Put Your Constipation Woes Behind You

In Pelvic Floor Physical Therapy by pelv_admin137 Comments

Constipation plays a major role in pelvic pain. It can cause existing pain to flare or can be a contributing factor responsible for the pelvic pain to begin with. So, it’s really important to maintain regular, healthy BMs. But, for so many women and men with pelvic pain/dysfunction that can be a major challenge. If you’re in that boat, this post is a must-read!

There are two different types of constipation. And what many don’t realize is that one type, “outlet constipation” is often caused by dysfunctional pelvic floor muscles. However, because both types can negatively impact your pelvic floor, in this post I plan to give you the run down on both of them, as well as a list of strategies, including a few that your pelvic floor PT can help you with, that can get things moving in the right direction.

The first type of constipation is “general constipation,” and is caused by a lack of motility in the large intestine. The large intestine a.k.a. the colon is designed to carry out a contracting and squeezing motion that propels stool through it. This action can become impaired causing stool to move excessively slow or not much at all. A variety of things can lead to this first type of constipation such as poor diet, lack of fluid intake, lack of exercise or a sluggish colon that may or may not be associated with irritable bowel syndrome. Also, many kinds of medication, like opiates or other pain meds can cause general constipation.

The second type of constipation is what is known as “outlet constipation.” Outlet constipation occurs when stool sits in the rectum and is difficult to eliminate. In other words, the train makes it to the station, but then gets stuck there and won’t go forward! This can be due to either tight pelvic floor muscles or a situation where the “posterior wall,” the wall that separates the vaginal and rectal canals, is weak causing the stool to become stuck. We discuss this at greater length here: “What’s The Right Way To Poop?”

When it comes to outlet constipation, dysfunctional pelvic floor muscles are often the cause. When a muscle becomes tight, it becomes shortened and has too much tension when at rest—a.k.a.: a muscle spasm. When the pelvic floor muscles are in spasm, they often cannot relax sufficiently enough to allow stool to pass through the external sphincter with ease and without pain.

When stool becomes stuck, we have a tendency to want to bear down and push in an effort to pass it. But, straining only makes matters worse; the more we push, the angrier the muscles become causing the muscles to tighten even further. Over time, this can cause the posterior wall to weaken, further exacerbating constipation. Now, not only is stool having a hard time getting through the external sphincter, it’s getting stuck and pocketing in a weak posterior wall.

Whatever its cause, it is essential to put an end to constipation.

So, what can you do if you suffer with constipation?

First, work with your doctor to figure out where the problem is—is it high up in the colon or further down in the rectum or both? Is your constipation outlet constipation or general constipation, or both. Be sure and ask your doctor if any of the current medications you are taking can be the cause of your constipation. If medication you are taking for your chronic pelvic pain is the cause, discuss whether this medication can be swapped for another without a constipation side effect.

In regards to outlet constipation, physical therapy is a must when the muscles are responsible for the problem. Working with an experienced pelvic floor physical therapist who can do transvaginal and/or rectal myofascial release and trigger point release to the pelvic floor muscles can decrease or eliminate this problem altogether. Your therapist will likely also teach you techniques, such as self treatment with dilators and the “squat stretch” technique to aid in decreasing or eliminating your outlet constipation issues.

If it’s general constipation you are dealing with, getting enough exercise is important. Additionally addressing deficiencies in your diet is essential. Consuming enough fiber—adding flax seed into your diet is a good way to increase your fiber intake—and drinking lots of water can be helpful. Also, taking a Magnesium supplement combined with a Vitamin C supplement can kick start your system. (But, before you begin taking these supplements, be sure and discuss it with your doctor to make sure they will not interfere with any current treatment or medication you are on.)

If these basic steps are not enough, your doctor can work with you suggesting things such as stool softeners or fiber supplements such as Citrucel or Metamucil.

Performing a daily colon massage is another excellent way to get your colon moving. Ask your physical therapist to show you how to do this.

Also, changing the way you sit on the toilet can help get things moving. The squatting position is one of the best positions for pelvic floor relaxation, and it is WAY easier to have BM in a position similar to a squat as compared to sitting upright on the toilet. To simulate the squatting position on the toilet, you can use a small stool or a phonebook to prop your feet on. Your knees should be higher than your hips. This position helps your pelvic floor muscles that sling around your rectum relax a bit, so the stool can pass easier through the rectum.

Finally, a complementary and alternative approach to general constipation is acupuncture.

Have you had any issues with constipation that have impacted your pelvic floor impairments? If so, what were/are the strategies you deploy to break the constipation cycle?

To leave an “anonymous” comment, simply leave the “name” and “email” info blank.

All the best and happy trails!



Are you unable to come see us in person? We offer virtual appointments!

Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online. 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. The cost for this service is $75.00 per 30 minutes. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.


  1. Hi Marcy:

    I never knew about the two types of constipation. When I was struggling with pelvic pain I had the constipation problem. It did get a lot better after I got trigger point release physical therapy through the rectum, as well as the vaginal area. My PT taught me how to massage my own trigger points there, as well as the external ones.

    A year later I worked with a clinical nutritionist who diagnosed me with low stomach acid and gave me treatment with HCL which fixed that problem. It also made my bowels happier. He recommended drinking 2 ounces of water every 30 minutes during the day and that has helped too. I didn’t realize that I was dehydrated most of the time. Drinking a little water throughout the day helps to keep the food in the bowel moving.

