Constipation Blues,

Tips and Lifestyle Help with Pelvic Physical Therapy

Maureen Mason, DPT, Function Smart PT

   In the realm of Pelvic Physical Therapy (PT) constipation is evaluated and treated with conservative care techniques, and some individuals  are improved rapidly, in a few sessions, while others may need several sessions to achieve results, in addition to lifestyle changes, supplements and pharmaceuticals. Let’s look into the medical side of things you may not know…fluid and fiber, nutrition, exercise, and the mechanics of motility and defecation. We will start with the basics, and then address more complex concerns you may have in your unique case.

Basics

  Fluid: drink 6-8 glasses of water a day, or more specifically, ½ body weight in ounces of water per day. This general guide helps a lot of people! Those with bladder leaks tend to limit hydration, which produces constipation, which then aggravates incontinence, so it is a cycle that is difficult. Gradually build up hydration in order to ease constipation. For example;160 # individual drinks 80 ounces per day. Drink most of the water outside of meals, and earlier in the day. You will likely have a need to urinate for several seconds, every 2-3 hours with the fluid intake.

Fiber: Consume 25-35 grams per day, mostly from cooked vegetables and small amounts of fruit. Ground flaxseeds, and or chia seeds may gradually be added to the diet as well. Psyllium fiber, or benefiber can be helpful as a supplement as well. Limit, or even eliminate bananas, bread, white rice, and highly processed foods. Dry fibers as in breads and “energy bars” or even too much raw kale can aggravate constipation, so hydrate, chew foods, and eating mostly cooked vegetables will work the best.

Exercise: Walking, stretching, and also deeply relaxing the abdomen, hips and back, and pelvic muscles helps “move things along” and also promotes “deep body relaxation”, which then facilitates digestive processing. When we are stressed, or only perform tightening and shortening exercises, the pelvic and other muscle clenching sends signals to the colon that it is not “safe” to go. Deep belly relaxation breathing is an important part of exercise as the diaphragm is a piston, a pump of sorts, for the digestive system, and the “relaxation exercise” component of pelvic PT often surprises people and they take a while to get on board with it.

Pay attention: to body “signals” that you need to go, and every time that you may “wait and hold it” this encourages a larger firmer stool. Pay attention to your digestion output. The time for the small intestine and large intestine processing and reacting to food intake 1 to 2 days or more after you eat. You may eliminate right after eating, if the for example, you have a rapid gastro-colic reflex for filling and emptying, but the immediate output is not from the meal you just consumed.

Food intolerances? Note that some people may bloat the next day following high dairy consumption, or wheat, and these are the two main triggers for indigestion as well as food additives, so strive for “whole food”, unprocessed.

Pooping technique: Relax your bottom, actually the pelvic muscles*, and bear down with a gentle firming of the abdomen to eliminate; many clench and tighten and this prevents output. Many use a squatting stool or “squatty potty” to help optimize output.

A colon massage can help you to eliminate.

Complex issues that can make constipation more difficult include medications such as necessary antibiotics for health conditions, which disrupt the gut biome of symbiotic, helpful bacteria. Post antibiotic dysfunction may be constipation, or diarrhea. Pain meds often slow digestion. Body tension, shallow breathing, and insufficient exercise are associated with constipation. A high junk food diet and lots of starchy, low fiber food can cause digestive issues and if this is you, the reader, a great plan is to add one new healthy item per week, and read free online nutrition education.**

What to expect with pelvic PT? A program and plan for your self -care, and in treatment a non-invasive Ultrasound on the abdomen, biofeedback with surface sensors on the pelvic muscles, therapeutic exercise and hands on manual therapy such as a specialty  colon massage and techniques to optimize rib, diaphragm, and pelvic muscle length and tone. Health trackers are provided to help you become a self -care detective as well!

References:

*pelvic muscles see mypelvicrehab.com post

http://www.Nutrition.gov

http://www.cedars-sinai.org How to relieve constipation naturally

Home

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Ezenwa L A, Brewer J, Markowski A, A Comprehensive Physical Therapy Approach including Visceral Manipulation after Failed Biofeedback Therapy for Constipation, Tech Colproctol 2016, 20

Krogh K, Chiarioni G, Whitehead W, Management of chronic constipation in adults, United European Gastroenterology Journal 2017, 5(4)

Ma-Re,  Wen N R, Hu Y L, Zhao L, Tuerhongjiang T, et al, Biofeedback -guided pelvic floor exercise therapy for obstructive defecation; an effective alternative, Randomized controlled trial, World J Gastroenterology 2014

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Saeed, Madiha, The holistic prescription, 2017, Rowman and Littlefield Lanham, Boulder, New York, London

Published by 1wcspt

Pelvic Rehab, Ortho and Pain specialist, Medical Yoga Therapist, Credential Clinical Instructor APTA, Integrative Therapy, member Academy of Integrative Health and Medicine (AIHM), Institute of Professional Yoga Therapy, National Institute of Complementary and Behavioral Medicine (NICABM), presenter on specialty topics in Physical Therapy

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