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Can Physical Therapy Help with Constipation?

Updated: Feb 27

Constipation can make you feel really bloated and uncomfortable. Not only is it uncomfortable, but great bowel movements are the body's key way to eliminate waste and toxins. Constipation can have very negative health effects! Finding lasting relief often involves more than just temporary solutions, like laxatives, which masks the real problem and create dependency.  In this guide, we'll explore how pelvic floor physical therapy can alleviate constipation and promote digestive health.

Understanding Constipation and Its Impact:

Constipation is an incredibly common digestive issue affecting about 20% of the population. Constipation is characterized by infrequent bowel movements (less than every 3 days by definition) or difficulty passing stools. This condition significantly impacts the body's digestive system, causing discomfort, bloating, and abdominal pain. The importance of regular bowel movements extends beyond mere convenience; it's a vital aspect of maintaining optimal health. Adequate bowel movements are one of the key ways that the body eliminates toxins and waste! Ideal stools should be type “4” on the Bristol Stool Chart: soft, smooth, like a ripe banana, and easy to pass. 

stool chart for constipation

Constipation may be caused by "slow motility" (poor visceral mobility (or mobility of the organs), scars impacting the flow of digestion, gut dysbiosis, a diet low in fiber and fluids, inadequate physical activity), "outlet dysfunction" (pelvic floor dysfunction)... or BOTH!

Slow motility is incredibly common: poor dietary choices lacking fiber, gut dysbiosis (an imbalance of the naturally occuring flora in the digestive system) and/or a sedentary lifestyle can slow down the digestive process. Scarring and internal adhesions from surgery (common ones are from appendectomy and cesarean scars) also can prevent the movement of stools through the intestines.

" Outlet dysfunction" is also incredibly common. It can feel like “something is stuck” or your stool may be quite narrow. It may be accompanied by other pelvic floor symptoms like back pain, tailbone pain, SIJ or buttock pain or incontinence/ leaking.

Finding the "why" behind your constipation is crucial to get lasting relief. This is what our expert team does at RVA Holistic PT: we figure out what your WHY is and solve for that!

If you are struggling with constipation, here are a few things that can help:

Breathing Techniques for Pelvic Floor Relaxation:

If you are like a lot of our patients, you may be in a "fight, flight or freeze" mode for much of your day. This fight-flight mode tells your digestive system that it is NOT a good time to digest food or have a bowel movement.

This is where getting more into a "rest and digest" mode is important. One way to do this is by deep breathing techniques, such as diaphragmatic breathing. Being in that parasympathetic (or "rest and digest" mode) tells your body it is safe to digest your food and it is safe to find a good time and place for elimination. Deep breathing exercises also trigger a response that promotes relaxation in the pelvic floor muscles. This relaxation is crucial, as excessive tension or tightness in these muscles can contribute to constipation or difficulty with bowel movements. When the pelvic floor muscles are relaxed through deep breathing techniques, it can aid in improving blood flow, reducing muscle spasms, and easing the passage of stool through the digestive tract.

Breathing Techniques to Try on The Toilet

Breathing techniques can help assist in the moment of passing stool.   The goal is to avoid breath holding and to utilize the abdominals to assist in pushing as you lengthen the pelvic floor.  

Start by taking a deep inhale.  With a prolonged exhalation, gently engage the abdominals and imagine the anus opening and the anus gently moving or bulging (ever so slightly!) towards the toilet.  You can incorporate any of the 3 sounds below during your exhalation to help:

1.) Snake - make a hiss sound like a snake

2.) Cow - make a low strong moo sound

3.) Huff and puff - exhale 3-6 times quickly like fogging a mirror or a panting dog

Optimizing Toilet Posture:

optimal posture for bowel movements

Correct toilet posture is crucial in preventing and alleviating constipation, significantly impacting the ease and efficiency of bowel movements. Traditional sitting positions on Western-style toilets often result in a partially closed angle between the rectum and the anus, making it harder to pass stool. However, adjusting sitting positions to mimic a more natural squatting (like you are camping and squatting to the ground) posture can significantly aid in bowel movements. Tools like squatting stools or adjustable platforms allow individuals to elevate their feet and mimic a squatting position while seated on the toilet. This posture straightens the rectum and aligns the colon more effectively, allowing for smoother and more natural elimination. By using such tools or adjusting sitting positions to achieve a more anatomically aligned posture, individuals can experience less strain during bowel movements, reduce the risk of pelvic floor dysfunction, and promote easier evacuation of waste, ultimately helping prevent and alleviate constipation-related discomfort.