    I have no trouble with constipation now, but I do eat prunes daily, just in case. Before I got the proper physical therapy and suffered with constipation and was on the cave man diet, I used a stool softener and I took psyllium husk capsules to keep things moving. When it got real bad I drank a herbal tea called “smooth move” in the evening. That was always good to move things along.

    Thanks for the informative blog post. I forwarded it to one of my clients who has this problem along with her pelvic pain.

  2. The foods I’ve had great luck with for constipation are:

    sunflower seeds!

  3. Aloe vera gel works for constipation and the great thing about it is that it also soothes the bladder, urinary track, so you get a two for one!

    1. what do you mean aloe gel? I know I have gel and there are also pills. where would you put the gel to help with constipation. I use it vaginally for the constant burning

      1. Hi Joan, it’s a gel that you drink. You can purchase at most health food stores. Whole Foods has a brand called Lily of the Desert Aloe Vera Gel Whole Leaf.

  4. I used to find ‘All Bran’ worked like a treat when nothing else would! Now it doesn’t work anymore and in any case I am trying to cut down on wheat products because I have a feeling wheat may aggravate constipation. I have tried magnesium in the past but it only makes it worse! But so does Calcium supplements and Multi B vits so maybe it’s something with the tablet itself? But there are other things that should make constipation better but aggravate it in me ; Physillium, Metamucil etc even though I drink plenty of extra water. I drink more water than anyone I know and lots of fibre! I am interested to know how aloe vera is taken – I only know it as something to rub onto your skin!

  5. My PT showed me two techniques to help with constipation that almost always do the trick:

    1. place your thumb inside your vagina and gently push up against the very back toward what I suppose is your colon to help get things moving.

    2. to put on a glove and use lubrication to gently massage the opening of the rectum.

    Are these appropriate techniques?

    Also, the times when all else has failed and I have been in a situation where as you put it “the train was at the station but wouldn’t move forward” I have had to manually help get things out. I have told my PT this and she didn’t say that it was harmful. My question is: is this okay to do when the situation calls for it? Can this in any way cause harm to my pelvic floor?

    1. Hello! Thank you for your question. Here is my opinion: I am assuming that your PT instructed you to continue with the manual evacuation technique that you described for a few reasons. If there is a “rectocele” present, or “posterior wall deficit” sometimes stool can get stuck, if you will, in the prolapsed section of the rectum. A rectocele is when the posterior aspect of the vaginal wall, where the rectum is, becomes compromised and a section of the rectum droops or sags down a little into the vaginal space. We don’t see the actual rectum when we look visually at the vagina, but what we see is the back wall of the vagina sagging into the vaginal canal. Remember, one of the main functions of the pelvic floor is a supportive one, so if the support function of the pelvic floor is not up to par, we can develop these “prolapses” or “vaginal wall deficits”. People can develop these from vaginal childbirth, chronic constipation (think of all that pushing and straining on the pelvic floor), chronic respiratory infections or asthma, and from obesity. What you are doing manually by inserting your finger into your vagina and pushing down is assisting the part of stool that is “stuck” in the prolapsed segment. I don’t think this is a harmful things to do, and I, personally, would rather my patients perform this technique than continue to push and strain to attempt to empty their bowels, and therefore make the prolapse worse. Does this make sense? Ideally, it would best not to have to perform these techniques, but when we are discussing the risk to benefit ratio, I think that the manual evacuation is better than straining. Sometimes changing your position when you sit on the toilet (see above for defecation mechanics), can remedy this. Also, making sure your stool is nice and bulky, and comes out in one piece is helpful too. If we can bulk your stool up with fiber and fluid, it will come out in one long piece and then there will be nothing left to get stuck in the prolapsed segment. Runny or soft stool will have a greater propensity to stay in the prolapsed segment and then warrant a manual evacuation technique. To address the second part of your question, yes that is an appropriate technique. Massaging or releasing the opening of the rectum is specific to the muscles around the opening of the rectum. When those muscles become tight or spastic, it is difficult for stool pass through the now-tiny opening. It can be beneficial to massage a little bit and help those muscles relax. I don’t think this is harmful, but of course, exercise sanitary measures and if there is any pain or bleeding, stop the technique. I don’t recommend it if there are hemorrhoids present or anal fissures. And I do agree with you, I think this goes on a situational, case-by-case- basis.

      Hope this helps!
      Thank you for your question,

      1. I have had motility issues for two decades, since I was diagnosed with ms. Metamucil doesn’t work, trulance doesn’t work. Lines doesn’t work. Chelated magnesium, 1,000 mg works for me. And has been for 3 years. I stopped taking this and started taking triphala powder, 1/2 teaspoon with lots of water. Works great. Have you heard of this Ayurvedic supplement?

    1. Hi Gaynor,

      Thank you for your comment; a button to allow for tweeting is a great idea! We will def. get that up and running soon.

      All the best!

  6. Really found this hopefully! Good information! My PT has talked to me about different ways to help with my constipation issues but still found this info great to read.

