Constipation - Why does it happen and how can PT treat it?
Constipation is defined as having a bowel movement fewer than three times a week. Take note, you do not need to have a bowel movement every day to be considered “normal”. With constipation, stools are typically hard, dry, and small in size as well as difficult to eliminate. In some cases, people complain of pain with bowel movements and often experience straining, bloating, and a sensation of incomplete emptying of the bowel.
In the United States alone, approximately $725 million is spent on over the counter treatments of constipation each year. Over 2.5 million office visits are for constipation annually. Constipation not only affects the United States financially, but has an effect of productivity and social engagement. One study found that almost 30% of those studied believed that they were less productive at work or at school, 13% missed work or school days, and nearly 10% were late or had to leave work or school because of their symptoms. Other studies found that among those with chronic constipation who were employed or attended school, there was a loss of 2.4 productive days per month due to their symptoms
Let’s take a look at how the large intestine works to form stool. As food moves through the colon, the colon absorbs water from the food and forms waste. Muscle contractions in the colon work to push the stool toward the rectum and by the time it reaches the rectum, it is solid because of the absorption of the water. When the colon absorbs too much water or if the colon is not efficient in pushing stool through, the stools become hard and dry.
What causes constipation?
Lack of fiber
Lack of physical activity/movement
Certain medications
Milk
IBS
Pregnancy, aging and/or travel
Ignoring or withholding bowel movements
Dehydration
Certain diseases
Problems with the colon/rectum
In a clinical setting, it is very common to find chronically constipated patients are lacking fiber in their diet. The bulk and soft texture of fiber helps prevent hard, dry stools. Americans typically eat 5-14 grams of fiber each day, when the recommended amount is actually between 27-35 grams of fiber per day!
Dehydration also plays a role in constipation. Liquids add fluid to the colon and bulk to stools, making it easier to pass softer stools. However, the type of liquid is important as those that contain caffeine or alcohol cause dehydration
Some people tend to ignore the urge to have a bowel movement. This happens often in school, the workplace, or public settings where people feel uncomfortable. However, those that ignore the urge to have a bowel movement may eventually stop feeling the need to have one and that will lead to constipation. This can turn into a vicious cycle in which the urge decreases and the constipation worsens, and eventually the stool becomes too large or too painful to pass.
When looking at stool type, the Bristol Stool Scale helps identify where on the spectrum your stool fits. Those with stools of Type 1-3 tend to exhibit signs of constipation while those with types 5-7 are passing through the colon too quickly. Utilizing the Bristol Stool Scale is a helpful tool to understand how your body is functioning.
In some individuals, there is a musculoskeletal component to constipation. Some individuals experience constipation because they have difficulty controlling their pelvic floor. The muscles of the pelvic floor are necessary for support and elongation for proper pelvic floor function. For those with constipation, these muscles can become very tight or may not properly lengthen when trying to pass stool. Physical therapists are trained to recognize this and treat this through education, manual therapy and activity modification. In addition, therapists are able to recognize poor bearing down techniques, poor management of intraabdominal pressure, and positional changes that may be helpful.
