While factors such as poor diet and lack of activity can lead to constipation, one of the less associated causes of constipation is pelvic floor dysfunction. In order to better understand the relationship between pelvic floor and constipation, let’s understand more about where the pelvic floor is and how the pelvic floor can become dysfunctional.

Where is the Pelvic Floor?

As the name implies, the pelvic floor is at the bottom of the pelvis but what most people fail to realize is that there are quite a few structures that are influencing and connected to this muscular floor and therefore, the integrity of those structures play a big role in the state of the pelvic floor.

Imagine a paper bag with a top and translates to the following:

  • The bottom of the paper bag on the outside is the surface between the vagina or penis and the anus. This surface is actually a few muscles and 2 sphincters. 
  • The inside of the bottom of the bag is also packed with many muscles, connective tissues, and ligaments. They all are the inner lining of what is referred to as the pelvic inlet, which is a bowl-like structure inside your pelvis. 
  • The sides of the bag are the oblique abdominals.
  • The front is the abdominal area.
  • The back of the bag is the lower part of the mid-back and the lower back muscles. 
  • The front and back of our hips connected to the pelvis are the 4 corners of the bag. 
  • The top of the bag is the abdominal diaphragm which is almost never looked at as a player in the health of the pelvic floor and a contributor to pelvic floor dysfunction.

Every connection to the floor of the bag plays a direct role in how the bag will be; after all, the floor is not a suspended surface. When it comes to constipation and pelvic floor, the missing ingredient in the treatment is the impact of breathing on the health of the internal organs such as the intestines!

Breathing, Pelvic Floor Dysfunction, and Constipation

You think you know how to breathe but I can assure you that what you are doing is simply enough to sustain life and is hardly optimal. The way we are designed to breathe is what babies do at birth and going forward until the age of 4 or 5 when the societal habits and rituals dictate activities that set the beginning of dysfunctional movement

Biological breathing as explained in the video below is the ‘tossing’ of air between the vocal and abdominal diaphragm which in turn increases the inner abdominal pressure between the abdominal diaphragm (at the bottom of the chest bone) and the pelvic diaphragm, which is at the pubic bone area. To understand the difference between the pelvic diaphragm and pelvic floor, read this blog I wrote. 

When living a sedentary lifestyle, either from work or our lack of activity in general, our posture declines. Our 2 diaphragms, the abdominal and pelvic diaphragm are no longer positioned parallel to each other and the pelvic floor. This means that the ‘tossing’ of the pressure from one to the other leading to the gentle rhythmic movement of the internal organs that is in sync with breathing is no longer taking place.

It is no mystery that with stagnation and compression comes a lack of mobility and rigidity. When, due to our poor posture, the diaphragms are not positioned as they were designed to be, the internal organs are housed in less abdominal space and under more pressure. That means the contents inside the intestines for example will have a harder time being pushed out to be evacuated, leading to constipation. We won’t discuss the impact of constipation on the overall health here but you should not disregard this very important issue.

How to Treat Pelvic Floor Constipation?

The obvious answer is to breathe based on the design of the body. The same way we all did as babies happens to be the same in all babies throughout the world regardless of our differences. While this is not a news flash, we tend to ignore the very obvious. The concepts of posture and movement, breathing and movement, and balance and movement are all the foundations of functional movement and Dynamic Neuromuscular Stabilization (DNS) specifically. DNS addresses the body of the paper bag metaphor I mentioned above. The actual floor of the ‘paper bag’ gets strengthened through kegel exercises to the best of our ability, which we’ll discuss below.

How to Practice Kegel Exercises

Next time you are in the bathroom urinating, stop midstream, then let go. The muscles that do the job are the ones involved in Kegel exercises. While almost all women know about kegel exercises from their OBGYN and from pregnancy, Kegel exercises are not only for women; after all, men have the same muscles in the pelvic floor and the connecting parts to the pelvic floor as women. 

The issue with Kegel exercises is that when there is pelvic floor dysfunction, what it takes to exercise those muscles effectively is much more than anyone can perform. Thanks to an FDA-approved machine to treat incontinence, Emsella, 400 Kegel exercise contractions a MINUTE will certainly do the job and do it fast. While Emsella helps with the pelvic floor muscles, I am reminding you again that with the pelvic floor dysfunction, all other attachments to the floor are compromised and if they are not looked at and assessed in posture and movement, the issues related to the pelvic floor dysfunction will return. Here is a blog I wrote on the obvious and subtle symptoms of pelvic floor dysfunction that you should review.

Taking laxatives in an attempt to address constipation from pelvic floor dysfunction is like a bandaid on a wound and not removing the cause. There are many treatments for pelvic floor dysfunction but none of them is as complete as the one that addresses all feeders of the cause of the dysfunction.

Dr. Shakib