  7. could you send to me the name of someone in the Passaic County NJ location who knows how to deal with outlet constipation and the pull on the pelvic floor muscles simply when walking

    1. Below is a list of our PT contacts in NJ. Hope it is helpful! All my best, Marcy

      Ankiewicz ,Alison DPT Wayside NJ (732) 660-1560 [email protected]
      Arditti Sharon PT Martinsville NJ (732) 321-7000 x62016 Solaris Health Systems
      Besante Jamie PT Beachwood NJ Southern Ocean Medical Center
      Buckley Mary PT Brick Township NJ (732) 202-1200 A Step Ahead Therapy Services
      Chyc-Olesiak Violetta PT Califon NJ (973) 971-4537 Morristown Memorial Hospital
      Dela Rosa Michelle DPT Columbus NJ (609) 379-0900 [email protected]
      Ely-Maskal Nancy PTA Rutherford NJ (201) 567-2277 [email protected] PMR Center
      Flynn Erin PT Montclair NJ [email protected] Morristown Memorial Hospital
      Goldman Debra PT Montclair NJ (973) 239-8889 [email protected] Four Corners Physical Therapy
      Kavalerchik Bella PT Fair Lawn NJ (201) 791-0008 [email protected] Bella Physical Therapy, P.C.
      Patel Mansi PT Randolph NJ (973) 971-4537 [email protected] Atlantic Health Institute
      Rachna Mehta DPT Lawrenceville NJ (732) 742-7250 [email protected] Hamilton Physical Therapy Services
      Schryer Pattie PT Bloomfield NJ [email protected]
      Sicola Corinne PT Hillsborough NJ (908) 874-4522 [email protected] Perfect Formation PT
      Smejkal Lynne PT Absecon NJ (609) 653-4960 [email protected] Bacharach Institute for Rehabilitation
      Del Vecchio Donna PT Livingston NJ 9739714833 [email protected] Atlantic Rehab Institute
      Ryan Angela MD Englewood NJ 2015672277 [email protected] Physical Medicine and Rehabilitation Center
      Ely-Maskal Nancy PTA Englewood NJ 2015672277 [email protected] Physical Medicine and Rehabilitation Center
      Rajter Eduard DPT Morristown NJ 2122882242 [email protected] EMH Physcial Therapy

  8. Since I left my last comment I have had no problem with constipation! Started to notice that when I commenced meditation I would have to get up after a few minutes for a bowel motion. I decided to try sitting on the toilet 30 minutes or so after breakfast every day and read a book to relax. I do this when there is no sensation at all that I need ‘to go’ and I originally decided that i was just going to relax completely for 10 minutes and get lost in the book. To my surprise I would find that I was out of the bathroom after more like 5 mins and had used virtually no muscles at all just felt it happen! So for me the secret is not to rush and not to push! Just relax and let it happen! My urinary stress incontinence seems better too. My body has definitely responded to this routine. Drinking plenty of water and a diet high in fibre should go without saying! Hope some people find my experience helpful.

  9. I just returned from the Mayo Clinic in Rochester and was diagnosed with outlet obstruction due to pelvic floor dysfunction. I have been telling doctors about my bladder, vaginal and pelvic pain for years, but no one thought about pelvic floor dysfunction. I suffer from every symptom, including prolapse and skin lesions. I have to use laxatives to have a bowl movement. The clinic wants me to return for biofeedback training, but I don’t think that will help unless the other issues are addressed, as well. Do you know of a good pelvic floor doctor in San Antonio, TX.

    1. Can you comment on what you mean by “skin lesions” in respect to pelvic floor weakness and outlet constipation… This sounds like a lot of my symptoms… Its difficult to explain that it’s not typical constipation, I do have to “go”, its there, it won’t come out! I’ve used the train analogy before, “the train pulls into the station, it just won’t leave!”I’m curious about the skin lesions and how it goes in..can you describe them? Are they large, deep, painful, infected, scabbed over? And where are they located on your skin, what part or parts of the body?

      1. Oops I meant how the lesions are related to the pelvic weakness.. Auto correct changed it to “how it goes in”?? Whatever, hate the auto correct..

  10. May God bless you. This was excellent information. I have been trying to figure out for years what the problem was. I thought I was going to have to rely on enemas for the rest of my life to clean out my rectum. Thank you, thank you, THANK YOU!!!!

    1. Can you give me any professionals in the Va Beach VA area who can help with outlet constipation and all that it involves? Like others on this site, I am living a miserable experience day to day with enemas and relentless pain. Thank you.

    2. Hello,

      I’m happy to see your successful story.
      I have the same problem and also struggling every day.
      Would you share how you solve your problem?

  11. Hi Marcy! Thank you so much for this info! I too have the outlet constipation. I’ve had two bouts of cancer and have had a stem cell transplant so with all of that comes a lot of meds. I have noticed that I do have to strain a lot to “get the train out of the station”! I know I shouldn’t push or stain but sometimes I can sit there for 20 mins and its very uncomfortable. I am working on adding more water and fiber to my diet but I think I need to strengthen my pelvic muscles. Do you know of any PT in the state of Maine or any place on the web where there is a video or diagram of some of these exercises?

    Again.. thank you.. 🙂

    1. Dear Laurie,

      I’m so sorry for all of the issues you are having to deal with!

      Also, I’m sorry that we do not have a PT referral to give you for Maine; however, please read this blog post about how to find a good pelvic floor PT in your area, it contains a handful of resources that I think will help you track down a good PT. I especially encourage you to check out Happy Pelvis, the Yahoo message group that counts as its members pelvic pain PT patients from around the U.S. I am thinking that someone in the group will be able to point you to a good PT in your area–the Happy Pelvis membership is extremely pro-active and supportive!

      Here is the link to the blog post: https://pelvicpainrehab.com/blog/2012/09/how-do-i-find-a-pelvic-floor-pt/

      Secondly, as for a resource on self-administered colon massage, I have found this YouTube video that might be of help to you:


      All my best,

      1. Thank you so much Marcy! I did find this video as well and have been trying to do the massages daily.. and I will also look into the group you mentioned also.

        Would you know if vaginal pain can be associated with what is going in, happens mostly during sex.. I haven’t been able to have sex cause of the pain. To me it makes sense.. and its only vaginal pain towards the back.. near the bum. Thank you again!

