What is Constipation?

Constipation is the inability to empty your bowels frequently. This generally occurs as the stool (ie. faeces) is often hard and dry and as a result, can be difficult to pass. Not passing a bowel motion at least once per day is a relatively high indicator of bowel dysfunction.

What Causes Constipation?

Many factors can lead to constipation, including:

Lifestyle factors:

• Not drinking enough water
• Not eating enough fibre/change in diet
• Lack of regular exercise
• Delaying/putting off bowel movements
• Change in daily routine
• Stress
• Age
• Obesity / overweight

Medical / Physiological and Psychological Factors:

• Metal health conditions, e.g. anxiety and depression
• Medical conditions that affect the nervous system, e.g. Parkinson’s disease or MS
• Medical conditions that affect the endocrine system, e.g. diabetes or hypothyroidism
• Medical conditions that affect the digestive system, e.g. IBS
• Blockage or obstruction of the colon/rectum, e.g. tumour or haemorrhoids
• “Slow transit” of the faeces through the colon
• Injury to the pelvic floor, abdomen or anus, eg. anal fissure.
• Surgery, eg. abdominal or gynaecological surgery.
• Some medications, eg. narcotics (codeine)
• Illness, particularly an illness resulting in hospitalisation
• Reduced mobility

What are the Symptoms of Constipation?

The symptoms of constipation may include:

• Decreased frequency of passing a bowel movement (two or less every week)
• Hard, dry stools that may be difficult or painful to pass
• Needing to push and strain when passing a bowel movement
• Taking longer than a couple of minutes to pass a bowel movement
• A feeling of incomplete emptying of the bowel
• Abdominal pain and bloating

How is Constipation Diagnosed?

Usually, a clinical diagnosis can be made using:

• Information gained from your medical history and subjective interview
  • toileting habits and lifestyle factors, eg. diet, fluid intake, medication, exercise
• Physical examination, including assessment of pelvic floor muscle function and occasionally an internal examination (only if indicated).
• Medical investigation with your doctor if required, such as imaging (eg. x-rays) or a colonoscopy. Your doctor will inform you of any other tests that may be required.

Treatments for Constipation

There are many treatments for constipation that physiotherapy can achieve. These treatments can include:

• Education
• Diet recommendations regarding fibre intake
• Recommendations regarding volume/timing of water intake
• Recommendations regarding exercise
• Pelvic floor exercise program
• The addition of stool softeners
• Adjustment of toileting habits and positioning

Other Treatments

A large proportion of people with constipation will have their symptoms improved or resolved with physiotherapy treatment. However, depending on the cause of your constipation, you may also need to follow up with your doctor for additional treatment if required, including:

• Medications review/ prescription (including some laxatives)
• Medical treatment for conditions that may put you at risk of constipation

What Results Can You Expect?

A large proportion of people with constipation will have their symptoms improved or resolved by adjusting lifestyle factors through physiotherapy treatment. However, if left untreated, the problem may worsen gradually and may affect other areas, including the pelvic floor and bladder.

Will You Need Surgery?

There are certain conditions or causes of constipation that may not fully resolve with physiotherapy alone. In some cases, people may require medical review and potentially surgery to resolve their symptoms.

For more information please consult your physiotherapist with a special interest in pelvic floor conditions.