Massage Techniques to Aid Digestion:

Gentle abdominal massage techniques can be effective in stimulating bowel movement and relieving constipation symptoms. In fact, there is grade-A evidence supporting the use of abdominal massage techniques in the treatment of constipation. One such technique involves performing clockwise circular massages on the abdomen, which can encourage peristalsis, the wave-like muscle contractions that move waste through the digestive system. Here's an introduction to these techniques:

massage for relief of constipation

The clockwise circular massage technique involves using gentle pressure and circular motions on the abdomen, following the path of the colon. Starting at the lower right side of the abdomen, near the hip bone, gently massage in a clockwise direction, moving up toward the ribcage, across the upper abdomen, and then down the left side towards the lower abdomen. This pattern follows the natural flow of the colon, stimulating peristalsis and helping to move waste along the digestive tract.

how to perform massage for relief for constipation

The pressure applied should be gentle and comfortable, avoiding any discomfort or pain. This massage technique can help relax abdominal muscles, reduce tension, and stimulate bowel movements. Additionally, it can aid in releasing trapped gas and relieving bloating, promoting overall digestive comfort.

It's important to note that individuals with certain health conditions or sensitivities should consult with a healthcare professional or a pelvic floor physical therapist before attempting abdominal massage techniques. When performed correctly and regularly, these gentle massages can complement other constipation-relief strategies and contribute to improved bowel regularity and comfort.

Importance of Exercise for Pelvic Health:

Regular exercise promotes overall body movement and circulation, which aids in stimulating digestive processes and encouraging more efficient bowel movements. Engaging in aerobic activities, such as brisk walking, jogging, cycling, or swimming, promotes increased heart rate and breathing, which in turn enhances blood flow throughout the body, including the gastrointestinal tract. This increased circulation encourages more efficient movement of waste through the intestines, aiding in regular bowel movements. Additionally, aerobic exercise helps stimulate the natural contractions of the intestinal muscles, known as peristalsis, promoting smoother and more regular bowel movements. Moreover, consistent aerobic exercise can reduce stress and anxiety, which can often contribute to digestive issues, thereby positively impacting overall gut health. Incorporating aerobic exercise into one's routine not only supports cardiovascular fitness but also plays a significant role in promoting digestive regularity and alleviating constipation.

Lifestyle and Dietary Considerations:

relieving constipation through healthy fiber intake

Making lifestyle modifications is essential for supporting healthy bowel movements and preventing constipation. Hydration plays a crucial role in maintaining regularity, as adequate water intake softens stool, making it easier to pass. Incorporating a fiber-rich diet, including fruits, vegetables, whole grains, and legumes, adds bulk to stool, aiding in its movement through the digestive tract. Establishing regular toilet routines, such as visiting the bathroom at consistent times each day, helps train the body and encourages a more predictable bowel pattern. These lifestyle changes contribute significantly to digestive health by promoting optimal hydration, providing necessary nutrients for proper bowel function, and establishing habits that support regular and comfortable bowel movements, reducing the likelihood of constipation and enhancing overall well-being.

Consulting a Pelvic Floor Specialist:

Because finding the root cause of constipation is essential to find lasting relief, it is essential to consult with a pelvic floor physical therapist. They can help you figure out if your problem is due to slow motility, outlet dysfunction... or both! Our team also has specialized training to treat contributing scar tissue restrictions or decreased mobility of the viscera. And, if it seems like your issue is due to gut dysbiosis, we know just the people to send you to! 


Constipation can be a persistent and uncomfortable issue, but with finding the underlying "why" through our expertise, relief is right around the corner!

If you are struggling with constipation, reach out for an appointment locally in Richmond, Virginia or via telehealth in the state of Virginia-- specially trained pelvic health physical therapists are trained to help with constipation, cesarean scar pain, low back pain, pelvic health issues and adhesions. Call us at 804-372-0291

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