        1. Hi there,

          No problem!

          In answer to your question: I’m sorry, but it’s impossible for me to answer your question without examining you. There are a number of issues that could cause the kind of pain you’re describing. Honestly, my best advice to you is to get an evaluation from a good PT to figure out if there is a musculoskeletal reason for your pain!

          All my best,

    2. Laurie, I too have the train can’t leave the station issue due to nerve issues after my stem cell transplant. Your post is 6 years old so I hope you see my response!
      I’m currently booked for an appointment for an interstim, to get my brain coordinated with my rectum. I pray it works after 13 years of searching for answers.
      I wonder what Marcy thinks about this?

  12. Hi there need help seen doctor after doctor and specialist but no one can help so here i go i am 23 i have always had a bad bowel since a baby but now that im older and cant deal with these pains and constipation issues i have seek medical help over the last couple of years and i was told i have a lazy bowel but i think there is more to it.
    Notice my vagina wall was getting real tight very painful when having sex cant even do a pap smear cause it wont go in.
    Going for pooh is painful and i get no urge to go but when indo i can feel it is stuck the pain is sort of near where my vagina is tighter and the space between your bum and vagina boulders out like a lump was told i had a small hemorrhoid but it was not interfering with anything i also get really bad wind pains that bring me to tear when it travels down for release when i pooh i can feel so much pressure and pain i think something is collapsing but they did a colonoscopy and found inflamed bowel i don’t know what to do no body can seem to help me or care and look at me like im stupid when i try to explain all this also when i had and internal vaginal ultrasound she couldn’t get it in there and when she did i cried and once she pushed past the tight spot it was fine no pain no nothing till she moved it facing towards my colon? And I had the worst pain ever she did say to me after I told her how it was feeling that she could feel the tightness and that it has something to do with my bowel im confused on what to do who to see cant live like this anymore help me please!

    1. Dear Melissa,

      I’m sorry to hear about the issues you are having. It sounds like you could really benefit from an evaluation from a good pelvic floor PT as your pelvic floor muscles may be either involved or the reason behind your pain. Where are you located, perhaps we can refer you to someone in your area?

      Also, it would be a good idea for you to read the following blog posts so that you can have an understanding of what pelvic floor PT is and the issues involved with finding the right one to treat you:


      All my best,

  13. Hi there,
    I live in western sydney near penrith ill check out the blog and any help would be awesome please thank you for replying.

    1. Melissa,

      There is a great resource in Australia. Her name is Bettina Arndt. She has lists of individual doctors and health experts recommended for pelvic pain issues. Please write to her giving details of your problem and where you live and she will try to help you: [email protected]. Here is her website: http://www.bettinaarndt.com.au/health-sex/pelvic-pain/pelvic-pain-help-list. Also, this is a recent radio broadcast from Australia about pelvic pain issues that you might want to check out: http://www.abc.net.au/radionational/programs/lifematters/pelvic-pain/4502250. Hang in there! Once you get the right providers in place, you will get better!

      All my best,

  14. Can I use vitamen A and aloe vera gel capsule once in awhile in the rectum will that be okey please email me back please

    1. Dear Ginny,

      I recommend that you consult a physician with your question.


  15. Interesting article highlighting the relationship between constipation and vaginal pain. I suffer with both!

    However, be careful as there are definitely more than 2 types of constipation. I suffer with a type that is functional but not due to motility issue. There are several of these, mine is called ‘right sided faecal loading’. while this can be transit/motility, mine isn’t and I’ve been informed it can be due to intolerance to insoluable fibre. I have to cut out wholemeal products and bran for a while, increase fluid intake and take regular exercise…

  16. Thank you for giving me the name of what I’ve been struggling with – outlet constipation. Could you provide the names of providers in NYC? I looked on your site but could not find info. Thanks!

    1. Dear J,

      Below is the name of the PT we refer to in NYC. Best, Liz

      Futterman Stacey PT New York NY (212) 226-2066

  17. Great article / have hiStory of sluggish colon and now seriously in trouble due to PFD. Would you plz recommend rehab therapists in Dallas TX? I’ve searched without success. Many thanks!

  18. I have PFD and have been suffering from constipation for
    the last 6 months or so, which I believe is related to
    rectal spasms. I’ve had PFD for 18 months now but only
    rectal spasming for the past 6 months. I can’t go at
    all without Miralax. This doesn’t make me happy. Even using
    Miralax I’m constantly bloated and have feelings of incomplete evacuation. I’ve had PT for almost 8 months. Internal/trigger point work has had no effect. I’ve had chronic pain related to the PFD and have tried to address the pain in a number of ways, working with a pain management doctor (medication, suppositories, trigger point injections, Botox,nerve block) without success. Both my PT and I feel the spasming and, in turn, the constipation, won’t be resolved until the pain is under control. Every time I have a bowel movement it triggers a tsunami of horrible pain through my rectum, lower abdomen, and vagina that lasts for hours and hours. Even if I could successfully relax my muscles enough to evacuate it won’t stop the pain in the aftermath. I actually put off emptying my bowels until the weekend because it takes so long to calm down from the pain that gets triggered. I wish I could
    say PT has been helpful but it has not been able to help me.

    1. if you also have chronic allergies and/or hives, you may want to look into Mast Cell Activation Syndrome.

