Rebecca Smith
What Can Happen If Your Constipated Too Long – Whenever I meet a new patient, I ask her about potties. Sometimes that wears people down and they’ll say “…but…I’m here for my shoulder” LOL jk, jk– I don’t treat people with basic shoulder problems. Remember, pelvic issues are my domain! BUT, even if people have a “pelvic” problem (and I put that in quotes because while I see that I’m an expert on the pelvis, the reality is that the pelvis is inside the body, so the whole body can affect the pelvis), they may have difficulty seeing the connection between bowel movements and bladder leakage, painful sex, back pain, prolapse – and more! The reality, however, is that what happens to your bowel movements is VERY important to any pelvic problem we see. This is especially true when a person struggles with constipation.
The reality is that the pelvis is not as big as you think. A full rectum that doesn’t empty well can put pressure on other surrounding structures (including the bladder and vagina, pelvic floor muscles and nerves around the pelvis) and can extend to uncomfortable levels and involve the lower back. Hard, dehydrated stools are also harder to pass and may require more effort, increasing stress on the pelvic organs and the pelvic floor muscles themselves.
What Can Happen If Your Constipated Too Long
This is where things get interesting. Because of how closely related everything is and how intricately the muscles are connected to bowel movements, people are often surprised by things related to their bowel movements. Let’s look at some:
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It’s fair! Constipation can worsen pelvic pain and even be the cause. There are several reasons for this. First, once stool enters the rectum, it puts pressure on the puborectalis muscle, which is designed to maintain the angle between the rectum and the anal canal, preventing it from leaking and opening to allow defecation. Normally, if the rectum is filled, it will trigger a sampling reaction where the rectum literally drops a small amount of contents into the anal canal to determine – solid, liquid or gas? It will then trigger a reflex to facilitate defecation. If a person has stools that are harder and less formed together, they may not empty their bowels properly, leading to rectal bloating. This will put pressure on the puborectal muscles, which can then lead to increased muscle activation (hey, there’s more poop to hold!) and ultimately to muscle irritation and hyperactivity. Excessive pelvic floor muscle activity can cause pain in the pelvis, tailbone, and sacrum. It’s a complicated cycle because overactive muscles also don’t stretch, making it harder to pass a bowel movement, and the harder it gets, the more irritated the muscles become.
Prolapse occurs when there is a loss of support around the vaginal walls and organs (bladder, rectum, small intestine, or uterus) protrude into the vagina. This can be very annoying and unpleasant and can cause vaginal bloating, heaviness in the pelvis, or pressure on the perineum or pelvis. Pregnancy and childbirth can be a big factor in prolapse due to loss of connective tissue or fascial support, however, increased pressure on the pelvic floor over time can also play a role. I’ve seen this happen to people who have worked in heavy lifting jobs, when people do physical exercise they can’t do well, and yes, with prolonged constipation. Constipation leads to increased pressure on the pelvic floor and more effort is required to empty. Therefore, when a person is constipated and has to strain harder to have a bowel movement, it can weaken the support around the vagina and end up being a big factor in people with prolapse. And the great thing – when we help fix it, we usually also see an improvement in hair loss symptoms!
As with pelvic pain, overactive pelvic floor muscles can be particularly severe when a person experiences pain during sex. Also, if their anus is full of feces, it will put pressure on the vagina and reduce the space for the vagina to stretch during insertion. So, you guessed it, optimizing constipation can make all the difference for people who experience pain during sex.
That is very interesting! We have talked about how the pelvic muscles can become overactive if someone is experiencing constipation, and of course this can be a factor in lower back pain. However, the colon itself can also stretch too much when stool is backed up, and this happens in the lower back. It’s surprisingly more common than you might think! I’ve seen many people struggling with chronic back pain see a significant difference (if not cure!) by optimizing their gut health. This makes sense when you consider how organs are often associated with somatic structures around the body (Remember how a heart attack can manifest as shoulder pain? Kidney stones as lower back pain?).
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I had to include PN in this group! The pudendal nerve passes through the pelvis, so it is located near the rectum. When a person is tense and has difficulty emptying the bowels, this nerve can become stretched and irritated. Long-term constipation can cause irritation of the pudendal nerve, and if a person already has problems with the pudendal nerve (due to injury during surgery, irritation from cycling, childbirth, or others), constipation will worsen pudendal nerve pain.
This is always the hardest thing for people to understand. Yes, constipation can be the cause of leaks, or it can make leaks worse! This can happen for a number of reasons. First, the pelvis is not that big. Therefore, a full rectum can compress the bladder, putting it in a position where it is more likely to leak. Also, remember how muscles are involved in constipation? Well, they are also important for the bladder! Overactive and irritated muscles do not work well for the bladder, so they often struggle with urinary retention.
First, understand that you are not alone. There’s a reason constipation is the #1 problem in the United States, and there’s a lot you can do to fix it! So don’t go alone. Don’t write it off as something you deal with all the time, or something that’s “in my family,” or whatever. Take steps today to help your body poop better, and I promise your world will be a happier place.
If possible, I highly recommend my mini-course to overcome constipation. In this class, Dr. Sara Reardon and I give you all our best tips to help you perform better, and for $39 you can’t beat the value you’ll get in this class!
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Check out the other articles I wrote about poo (yes, I write about it a lot!) and I hope it gets you started!
Previous PT Pelvic Floor Previous: Too IN Now! Festive pelvic health challenges and 5 tips to help! Constipation occurs when you have infrequent or difficult bowel movements, have hard stools, or feel that your stools are incomplete.
Constipation is when you have infrequent or difficult bowel movements (meaning they are painful or you have to strain), have hard stools, or feel like your bowel movements are incomplete. Infrequent means having a bowel movement less than three times a week.
In most cases, constipation is a symptom, not a disease. It is more common in nonwhite populations, as well as those with lower socioeconomic status, lower levels of parental education, less physical activity, depression, physical and sexual abuse, and stressful life events.
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Many medications can cause constipation. Before starting a new medication, tell your doctor about all the medications you are taking, or tell your doctor if you have had constipation in the past.
Also known as IBS with constipation or IBS-C, this condition is one of the most common causes of constipation in the US. IBS-C is associated with more abdominal pain than some other causes of constipation. Read more about IBS.
You can start the cycle of constipation by not walking when you feel like having a bowel movement (for example, when you’re too busy or don’t want to use a public toilet). After a while, you may stop feeling the need to go altogether. This leads to constipation.
When the pelvic floor muscles don’t relax properly to allow stool to pass easily, it causes constipation and the feeling that you need to go but nothing comes out. This is treated with biofeedback and retraining these muscles through pelvic floor physical therapy.
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Most people experience a brief bout of constipation at some point. In most cases, this can be managed with diet, drinking more water, exercise and over-the-counter (OTC) medications. If you feel constipated, try this one first. However, sometimes it doesn’t go away or come back.
5. You see blood in your stool, especially if it is mixed with your stool