If you’ve ever been to a pelvic health physio, you’ll know that with basically any pelvic issue, we will always address any constipation first. Prolapse, bladder leakage, bladder urgency, pelvic pain, painful sex: will all usually get better if we get rid of the constipation.

The reason being, is two fold:

1. There is only a limited amount of space in our pelvis. Our three pelvic organs, bladder, uterus and bowels, are crammed into a little bowl of pelvis. Our rectum is the holding unit, at the end of our gastrointestinal tract. So, when our rectum is filled with stool, it takes up a lot of space in our little pelvis. It can push forward onto the vagina and bladder. It’s because of this, if you have a back vaginal wall prolapse, you can feel heaviness in the vagina when you need to do a poo. Or, if you have bladder leakage or bladder urgency, your bladder symptoms are often worse when you’re constipated - there’s just not enough room in your pelvis for your bladder to be happy to hold wee!

2. Straining on the toilet can weaken and lengthen your pelvic floor muscles. When we’re constipated, we often have to push or strain to open our bowels. This increases the pressure inside our pelvis, and over time, can cause our pelvic floor muscles to get weaker, and can lead to elongation of nerves in our pelvis. This can contribute to bladder control issues, bowel control issues, prolapse, and painful things like haemorrhoids and anal fissures.

   
   

Constipation is defined as having less than 3 bowel movements per week, or going regularly, but you have stools that are dry, hard and difficult to pass.

So what is normal?

Normal bowel movements do not have to be every day - normal bowel frequency is anywhere between three times a day, and three times a week. They should always be easy to pass ideally like a “smooth soft sausage”.

How can we improve constipation?

Conservative management (which basically means non-medical or surgical treatment) focusses on the four “F”s

1.    Fluid: if we don’t consume enough fluid to keep us hydrated, our body wants to hold onto water. One of the first things it does when we are dehydrated, is suck fluid out of our stool that is in our intestines, to hold onto the water in our body. This can leave us with dry/hard stool. Most people need about 1.5-2L of fluid a day (this includes all of your drinks, but should mostly be water). You’ll need more if you’re breastfeeding (up to a litre extra, or however much breastmilk your baby is taking a day) or have specific medical issues.

2.    Fibre: Fibre is found in plant food. Our body can’t digest it, so it stays in our bowel motions and works to soften and bulk our stool. So, adequate dietary fibre intake can help; a diet high in vegetables is recommended. Kiwifruit can be a panacea - one kiwi per 30kg body weight per day can increase frequency and ease of defecation. Prunes or flaxseeds may also relieve symptoms of constipation. Pear juice or prune juice contain sorbitol and as such may have a benefit in constipation. BUT, Ingestion of a high fibre diet without sufficient fluid intake may contribute to worsening constipation, so keep your fluids up as you increase your fibre.

3.    Fitness: regular exercise can help to get your bowels moving. Even just getting up and going for a short walk can help.

4.    Footstool: One of our pelvic floor muscles (puborectalis) wraps around our rectum, and kinks our back passage off, whenever we’re in a sitting or standing position. When we’re in a squatting position, the puborectalis muscle relxaxes and allows the rectum to straighten out, allowing stool to move through easier. To mimic a squatting position, sit on the toilet, but put a footstool under your feet, to bring your knees higher than hips. Straighten your spine, and lean forward with your elbows on your knees. Voila! You’re in a semi squat position, and research shows you are more likely to have a faster, effortless poo.

If all of these things don’t work, it’s time to see your GP for medication (there’s a whole new world of laxatives out there (think bulk-forming, osmotic, stimulant, liquid, syrup, powder, pill, suppository) so if one doesn’t work for you, there are others that can. Or they may order extra tests, or refer you on for specialist review if they think there might be something else going on.