  19. Great article. I am helping an elderly lady who has suffered with severe constipation all her life – both forms it sounds like. You mention use of dilators. She has used a rectal dilator for years to help her (the Dr. Young type). Now she has Parkinson’s disease and dementia is beginning to set in and going to a pelvic floor PT specialist is out of the question. Unfortunately, she has lost the dilator and we are trying to locate another for her. In searching online, we can only find ones that are for other purposes and seem too large. Can you recommend a source? Or do you recommend the use of this kind of dilator?
    Thanks for your help.

    1. Hi Sen,

      We do not use rectal dialators with our patients, and unfortunately cannot offer any recommendations.

      All my best,


  20. Hello Marcy,
    I am a Pelvic floor PT in CT and I am currently gathering support documentation/research for the denial of treatment for one of my patients with constipation. This is the first time this has occured in my 32 years of practice. I have several articles supporting biofeedback treatment however I am looking for articles that support other PT treatments including the use of manual PT. Can you direct me to any??

    1. Hello Lisa,

      Rhonda Kotarinos has written several articles that you might find useful. PubMed should have them.



  21. Thank for this wealth of information. I have always had intermittent bouts with constipation and developed severe hemorrhoids 18 years ago when my first child was born. Much of my problem with constipation I know stems from not drinking enough water. A few years ago my gyn diagnosed me with a prolapsed vaginal wall (from straining during bowel movements), gave me some nutritional guidelines and said if they didn’t work to come back for pelvic PT. I thought she was crazy 🙂 and I didn’t go back. I did however become vegan and do much better at consuming fluids. Recently I had a major shoulder surgery and was put on Norco and Dilaudid for pain, was also started on Ducosate as a stool softener (although I started it a day after surgery) to prevent constipation. It wasn’t enough. When I realized on day 4 that I was constipated it was too late so I stopped taking my pain meds and with advice from PA and NP started 3x daily miralax, 1 x daily senna and 2 x daily continuation of Ducosate. Am having a bit of response but as another here did manual elimination to get things started. Having a bit of movement today but it is moving in “pieces.” My hemorrhoids are very painful and bleeding and it burns during the movements albeit small. Any other recommendations? Thank you for this info, once I get over this bout I am going to take my GYN up on her suggestion! Anyone you can recommend in
    San Diego, CA?

    1. Hi Caroline,

      We recommend that you contact Cindy Furey, at Comprehensive Therapy in San Digeo. Although an internal rectal examination may not be possible with an open wound such as hemorrhoids, Cindy will be able to evaluate your pelvic muscles, as well as conduct an external assessment. Her information is located below.



      Cindy Furey, PT
      Comprehensive Therapy
      San Diego, CA
      (858) 457-8419

      1. Thank you, I will call her tomorrow. Is it possible that hemorrhoids are so swollen that one can’t have a normal bowel movement? Cutting back on the senna and ducosate but still diarrhea like and painful “bowl movements.”

  22. After suffering years of bloating and constipation, I plucked up courage and went yesterday to have colon hydrotherapy. The therapist was lovely and talked me through it, so I was relaxed and lay down on the bed. However – she was unable to insert the tube. She said she did not want to push – and it was painful. She suggested I see the doctor as there may be some obstruction, possibly haemorrhoids, or something. Do you think I should see the doctor, or is this something I can self help myself with. I am now feeling concerned.

    1. Hello Gill,

      You may want to see your doctor if you have active hemorrhoids.



    2. It is possible that you have pelvic floor hypertonus. It is a good idea to see you primary care physician and also consult with a pelvic floor physical therapist.

  23. Hi
    Great read.
    Could you recommend PT trainers in the UK (london- or ideally in Enfield, Uk)

    Many thanks

  24. Thank you for this post – it makes a lot of sense!

    I have been suffering with anal fissures since the birth of my second son 6 months ago (no problems after my first son was born). The birth was quite quick and I have alful lot of pressure on my back passage towards the end.

    The anal fissures have been incredibly painful and sometimes going to the toliet can be like labour again! Generally I am suffering daily pain and getting quite upset that it’s never ending. The doctor has prescribed laxatives that I found made me very “urgent” and now I have moved on to Fybogel and Lepicol psyllium husk, selecting wholewheat, things like prunes and lots of water. i have been told it will heal in time, but I cant seem to break the cycle. Apparently I have a high tone on sphincter and I find it can spasm which makes things worse. Although I manage to go once a day at the moment, this is not like my usual pre pregnancy self where I was more regular (2-3 times a day) and I often feel I should go again but it’s a real strain.

    It’s made me question (and discuss!) my bowel habits and I’ve realised ive always had problems with constipation and bloating but just figured that was normal. I think I have both types of constipation and currently breastfeeding, which also be making it worse. I am reluctantly trying to move my son on to formula now. Any idea if breastfeeding hormones affect the digestive system as some people say they do?

    I wonder if there is a prolapse into the vagina wall, as I am also finding sex painful. I’m not finding my doctor much help, and just get general response of “this is normal after a baby”.

    Can you recommend any UK based PElvic Floor therapists or help groups, or what my next port of call should be.

    Many thanks.

  25. Hi,

    This is such a great article, so glad I’ve come accross it 🙂 I’ve been diagnosed with PFD and currently awaiting PT, I’ll be sure to ask about the two types of constipation! Although from the article and looking at x Rays I think I may have both…

    I do have one question that has been on my mind since my diagnosis, I’m wondering if a tight PF would make it difficult to peform excersises such as sit ups or v-ups ? I try to keep as active as possible but no matter how hard I try for the whole of my adult life that’s the one thing I can’t do. And I’ve been trying for 12 years.

