Q&A Bowel Dysfunction

In pelvic floor physical therapy, Pelvic Health, Uncategorized by Stephanie PrendergastLeave a Comment

By Stephanie A. Prendergast, DPT, MPT, Cofounder, PHRC Los Angeles

A few weeks ago we published a blog about How Pelvic Floor Physical Therapy Helps Bowel Dysfunction. In it we discussed how one might develop a bowel dysfunction, symptoms, associated diagnoses and how pelvic floor PT can help in recovery. This week, we asked our social media audience to submit their own questions about bowel dysfunction. Below are the most commonly asked questions and their answers!


Q: How can my pelvic floor affect my bowel movement?

A: The pelvic floor muscles keep stool in when we need to and are responsible for letting it out when we decide the time is right. There are a number of reflexive and voluntary movements that allow both to happen! Ti simply slightly we included one example below.


In order to have a bowel movement, the pressure of the stool in your rectum should be greater than the pressure in your pelvic floor. This is why your pelvic floor has the ability to contract and relax, so that you can contract and maintain continence when you want to, and relax to allow passage of stool when you want to. At PHRC, we often see patients who have trouble relaxing their pelvic floor muscles. This results in things like straining, incomplete emptying, and holding your breath when you have a bowel movement, which all reinforce those bad habits. Pushing against a contracted muscle is like pushing against a closed door. Nothing will get through! An indepth blog about the anatomy & physiology of our anal sphincter, is available on our website to further your self-education!


Q: How can Vulvodynia and constipation be related?

A: Studies show that people with constipation are more likely to develop pelvic floor dysfunction and pelvic pain because repetitive straining can lead to an overuse injury of the pelvic floor muscles and/or pudendal nerve irritation, both of which can cause pelvic pain, including vulvodynia. Medications that are therapeutic for vulvodynia symptoms, such as the tricyclic antidepressants, can cause constipation. Pelvic floor PT can help with all of the above!


Q: When I pass, it’s like pebbles and has been since October. I’ve tried every remedy, what is next?

A: Multiple factors can result in changes in the shape of your stool. Two pelvic floor factors include the ability to relax the pelvic floor muscles to initiate a bowel movement and the ability of the pelvic floor muscles to remain relaxed to allow all of the stool to empty. Many times people have a problem in one of these areas, or both, and have difficulty with complete emptying and passing a more formed stool. Factors such as rectoceles can also play a role. “Pebble Stool” is a symptom that there is something going on with the pelvic floor muscles and can be effectively evaluated by a pelvic floor physical therapist. 


Q: Is taking laxatives once a week bad if you struggle to have bowel movements?

A: Struggling with bowel movements is a symptom. Sometimes the issues with bowel movements can be due to GI issues, sometimes pelvic floor issues, sometimes both. While laxatives can help we recommend getting to the root cause of the issues and correcting them. When used correctly laxatives are not ‘bad’ and can be part of someone’s health routine. 


Q: How can we help our constipation?

A: 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. Whatever its cause, it is essential to put an end to constipation. So, what can you do if you suffer with constipation? This is going to depend on what type of constipation you have. We have an entire blog dedicated to helping you, Put Your Constipation Woes Behind You (quiet literally!).


Q: Can IBS contribute to endometriosis?

A: In those with endometriosis, it is estimated that 90% have IBS, or at least GI symptoms, the most common being bloating, followed by changes in bowel movements (diarrhea, constipation, or both). 


Related Blogs: 

New Perspectives on Endo: Gut-Immune Link & IG Live w/ Dr. Orbuch

THINKING OUTSIDE THE GUT: Could Endometriosis be the culprit behind your Constipation or Bloating?


Q: I know having to urinate in the middle of the night is bad, what about bowel urges?

A: Urinating in the middle of the night is not necessarily ‘bad’, but it can be a symptom of PFD. Under normal circumstances we do not get bowel urges at night on a regular basis. If this is happening we recommend seeing a medical provider for an evaluation. 


Q: Why does your period make you poop?

A: You have a shift in your hormones during your period, just before your period, your estrogen and progesterone drop to stimulate contraction of your uterus to shed the lining if pregnancy does not occur. As you start menstruating (bleeding), your estrogen begins to rise; at the same time, your uterus is driven to contract by the release of prostaglandins (lipids or fats that are hormone-like). These also can act on your GI tract causing an increase in contraction or motility. Contractions of the bowel (also known as peristalsis) are important and are important for what we call GI motility. Those with slow motility may report issues with constipation and those with fast motility tend towards loose stool or diarrhea. So an overall increase in prostaglandins, necessary for uterine contractions, can cause one to also have increased bowel movements during this time. For some this means relief from constipation, for others this is too much and causes diarrhea or loose stools during their period.

We have an entire blog dedicated to this question! Along with a 3 part series about Period Health (Everything you should have learned in 6th grade, but didn’t).


Q: Do you recommend using a squatty potty? 

A: Yes! A not-so-fun fact is the height of our toilets actually results in less than optimal pelvic floor biomechanics. A squatty potty raises our knees higher than our hips which allows better pelvic floor relaxation, assisting with evacuation of stool. 


Q: I am eating a high fiber diet and drinking all the water, but still constipated. What do I do? See a pelvic floor PT or GI referral? 

A: Multiple providers can help with constipation. Going to the bathroom is more complicated than it seems! Integrated health providers, GI doctors, pelvic floor physical therapists, nutritionists and acupuncturists can all be helpful. 


Q: What can I do to reverse change in bowel habits due to too many antibiotics last year? 

A: Antibiotics can result in changes to the gut and this can lead to bloating, pain and constipation or diarrhea. It is best to get to the root cause of the problem, stool tests such as the GI Effects test can be helpful to help you better understand what is going on in your gut and your provider can help you figure out what to do about it. 


Q: How to tell if it’s your pelvic floor or just your diet? 

A: In general, if you have difficulty with the actual execution of a bowel movement, meaning you have to strain to evacuate you may have a pelvic floor problem. People often have diet and pelvic floor problems together. If you have bowel trouble and pelvic pain or urinary dysfunction chances are there is pelvic floor involvement too. 


Thank you to all that contributed to the Q&A! If you didn’t see your question answered here, please drop a comment below or follow us on social media to be the first to know when we do another Q&A!


Additional Resources:

Anatomy and Education

Pooping Mechanics


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

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. 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

PHRC is also offering individualized movement sessions, hosted by Karah Charette, DPT. Karah is a pelvic floor physical therapist at the Berkeley and San Francisco locations. She is certified in classical mat and reformer Pilates, as well as a registered 200 hour Ashtanga Vinyasa yoga teacher. There are 30 min and 60 min sessions options where you can: (1) Consult on what type of Pilates or yoga class would be appropriate to participate in (2) Review ways to modify poses to fit your individual needs and (3) Create a synthesis of your home exercise program into a movement flow. To schedule a 1-on-1 appointment call us at (510) 922-9836

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