Physical Therapy Can Play a Part in Effective Constipation Treatment

Constipation is a condition that affects approximately 63 million people in North America and it is the most common gastrointestinal complaint. The definition of constipation may vary depending on who you ask, however it is more than just a reduction in frequency of bowel movements. 

According to the Rome IV criteria, the diagnostic criteria for functional constipation states that at least 2 of the following symptoms must have occurred for at least 6 months before diagnosis, and during the last 3 months:

• Straining during more than ¼ of bowel movements
• Lumpy or hard stools for more than ¼ of defecations
• Sensation of incomplete evacuation for more than ¼ of defecations
• Sensations of anorectal blockage for more than ¼ of defecations
• Manual maneuvers required to facilitate more than ¼ of bowel movements
• Fewer than 3 spontaneous bowel movements per week
• Loose stool rarely present without the use of laxatives
• Insufficient criteria present for IBS. 

50% of individuals having constipation will also have a defecatory disorder, which is characterized by long toileting time to produce a bowel movement, straining, or needing to use manual maneuvers to empty the rectum. Pelvic floor physical therapy is known to be helpful to address physical impairments and functional limitations that contribute to constipation and its impact on a person’s daily life. In a recent article published in the Journal of Women’s and Pelvic Health Physical Therapy in 2021, authors highlighted several evidence-based treatments that physical therapists utilize to manage symptoms of functional constipation:

Evidence Based Treatments for Functional Constipation

Lifestyle modifications:

There are a variety of lifestyle factors that may contribute to your constipation symptoms such as fiber and fluid intake, musculoskeletal impairments, defecation mechanics, response to bowel urges and other toileting habits. Our staff of highly trained physical therapists at Fusion Wellness & Physical Therapy can help you to identify adverse lifestyle factors and guide you towards effective constipation treatment that can improve your overall bowel health. 

Coordination Training: 

For proper functional defecation to occur, adequate coordination from the pelvic floor and abdominal muscles must occur. The pelvic floor muscles control the expulsion of stool from the rectum. Physical therapy to work on muscular coordination can be helpful to restore proper function for those that suffer with functional constipation. 

Manual Therapy: 

According to the latest research guidelines update, there is good evidence to support that manual therapy and massage of the abdomen can help to increase gastrointestinal motility and aid with constipation symptoms including improving feelings of complete emptying, improved defecation frequency, and improved stool consistency. Our staff is trained in visceral mobilization - a technique used to restore mobility in the visceral organs, including the gastrointestinal system which is often restricted in those with chronic constipation.

Biofeedback Training:

Anorectal biofeedback training is another treatment method that can help with symptoms of chronic constipation. Biofeedback can be applied in multiple ways - electrodes may be placed around the anus that monitor pelvic floor muscle activity. We can use real time information that can show you how to relax your pelvic floor muscles completely to allow for easier, more complete bowel movements. 

Biofeedback can also be applied through the use of rectal balloons. This method may be more effective as it can mimic rectal fullness and can help to restore the brain-body connection in relation to muscle control with defecation. It can help to restore rectal sensory perception which is necessary to signal to your body that it is ready to have a bowel movement. This is helpful for those who do not have regular urges to defecate, as delayed time between bowel movements can cause stools to become hard and compacted. 

There are many physiological sources that may be contributing to your constipation symptoms and should be evaluated through a whole body and multi-systems. To schedule an evaluation with one of our physical therapists at Fusion Wellness & Femina PT, click here.

To read more about Constipation check out our other blog articles here.

References:

1. LaCross, Jennifer A. PT, DPT, PhD(c)1; Borello-France, Diane PT, PhD2; Marchetti, Gregory F. PT, PhD2; Turner, Rose MLIS3; George, Susan PT, DPT4. Physical Therapy Management of Functional Constipation in Adults: A 2021 Evidence-Based Clinical Practice Guideline From the American Physical Therapy Association's Academy of Pelvic Health Physical Therapy. Journal of Women's Health Physical Therapy 46(3):p E59-E84, July/September 2022. | DOI: 10.1097/JWH.0000000000000244
2. Binford, Joyce PT. Physical Therapy Management of Outlet Dysfunction Constipation and Pelvic Pain. Journal of Women's Health Physical Therapy 37(2):p 59-69, May/August 2013. | DOI: 10.1097/JWH.0b013e31829df717