Constipation & Your Pelvic Floor: Position Matters!

Have you ever thought about the mechanics of how you have a bowel movement? If you’re regular, then probably not. Even if you suffer from constipation, as many people do, you still may never have thought about it! There are many dietary factors and health conditions, such as IBS, that can result in constipation. However, your pelvic floor muscles play a role in your bowel movements as well. And this means that how you have a bowel movement matters. 

Let’s talk anatomy. Your pelvic floor is like a sling or hammock at the bottom of your pelvis. This means that important exit paths for waste, like your urethra and your rectum, need to pass through it to get to the outside. One particular muscle, called your puborectalis, plays a very important role in your bowel function. This muscle encircles itself around the rectum like a tether. When the muscle is pulled more tightly around the rectum it cinches the passageway and helps us keep fecal matter in. This is good most of the time because we certainly don’t want to have a bowel movement at the wrong time! Conversely, when we do want or need to have a bowel movement, that muscle needs to be able to relax and lengthen so that the rectum can become an easy passageway.  

So what does this mean for how we have a bowel movement? This anatomy means that the position we’re in while having a bowel movement can impact whether the puborectalis muscle is pulled taught (constricting the rectum) or allowed to lengthen (leaving the rectal passageway more open). When we’re sitting, as we are on standard Western toilets, our positioning doesn’t help us loosen the puborectalis. But if we come into a squatting position, as many Eastern countries do, the puborectalis muscle relaxes and lengthens to allow stool to pass more easily. 

 The good news is that you don’t need to throw out your current toilet! All you need to do is place your feet on a small stool in front of you to get your knees higher than your hips. Once you’ve done this you’re essentially in a squatting position and your puborectalis will be easier to relax. If you are dealing with constipation this can make bowel movements both easier and more comfortable. Managing diet, getting regular exercise, and reducing stress are also key pillars in dealing with constipation, as well as working with your doctor and a pelvic floor physical therapist on determining the underlying cause. However, understanding the mechanics of bowel movements and changing your position is one more small way to make things easier! 

– Dr. Lindsay Brunner, PT, DPT, OCS

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