooping less than 3 times per week, straining with pooping, feeling like the colon isn’t empty, or having to using other techniques (finger, enema) to be able to poop. There are many reasons to be constipated, but here we are going to focus on pelvic floor dysfunction.  So, besides not eating your leafy greens, what cause constipation?  When looking at constipation from a pelvic floor perspective, some of the most common causes include not enough fiber, lack of exercise, medications (many can cause constipation), ignoring the urge to go poop, travel or just getting off routine, pregnancy, irritable bowel syndrome, and aging.  In these situations the root of the problem is the inability to relax the pelvic floor muscles in order to poop.  The rectum is a complex organ that has the amazing ability to sense whether you need to pass gas, liquid, or solid.  Based on that sampling response, your pelvic floor is able to relax enough to pass the gas or tighten up enough to stop the liquid stool.  This is at the level of the internal anal sphincter, which is involuntary.  This means that you are not able to control this muscle—kind of like your heart.  The internal anal sphincter relaxes when you sit down to poop but stays tightened until it is time to go.

The external anal sphincter (EAS) is the layer of muscle that you are able to control.  You are able to tighten this muscle to close off your rectum to prevent the passage of gas at inappropriate times.  But it also must be able to relax when it is time to have a bowel movement.  If the muscles are unable to relax, it becomes difficult and sometimes painful to poop.  When this occurs, your body tightens up more against the pain, which adds to the hurt.  All of a sudden, a vicious cycle has started and it is important to find a way to stop the madness!

Toileting techniques can play an important role in easing constipation.  When you are standing, the anus and rectum are at an 80-100 degree angle to each other, making it hard to have an accident in standing since there is a kink in the tube.  When you sit down and lean forward with your hands on your knees, the angle of the rectum to the anus increases closer to 170 degrees, making the tube straighter and thus, easier to poop.

Pelvic floor therapists can be very helpful in the treatment of constipation.  We can help break the cycle!  To treat constipation, pelvic floor therapists begin by examining the patient’s ability to relax the pelvic floor muscles and looking for connective tissue issues. We also talk about toileting habits, food, and exercise.

Pelvic floor therapists spend a lot of time teaching is proper pooping technique.  Again, if the pelvic floor muscles are not able to relax, you are trying to poop through a closed tube.  Working on relaxing the appropriate muscles through biofeedback, manual therapy, and exercises is the first important step.  Taking the ability to relax the muscles laying down and then into sitting and then into the bathroom are big steps and there can be a big learning curve.  It is hard to break bad habits even when the habits are painful.  That’s where working on the proper techniques comes into play—posture, breathing, relaxing the pelvic floor.

Pelvic floor physical therapists play an important role in helping to treat constipation and help prevent it from coming back by teaching you how to relax the pelvic floor muscles instead of fighting against the poop and how to use techniques to improve your success!

–Jennifer Cumming, PT, MSPT, CLT

This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT and like us on Facebook at Foundational Concepts for updates.

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