Sunday, November 5, 2017
Most people experience occassional constipation. Constipation isn’t just the inability to have a bowel movement, and includes the difficulty associated with bowel movements. Travel, inactivity, illness, and certain over the counter medications taken “as needed” commonly result in short-term or acute constipation. Constipation lasting longer than three months is considered chronic constipation. Chronic constipation should be treated by a doctor to prevent health complications.
Clear communication is essential to working with doctors, but the general public often has only a rudimentary understanding of medical terms - including constipation. There is often a gap between the physician and the patient’s perception of constipation which can lead to confusion. (1, 2, 7, 10) A study of people who thought they had constipation showed that only a third actually fit the criteria for constipation, while the rest actually had Irritable Bowel Syndrome or other gastrointestinal disorders. (9) So what are the criteria for constipation?
If you have two or more of these symptoms, you may have constipation: (Rome IV)
If these symptoms last three consecutive months, your constipation may classified as chronic constipation.
You don’t need to have a daily bowel movement to be healthy. Normal bowel function is different for everyone. Normal stool elimination varies from three times daily to three times weekly. This means that some people have a bowel movement every day or multiple times per day while others can skip an entire day, and both cases are considered normal. Even if you normally have a bowel movement every day and miss a day, that’s normal. If you find yourself going more than three times per day or less than three times per week, then you should see your doctor. (7, 10)
Ideal stools are “like a sausage or snake, smooth and soft,” or “like a sausage but with cracks on its surface.” Ideal stools are easy to pass and don’t require any straining or pushing. (11)
There are a wide variety of reasons you might become constipated. Diets low in fiber and with low fluid intake can cause constipation, as can a sedentary lifestyle. Constipation is also a side effect of medications including opiates, antacids, and some antidepressants or blood pressure medications. You can become constipated from prolonged use of laxatives or ignoring the urge to have a bowel movement. You might become constipated if certain pelvic floor or abdominal muscles aren’t able to relax or work together properly. Even health conditions including diabetes, Parkinson’s disease, anorexia, and hypothyroidism can cause constipation. Changes in life or daily routine including aging, pregnancy, and travel can all cause constipation, too. Problems with the colon and rectum including scar tissue and diverticulosis. Problems with intestinal function such as Irritable Bowel Syndrome, idiopathic (of unknown origin) constipation, and functional constipation. Poor dietary habits and lifestyle can lead to functional constipation, when the bowel is healthy but not working properly. In short, constipation can come from many different sources, and your doctor can help you find or rule out what might be causing it. (5,7,8)
Besides being uncomfortable, complications of chronic constipation can be very serious, even requiring surgery:
You should see your doctor if you experience any of the following: (4, 6, 7)
Constipation is often an embarrassing problem that is hard to discuss with friends and family, but your doctor is there for you and can offer a variety of treatments and solutions that work for you. The first step is to gain a better understanding of the problem, and I hope this article has helped you do just that. At Fusion Wellness Therapy we can offer support and treatment for constipation as well as a wide variety of pelvic floor issues and concerns.
Check back soon for upcoming articles on identifying the cause of constipation, treatments and self-care for constipation.
**This information is for educational purposes only and is not intended to replace the advice of your doctor.
Recently, I was on a plane flight and sat next to two women. They were very chatty with one another and quickly swept me up into their conversation. Inevitably, in situations like this, everyone asks “So what do you do for a living?”. My answer always used to be “I’m a physical therapist”. The past couple of years, however, my standard response is “I’m a physical therapist, but let me tell you about what kind of physical therapist I am”. Then I go into the diagnoses I treat related to bowel, bladder and sexual health and, in general, how I treat them. Across the board, their reaction is a mix of astonishment and genuine interest. The follow up dialogue is always eye-opening for them, and more often than not, they will report either knowing someone close to them as having one of these pelvic floor issues, or they have it themselves.
In my early days of being a pelvic floor PT, I was convinced I had the answer to all the woes of the pelvic floor. One word – Kegels. As I’ve developed professionally over more than 15 years, I realized Kegels have their place. However, they are not the answer for all things pelvic floor. They should be used, in general, if muscles are weak because they are overlengthened/overstretched, or in a good place, just weak. There are specific instances when Kegels (also known as PC or pelvic floor muscle contractions) are the answer. I’m a firm believer in doing a Kegel program combined with a core strengthening program that will address the bigger picture. Here’s who should be doing Kegels and why:
1) Most men and women that experience urinary incontinence
a. A thorough physical exam can identify if postural dysfunction and weakness in your pelvic floor and what I call “pelvic floor accessory muscles” that are contributing to your incontinence.
b. There are 3 primary types of urinary incontinence that physical therapy can treat:
i. Stress Urinary Incontinence (SUI)
1. Involuntary urine leakage with coughing, laughing, sneezing, exercise
ii. Urge Urinary Incontinence (UUI)
What are Kegels?
Kegels are a contraction of a group of muscles known as "pelvic floor muscles", sometimes referred to as the "PC muscle". PC is short for “pubococcygeus”, the name of just one of the many pelvic floor muscles.
However, over 15 years of practice, I have found that simply telling a patient to “Do Kegels” is usually not enough. Often, women perform pelvic floor exercises incorrectly, or do not do an amount appropriate for their strength levels. This finding has been confirmed by Bump et al in an August 1991 article from the American Journal of Obstetrics & Gynecology, “Assessment of Kegel pelvic muscles exercise performance after brief verbal instruction”. While the article was published quite some time ago, the data is still relevant and referred to frequently in current research studies. The results of that study on verbal instruction were 60/40 (60% could/40% could not perform a pelvic floor contraction or, Kegel, correctly). This article also stated that a very high percentage of women that were doing Kegels incorrectly were not only doing them wrong, but doing them in such a way that they were actually making their incontinence (or light bladder leakage) WORSE (about 25% of the women studied). I have seen this initial frustration with many of my own patients over the years, not realizing before they started physical therapy why they were getting worse. I continue to cite this study, as despite it’s age, it was really revolutionary in identifying why so many women think Kegels do not work.
But I'm a male with incontinence. Should I be doing Kegels, too?
YES! Men have a pelvic floor, too and should absolutely be doing Kegels if there is weakness in that area.
How do I know if I am doing Kegels correctly?
Chances are if you have basic stress, urge or mixed incontinence or light bladder leakage, and see no improvement in your symptoms, you may not be doing your Kegels appropriately. This is not to say that you don’t know how to do a Kegel, but you many not be doing the proper routine based on your strength levels.
How many do I do? How long should I hold them for? There are different types of Kegels?!
I am proud to announce the official book release today of Sex Without Pain: A Self-Treatment Guide To The Sex Life You Deserve. It is available on Amazon.com, iBooks and other retailers.
43% of women will experience pain during sex or other sexual problems – why isn’t this a public health concern? http://www.prweb.com/releases/2014/09/prweb12156888.htm
Join us in helping to increase the awareness of female sexual dysfunction, including vaginismus, vulvodynia, vulvar vestibulitis, overactive pelvic floor and more. You are not alone if you or your loved one are experiencing painful intercourse. There is help!