Constipated or Bloated? Why your Pelvic Floor might be to blame and what you can do to help

Do you have to strain or spend hours on the toilet before you can empty your bowels? It might be your pelvic floor! Find out why and how to remedy it.

Our pelvic floor is designed to prevent accidental leakages and incontinence whilst at the same time allowing us to empty our bowels and pass urine. So it is designed to be tightly shut for a large part of our day-to-day life but also to relax sufficiently to allow the elimination of urine and stool. This is largely the role of sphincters around the urethra and the anus. Each sphincter has an external and internal part. The external sphincters are under our voluntary control, which means we can tighten and relax them at will. The internal part is a more complex system with nerves and reflexes that are not under our voluntary control. If the internal sphincter is the problem you will need to seek medical help. Most often, however, the problem is the external sphincter and there are quite a few things we can do.

Why the external sphincter may make poo-ing difficult

So the external anal sphincter is usually shut until we are ready to empty our bowels. Then we relax the muscles to defecate. Easy, right? Well, yes, in theory! In practice, some people find it difficult to release tension in these muscles - some people even tighten them more when they sit on the toilet... Why?

1. We may have overriden the need to go to the toilet so often that it has become difficult to relax these muscles. We may even have become unaware of the chronic tension in this area

This may have happened because we didn't want to use the toilet at work, for example. We may have spent months or years overriding our need to empty our bowels and have always waited until we get back home in the evening. If we do this once or twice it's okay but if we do this every day over a period of time we may need to re-learn to relax the anal sphincter. To do that, first of all, we need to reconnect to these muscles, re-learn to notice tension and how to release it. Gentle reverse Kegels can be helpful to bring our awareness to this area. Now, make sure you don't just practice tensing the muscles, instead focus on relaxing them. One of my favourites versions of the Kegel-exercises for people with a tight pelvic floor is picking ripe blueberries with your anal sphincter - imaginary blueberries, not real ones!!! Pick up the imaginary blueberry so gently that you don't destroy it (imagine it's very very ripe!). Then relax your anal sphincter and let go of and drop the blueberry. That's it. Breathing, incidentally, is another great way to help you relax the pelvic floor (see the video below).

By the way, tension in this area - like tension in many other places - may also be linked to feelings and emotions, so I generally teach my pelvic floor students mindfulness and emotional release practices. Meditation, mindfulness and breathing practices are all worth a try if you hold chronic tension.

2. Our posture may not allow us to relax these muscles.

Posture is a very common problem in pelvic floor tension and difficulty to defecate. Slouching actually kinks the rectum, making it difficult for stool to pass. It can also lead to sphincter tension (although in the long term the sphincter may weaken - but that's another story). This applies to slouching in daily life and, even more commonly, to slouching when we are sitting on the toilet. This is very common, especially if we read a book or newspaper, or scroll our phone.

To empty our bowels easily, lean forward at the hips with a straight back, forearms resting on the thighs and let your tummy flop. Your feet need to be supported by the floor and your knees should be at least hip height or higher. Put a few books under your feet to raise the knees (or check out a "squatty potty"). In this position the posterior pelvic floor muscles release and the rectum straightens and allows the stool to pass easily. Now, this doesn't always work for everyone: Some people like to shuffle or rock forward and back for a while to release their bowels. Play around a little and find a way that works for you. I've got a number of short videos on You Tube with ideas, including some face yoga for the pelvic floor.

Here is a short lesson on sounds and the pelvic floor:

3. Our pelvic floor has become fibrotic

The tissue of the pelvic floor can become tighter as we age. The pelvic floor is actually largely made of fascia/connective tissue with a lesser amount of muscle tissue. This gives good support and also allows us some voluntary control over these muscles. As we age, however, the connective tissue becomes stiffer and some of the muscle tissue is replaced with collagen fibres. The pelvic floor becomes less elastic and more fibrotic. So the traditional pelvic floor exercises are not enough. Pelvic floor exercises need to target the fascia not just the muscles. Including the fascial pelvic floor instead of just the traditional muscle-only workout is also a lot more beneficial for the rest of the body and can help to relieve problems in the back and neck, for example.

