Can Physiotherapy Help with Constipation?

Understanding Constipation

Constipation is commonly defined as having three or fewer bowel movements per week. However, the perception of constipation varies among individuals. Many people believe they should have daily bowel movements to feel healthy. In reality, having three bowel movements weekly can be entirely normal, especially if this frequency has been consistent for an individual over time.

Several factors contribute to how people perceive their bowel movements. According to the Rome IV criteria, used widely in clinical research, a diagnosis of constipation is not solely based on frequency. Individuals who experience two or more of the following symptoms for more than three months may be diagnosed with constipation:

• Feelings of incomplete evacuation
• Straining during bowel movements
• Lumpy or hard stools
• A sensation of blockage
• The need to use a finger to aid in stool dislodgement.

How Does Endometriosis Cause Constipation?

A significant number of individuals with endometriosis report gastrointestinal issues, including constipation. This condition can complicate bowel movements for several reasons, including:

1. Slow Movement of the Colon: In some cases, the colon's transit time is prolonged, leading to harder stools and difficulty in evacuation.
2. Endometrial Lesions: Larger nodules infiltrating the intestinal muscular layer can result in a range of symptoms. These include dyschezia (painful bowel movements), abdominal bloating, diarrhea, and cyclical rectal bleeding. These symptoms often resemble those of irritable bowel syndrome (IBS), making it challenging to distinguish between the two conditions.
3. Pelvic Floor Dysfunction: Characterized by the incomplete relaxation or paradoxical contraction of the puborectalis muscle and anal sphincter, pelvic floor dysfunction can severely impact bowel movements. This condition, known as dyssynergic defecation, is often seen in individuals with chronic pelvic pain, a common symptom of endometriosis. The interplay of chronic pain, hyperalgesia (increased sensitivity to pain), and muscle spasms can contribute to a cycle of dysfunction, further complicating bowel health.

Other factors that may contribute to constipation in those with endometriosis include:

• Psychological Factors: Conditions like depression and anxiety can influence bowel habits.
• Behavioral Aspects: Avoiding public restrooms or delaying bowel movements when the urge arises can lead to constipation.
• Lifestyle Choices: Stress, inadequate diet and fluid intake, and a lack of physical activity play a significant role in bowel health.
• Medication Side Effects: Certain medications, such as opioids, antidepressants, and supplements containing iron, can lead to constipation.
• Genetic Predisposition: A family history of gastrointestinal issues can increase the likelihood of experiencing constipation.
• Functional Disorders: Conditions like IBS can complicate bowel function.
• Idiopathic Causes: Sometimes, no clear reason for constipation can be identified.

Can Physiotherapy Help with Constipation?

Physiotherapy is emerging as an effective treatment option for constipation, particularly for those affected by endometriosis. Various therapeutic approaches can be employed to enhance bowel function and relieve symptoms:

1. Pelvic Floor Manual Therapy: Physiotherapists can use both internal and external hands-on techniques to improve pelvic floor function, which may help alleviate constipation symptoms.
2. Pelvic Floor Muscle Retraining: A tailored program can help patients learn to coordinate and relax their pelvic floor muscles, which is crucial for proper bowel function.
3. Proper Toileting Techniques: Education on optimal toileting practices, such as using a toilet stool to facilitate bowel movements, can make a significant difference.
4. Biofeedback: This technique helps patients gain awareness of their bodily functions and teaches them how to improve bowel habits effectively.
5. Colon Massage: Therapeutic massage can stimulate bowel activity and promote more regular bowel movements.
6. Exercise Programs: Specific abdominal and thoraco-lumbar exercises can strengthen muscles and promote healthy digestion.
7. Breathing Pattern Re-education: Proper breathing techniques can help reduce tension in the pelvic floor and improve overall bowel function.

The multifaceted nature of physiotherapy allows it to address both the physical and psychological components of constipation, making it a valuable tool for individuals, particularly women with endometriosis, seeking relief from this common but often overlooked symptom.

Conclusion

In summary, physiotherapy can be a vital resource for those struggling with constipation, especially when compounded by the challenges of endometriosis. By focusing on pelvic floor health, enhancing muscle coordination, and incorporating specific techniques and exercises, physiotherapists can provide patients with effective strategies to find relief and improve their overall quality of life. If you are experiencing constipation, consider consulting a physiotherapist who specializes in pelvic health to explore your options and regain control over your bowel health.

References:

^{Analysis of the efficacy of abdominal massage on functional constipation: A meta-analysis - PMC}

^{The effects of abdominal "I LOV U" massage along with lifestyle training on constipation and distension in the elderly with stroke - ScienceDirect}

^{(Gastrointestinal symptoms among endometriosis patients—A case-cohort study - PMC)}

^{Bowel endometriosis: Recent insights and unsolved problems - PMC}

 ^{Does colorectal endometriosis alter intestinal functions? A prospective manometric and questionnaire-based study - ScienceDirect}

^{Managing a patient's constipation with physical therapy - PubMed}

^{Chronic constipation: A review of literature - PMC}

^{An overview of interventions for constipation in adults - PubMed}