Constipation

1 in 7 adults and 1 in 3 children suffer from constipation.
Poor toileting habits and fear of passing a stool can stem from childhood or an experience of passing a particularly bad or painful stool. It can only take 1 bad experience to change how you go to the toilet.
 
Causes of constipation can include:
 
Dehydration: The average adult should drink between 1.5 – 2 litres of water per day. If it is hot or you are exercising, this number should be more. Alcohol is not included in this amount as it is a diuretic and can cause dehydration.
 
Lack of Fibre: It is important to have a varied and colourful diet that includes soluble and insoluble fibre. If you are usure of what this includes, have a look at the British Nutrition foundation website.
https://www.nutrition.org.uk/nutritionscience/nutrients-food-and-ingredients/dietary-fibre.html
 
Poor toileting position: 
For thousands of years humans have gone to the toilet in a squatting position (over a bucket or hole in the ground), however the invention of the toilet changed the dynamics of how we defaecate. By bringing the hips to 90 degrees when sitting on the toilet it means that the muscle which curls around the colon (helping with continence when we are standing or are sitting) is not relaxed and therefore it can be harder to pass a stool. 

​To change the way you sit on the toilet into a way that allows the muscle curling around the colon to relax, it is as simple as lifting your feet onto a stool. Lean forwards bringing your elbows onto your knees and breath out using a diaphragmatic breath. The best way to do this is by breathing out making a 'moo' sound or 'sssss' sound. 
 
This technique will help relax the pelvic floor and abdominal muscles allowing for a smoother bowel movement and will avoid any straining or breath holding which can strain and stretch your pelvic floor, eventually weakening it.

Don’t delay: 
When you need to go to the toilet your internal sphincter sends a signal to the brain to tell you that you need to go. To maintain continence your body uses your external sphincter and pelvic floor to hold onto the bowel movement until you are ready to go. You should aim to empty your bowel within 20 minutes of receiving this signal. If you ignore this signal and don't empty your bowel, the stool moves back up into the colon. While it is waiting the remaining water that hasn’t already been extracted by the colon continues to be extracted which makes the stool much drier and harder to pass.
If you ignore the signal that tells you, you need to go to the toilet too often the body stops sending it which can cause a whole lot more problems.

Poor Breathing Pattern
​To take a breathe, the diaphragm (the muscle that divides your chest cavity from your other organs) descends, causing the a negative pressure in the chest forcing the lungs to fill with air.
When we take a deep breath using the full capacity of our lungs, the diaphragm descends the full distance and flattens in co-ordination with the pelvic floor. This is called Diaphragmatic breathing.
If you only breathe using shallow breaths the pelvic floor doesn't descend and relax through it's range. This can lead to tightness developing in the muscles of the pelvic floor. A tightness in the pelvic floor muscles will make it harder to relax and pass a stool out of your rectum.
 
Pelvic floor:
Our pelvic floor can be both overactive or underactive. An overactive pelvic floor can impact your ability to pass stools and an under active pelvic floor can impact your ability to remain continent. 

Factors that can influence overactivity:
 
- Increase in stress / body tension
- Physical trauma / sexual abuse
- Birth injury
- Poor posture
-poor breathing pattern
 
Factors that can influence underactivity or weakness:
 
- Bearing down or straining when going to the toilet
- Pregnancy and childbirth – Vaginal and C-section
- Increased intra-abdominal pressure
- Poor technique when doing ‘core exercises’
- Bad posture
- Nerve injury

It's important to maintain a strong pelvic floor with the ability to relax and contract it when needed. For further information on how to engage your pelvic floor, take a look at my blood on the pelvic floor.

If you have any issues with constipation, following the above techniques can help reduce your symptoms. If you continue having issues, contact your local women's health physio.