    Warm regards

  26. I find sat in the squatting position but blowing on your arm helps take ur mind off it u need to get in a zone or you’ll be in a lot of pain

  27. I’m 21 years old and i think i have this . but i’m afraid of going to the drs any advice?

    1. Hello Ann,

      I would suggest that you see a physical therapist that specializes in pelvic floor PT. Not only will he/she help calm any concerns you might have, but he/she can can help you tackle your constipation by addressing your physical impairments, revising your nutrition, and coordinating care for any additional needs. Where are you located? I may be able to recommend a therapist in your area.

      All my best,


      1. thank you for your advice, i went to the dr for this pain before but she couldn’t find anything wrong .i live in Denver Co.

  28. Hi there, do you know anyone who is trained in this around central Scotland, that I could make an apt with?


    1. Hello Fm,

      Yes we recommend Bill Taylor. His information is located below.



      Bill Taylor, PT
      Taylor Physiotherapy Sports Injury Clinic
      Edinburgh Scotland
      [email protected]

  29. I have been constipated for three days my diet has been poor I have not taken care of my body. With that being said I have no insurance for pt for help and I can barley walk due to the pelvic pain it is easing some as today I’ve had luck passing movements, but I’m still very much in pain and if I cough it feels like I’m being kicked in the pelvic area. I’m a lil worried and feel I should go to the hospital, I’m not bleeding rectal or any blood in urine please help with any advise thank you.

    1. Hello Guy in pain,

      Unfortunately, going to the hospital or emergency room will do little to help your situation. I presume that a nurse would prescribe pain medications to you, which may increase your constipation problems. I would strongly recommend that you see a local pelvic floor therapist, as he or she will be able to address the underlying cause of your symptoms, and give you specific tools to ease your discomfort.



  30. I have been constipated and know that e while bottom of My stomach hurts so bad I can’t walk or move

    1. Hello Mary,

      A pelvic floor therapist can help relieve your symptoms, and give you tools to help combat your constipation issues.



    2. This is an old post and old problem but I felt compelled to reply. Constipation is 100% eliminated with the (1) removal all animal products from the daily menu, (2) removal of all processed food from the daily menu, (3) eating food as grown (uncooked), in season, exclusively from a local farmers market (all you can eat), (4) eating gently cooked traditional food such as rice, beans, potatoes, quinoa, etc. which are naturally gluten free, (5) consuming only clean fluids (64 oz minimum) such as herbal teas, fresh pressed, homemade vegetable and fruit juices (there is pure water in all fresh press juices), free of chemicals (“natural” this and that) and (6) moving the body daily (sit only when tired, re-evaluate the job/career as it may not be good for your health i.e. sitting all day). Done correctly on a daily basis, constipation does not occur. In other words, live, think and act like wise elders that lived to be 100+ (great & great-great grandparents) and you will be well.

      1. Hello AMB,

        This is great information, and can be helpful for patients who suffer from constipation. However, constipation can also be caused by other musculoskeletal impairments, and diet alone cannot address those issues. Also, we recommend that each patient consult with their medical provider prior to starting any diet modifications. What works for one individual, may not work for the next.



  31. hello, i’m new to the sight. Was just diagnosed with rectal rectocele & pelvic floor dysfunction after years of IBS & constipation which became worse a year ago. I’m currently on Linzess, miralax twice a day, & psyllium fiber (all natural brand)3xs a day. my bloating is now so bad i can barely eat. Haven’t started PT for the pelvic floor dysfunction yet as I need to make an appt. I still don’t have a bowel movement. Any help you can provide for the bloating & constipation is greatly appreciated. Too much fiber?? I don’t do well w/meds & prefer natural remedies but am at my wits end Many thanks, Laura

    1. Hello Laura,

      A pelvic floor therapist will be able to help you with your symptoms. Where are you located? I may be able to recommend a local therapist.



      1. I think the Metamucil can contribute to your ab pains, esp if you can’t eliminate any fecal matter. I was taking Metamucil for weeks without a bm and it just got worse. Try taking chelated magnesium, start with 500 mg every night with a glass of warm water.

    1. Hello Guest,

      Below are our therapist recommendations for Florida:

      Ashley Arango, PT and Katherine Marsh, PT
      Florida Hospital Pelvic Health Rehab
      Orlando FL
      (407) 303-8280

      Tracy Sher, PT
      Florida Hospital
      Altamonte Springs

      Pamela Downey, PT
      Miami FL
      (305) 666-3232



  32. I have had severe pelvic pain for 4 years. I have had physical therapy for 3 years all this time I have complained about severe constipation. I drink at least 64 oz of water a day, eating 1 cup of blueberries, 2 tablespoons on flax seeds ground, 5,000 units of vitamin c and take 2 tablespoons of magnesium with little difference. I eat a gluten free diet I will do anything Do you know of a therapist in Connecticut and a doctor I am willing to travel to surrounding states please let me know thanks

    1. Hello Claire,

      If you are interested in receiving a second opinion, our Waltham, MA office is currently accepting new patients (late June-July). Please contact our office for more information (781) 577-6648.



  33. Any thoughts on someone to help in Oklahoma? I have no pain just perineum pressure at times!I can’t have a movement without a laxative but never have the urge to go on my own! So frustrating just want my life back!

    1. Hello Michelle,

      Lisa Herring, PT is located in Oklahoma City, OK and would be a great resource for you. Below is her contact information:

      Lisa Herring, PT
      Specialized Physical Therapy
      (405) 751-9955



  34. I have a very tight sphincter muscle. I have never had an urge to have a BM and have to strain and only go very little amount each day. I’m going to PT and been doing this for a month. (2X a week) All she is having me do is abdominal exercises and breathing techinique. I’m keeping track of my fiber and liquids. I eat approx. 30 grams of fiber a day and drink more than 60 oz a day. I have always done kegel exercises so that’s not a problem and I have strong abs. The PT is not working and don’t understand how making my abs stronger can make my sphincter muscle relax. Help.