And that's not all. In addition to the natural changes in our pelvic floor through aging, many of us have had minor damage to the pelvic floor throughout our life, small injuries that we didn't notice at the time but that have caused minor scarring (or major, if you had an injury during child birth). Scars are less flexible than muscles. We can sometime mobilise this scar tissue with specific stretches a deep tissue massage, say by sitting and moving on a soft ball, for example. This is such a common problem that one of my colleagues has developed a course that specifically deals with this issue.

Now, these are pelvic floor issues that may affect digestion that we can try at home. The next one may need to be diagnosed by a women's health specialist. I want to mention it because it's common but often overlooked:

4. Pelvic Floor Dysfunctions, Prolapse and Hormones

Pelvic floor dysfunctions and prolapses, even minor ones, can be the problem. These should generally be diagosed by a women's health specialist.

I found that my cancer treatment, the medications that suppressed oestrogen, affected my pelvic floor. Once I was prescribed localised, vaginal oestrogen these issues resolved quickly.

Another common problem are rectoceles - posterior vaginal prolapse where the rectum pushes into the wall of the vagina. Minor ones are quite common and most people don't even know that they have one apart from that they find passing stool a bit more difficult. People with minor rectoceles often need to find their own way of sitting on the toilet: some slouch a bit, some sit slightly sideways.... If you have been diagnosed with a minor rectocele, try to find a way that works for you. Your health specialist might be able to help. And don't be shy: they are used to talking about poo-ing! I remember having lunch in a posh restaurant with women's health physiotherapist, Julia Endacott. We got carried away as we shared ideas on how to poo and ended up squatting on the floor with Julia teaching me to close my glottis and vocalise "idge". Even though we tried to be very quiet, I am not sure I wouldn't have liked to be a diner next to us. The world of intimate pelvic floor health and digestion is full of eccentric and very passionate practitioners. Maybe now you understand why it's my passion....

This article does not replace medical advice. See your doctor to get a proper diagnosis. Digestive issue, such as bloating, constipation, gas, reflux and any other issues can have serious underlying causes.

Digestive issues are affected by diet, medication, stress, emotions and lifestyle. As a movement therapist, lifestyle and relaxation coach, I advise clients on how to return to health, especially digestive, intimate and sexual health. If you are interested to find out if I can support your health and wellbeing, contact me via this form.

Want to find out more about me first?

After many years of working with the pelvic floor as a movement therapist and intimate health practitioner, I trained in hypopressives with Marcel Caufriez and learned that only 20% of our pelvic floor is made up of muscles, the other 80% is fascia. It was an eye opener as it completely changes the way we need to exercise for a healthy pelvic floor. I subsequently trained as a level 2 instructor for pelvic floor rehabilitation with the Somatic Academy in Germany, a renowned centre for fascia movement and manual therapy where I learned how to develop exercise plans that also included breathing and the voice for a healthy pelvic floor.

I also have a Batchelor degree in health science (herbal medicine) which means I have extensive training in women’s health, including urinary and digestive health. In addition, I am a qualified Yoga, Chi Gong, Pilates and somatic movement, Feldenkrais and Face Yoga teacher, am qualified in relaxation techniques and also hold various qualifications in movement practices designed for rehabilitation, including for pelvic floor and digestive health. As a movement therapist I develop tailor-made health and wellbeing programmes for individuals and groups. I am presently studying for a Masters degree in Mindfulness and also hold a certificate in psychosexual counselling.

If you are interested in working with me, please contact me. I teach weekly classes for general health and wellbeing or you can work with me privately for your digestive health issues.

A big thank you to Julia Endacott, women's health physiotherapist and Pilates teacher for proof-reading

Categories: : digestive health, womens intimate health