    1. Hello Bonnie,

      It sounds like you may benefit from a second opinion, as manual therapy could be the missing link here. Where are you located? I may be able to recommend a therapist near you.



  35. After puberty I started having all these changes in my body but I noticed I was more severely conspicated and it sounds like I have outlet conspications so what should I do about it because I’m to embarrass to talk to my parents about it what can I do to fix it myself and will it always keep happening

    1. Hello Anonymous,

      Changes are natural especially around this time in life. We encourage you to speak with your loved ones, as seeing a pelvic floor therapist may be necessary for you. We recommend that you forward our blog to them.



    1. Hello Bridgette,

      Below are therapist recommendations near you:

      Devine Stacey PT Eldersburg MD (410) 404-4772 Devine Intervention Physical Therapy
      Marshall Marci PT Frederick MD (301)698-9214 Women’s Wellness Works
      Graham Miriam PT Rockville MD (301) 881-9313 Restore Motion
      Ortiz Jennifer PT Columbia MD (443)283-2018 [email protected] Her Health Physical Therapy
      Reinhardt Melissa PT Columbia MD (443)283-2018 [email protected] Her Health Physical Therapy



  36. So glad to have found this posting. The “train at the station” analogy sounds all too familiar! I am someone who experiences what most doctors would classify as constipated stools most of my life… If well-formed they’re frighteningly substantial… Otherwise… Moose droppings. I consume tons of fibre including psyllium fibre, flax, prunes, smoothies every day… And make efforts to drink lots of water (although in my experience one can always drink more). Recently discovered what seems to be a rectocele, which doesn’t surprise me given my experiences. Reading your post made so much sense to me. I’ve always felt ‘uptight’ ‘down there’. I live in British Columbia close to Kelowna BC. Do you know of any PTs up here that have this specialization? Any suggestions would be much appreciated. Thank-you!

    1. Hello Ik,

      I am sorry to hear about your situation. There are therapists in your area that will be able to help you. Their information is located below:

      Sabourin Johanne PT Coquitlam, British Columbia Canada 604-475-0522 [email protected]
      Nerreter Tamarah PT South Surrey, British Columbia Canada 604-475-0522 [email protected]



  37. I have outlet constipation and have a very hard time going and it’s affected the quality of life. I take lactulose but it’s gross and doesn’t always work that well. I was diagnosed with internal hemorrhoids. When I try to go it feels like I am giving birth to a jagged rock. The internal sphincter muscle won’t budge. I feel a bulge when I try to manually get it out. The bulge is painful and aches. When any stool comes out its like a ribbon. Fiber is not my friend as it makes it worse. Could it be that the internal hemorrhoids cause some type of blockage in the rectum so that the stools are flat like a ribbon? I have thought of colonic irrigation but I don’t know if that would help. I live in San Diego and have Kaiser. I have tried squatty potty but it doesn’t help. I have tried so many things I am afraid this will always be a problem. I have had this for 1 year 9 months. I am on a few antidepressants one is Welbutrin which I know causes constipation. But it feels like the train got to the station but the doors won’t open to get the passengers out. I hate the feeling that there is stool in the rectum just sitting there. I don’t get much peristalsis. My Dr thinks that I am too stressed about going and that makes it worse. I feel hopeless.

    1. Hello Linda,

      We encourage you to consult with Cindy Furey, PT. She may be able to assist you:

      Furey Cindy PT San Diego CA (858) 457-8419. Comprehensive Therapy



  38. Can vaginal pain burning and urgency be a result of constipation as in after straining to poop? Like when there is no UTI, no yeast infection and no bacterial infection? I went round and round with this same scrnario last winter. Ultimately put on Extrace cream. Finally yhe pain went away and I have not been bothered for quite sometime. But after a difficult poop last week the symptoms are back. I had of late been forgetting to take Extrace now been taking regularly for a week. Does constipation and straining have anything to do with it?

    1. Hi Elizabeth,

      Straining during a bowel movement can cause irritation to muscles, tissues, and nerves which can result in vaginal pain and urinary symptoms. The squatty potty is a good thing to help with proper bowel mechanics, it is also helpful to consult with someone about diet suggestions. Estrace is intended to help maintain vulvar tissue integrity and reduce vulvar irritation from atrophy. Estrace is not intended to help with constipation but can help symptoms of vaginal pain if they are stemming from tissue irritation.



  39. Hello. I have had vaginal burning with most bowel movements, difficult or easy, for 27+years. The burning also sometimes occurs with vaginal intercourse. Peridium helps, but doc is reluctant to prescribe it as much as I need it. Any suggestions would be greatly appreciated.

  40. I just wanted to add that tho I have had PFD since 2006, as stated in the beginning of my post..
    I am just guessing the ‘gentle pushing’ to get that ‘last drop’ of urine out, since about age 17, many years ago, MAY be causal. At that time I had no idea why this “feeling” started.
    However, I had no symptoms tho until my late 40s, in 2006.
    Thx,,just wanted to clarify.

  41. Hello my name is Gloria I’ve struggling with constipation for a couple of yrs and it’s like every one have stated before I don’t have the urge to go without prune juice I just uped my fiber yesterday with the help of prune juice it felt like a normal poop, I felt my floor muscle work after a months of trying is there a Pt, you can recommend me to here in chicago Illinois please thank you,

    1. Hi Gloria, Rush Hospital has 2 women pelvic floor physical therapists, which is where I go.
      I have also been to the Kotarinos Group for pelvic floor PT in Oakbrook. They also see patients at Northwestern Memorial Hospital one day a week in Chicago. Good luck! Ann

  42. I dont know how old this post is or if you will see it…but can u recommend a pt in southern California? Please…

    1. Hello,

      What part of Southern California are you located in? We have a center in Los Angeles. To schedule an evaluation please call 424-293-2305.


  43. Is there someone you can recommend in Portland, OR for help with outlet constipation?

  44. Hi can you recommend a therapist in salt lake city, ut?
    My condition is rather perplexing as I have what seems like a full bowel movement every morning without much straining. Within minutes, there is what feels like an entirely new bowel movement waiting to come out. If I can sit on the toilet a 2nd time about an hour after the 1st for about 20-30 minutes, I can usually push out more stool. However, there always seems to be another bowel movement next in line to come out and I can never push more out after those two attempts. It is almost like the actual 1st bowel movement closes something up and doesn’t allow for the rest of the stool to come out. This happens day after day and eventually about every other week, I feel so backed up I cannot even pass gas and I have to use multiple suppositories and enemas. Even after doing this, I still feel like there is more stool (and almost everytime after a suppository, there is). Drs have told me to try biofeedback, but the therapists I have seen have mostly concentrated on kegels and breathing exercises. Have you ever heard of these symptoms before? I would appreciate your feedback very much 🙂

    1. Stephanie Prendergast, MPT says:

      Kegel exercises are not therapeutic for outlet obstruction constipation, which may be one of your diagnoses. We suggest you use the find a provider section of the blog to find a physical therapist with different training that includes manual therapy, neuromuscular re-education, and can help you work with your GI doctors to make sure you do not have higher level GI issues.

  45. I am reading this and wow! I am not alone. My life has become all about doctors who do nothing, er visits that also do nothing, and I have become so depressed that the quality of my life is about zero. What i didn’t see on here is if people get therapy to deal with the anxiety and depression this problem causes, because I am having huge issues with that and then we work on the anxiety and they want to give meds that will help your mood, but will increase your constipation. I think at least one post did mention that she felt it was being caused by certain medications and I think every medication I take for spasm, pain nausea, depression, Etc. Etc. is causing a lot of the problem, but if I don’t have the medication I am in so much more pain that I can’t handle it. I have been diagnosed with outlet obstruction and hope to get more help with this from a specialist kind of far away from where I live. I thought of going to the Mayo clinic but it seems they will all say the same thing, biofeedback and pelvic floor therapy. I can honestly say the enemas that I have to use to clean out are a major part of not having a life. Even if certain laxatives would work and I wouldn’t have to do all these enemas I would be grateful that something works even if I have to stay on them. but the laxatives do not work well at all. I live in Sacramento, Ca and wonder if there is someone else I could go to to solve this really horrible problem? I already tried Stanford but they actually are pretty limited about this problem. Definitely staying in bed, too depressed to get up or fighting the pain is not helping me! The PT at Davis involves doing kegels, which is totally wrong for me. Would appreciate any help. I am afraid they might have to take my colon out. Has anybody been told that is the only other answer?

    1. Hi Jami,

      It sounds like you may have a pelvic floor disorder. Unfortunately we cannot make specific recommendations without evaluating you. We would be happy to evaluate you in one of our locations or you can use our website to find a pelvic floor physical therapist in your area that can help.


  46. Do you recommend any pelvic floor PTs in south eastern Pennsylvania? Near Reading, Pottstown, Philadelphia. Thank you!

  47. Hi,

    I’m wondering if you know of a therapist in the north-west of England, London and Edinburgh are a long way to go on a regular basis.





  49. Im curious, as far back as i can remember the only time ive ever had a regular bowel movement is during my period.
    For several days during my period( always the first few days) i will have several bowel movements in a day over the next several days. Is this a sign of oulet constpation?
    I take a regular fiber substitue because i have diverticulitus and much of the foods that help you poop i cant eat. Then to top it all off ive developed food allergies over the past 10 years that make it even worse.

    1. Stephanie Prendergast, MPT says:

      I am sorry to hear of your trouble. Unfortunately it is hard to say with this limited information but it makes sense to see a GI physician and a pelvic floor physical therapist to obtain a diagnosis.

  50. Hi! I think I may have this. I have had terrible pain in my rectum because I can’t get all the stool out. It’s been going on for 5 months. The proctologist removed a hemorrhoid and I’m still recovering but I don’t think that was the main problem. Please help! What kind of doctor diagnoses rectocele (proctologist, gastro, or gyn?) Also my stools are not well formed. Do you think Metamucil would help? Someone told me muscle milk helped them? Will caffeine help the muscles get it all out? I’m desperate ! Do you know of any Pelvic Floor PT in Vero Beach, FL. Thank you!! I hope someone replies to me! please email me 772-696-3926

    1. Stephanie Prendergast, MPT says:

      Acupuncture can be helpful for the symptoms associated with pelvic floor disorders .

  51. Hello, can you please suggest a PFT for me in Calgary Alberta. I have stage 4 Endometriosis and take opioids daily. I’m getting another surgery for it in the spring but the doctor told me I need to get rid of all the poop I’m full of(saw it all in a pelvic ultrasound)

  52. Do you know of any therapist in the minneapolis area that include manual as well? Thanks so much!

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