Recently, a former patient of mine came back to see me after several months away. Her distress was obvious, echoed in her panicked gaze and furrowed brow. In the previous weeks, she had noticed a drastic increase in urinary leakage, a concern that was previously resolved with a set of consistent exercises and behavioral changes. In an attempt to curb that leakage, she had reduced her water intake and stopped exercising, but that wasn’t helping.
I took her through some standard questions, asking about stress, dietary changes, and sleep patterns. When I asked her about any changes in bowel habits, she informed me that she had not had a bowel movement for three weeks (and no, your eyes didn’t read that incorrectly!).
The lack of a recent bowel movement certainly explained the lack of appetite and abdominal pain, but she was surprised to learn that it was likely a significant contributor to her urinary leakage.
Constipation is defined in many ways, but it is typically seen as having fewer than 3 bowel movements a week. Constipation may also make itself known through harder than normal stool, difficulty passing stool, decreased appetite, pain, abdominal distension, and foul body odor (especially in children).
Most of us will experience brief episodes of constipation throughout our life, but constipation can contribute to a host of other concerns when it becomes chronic. There are numerous factors that can contribute to the development of constipation, but some of the most common causes are inadequate water and fiber intake, dietary changes, stress and hormonal fluctuations, medication changes, lack of physical activity, or repeatedly ignoring the urge to have a bowel movement (also known as “withholding”).
My patient was a bit baffled when I mentioned that constipation was likely contributing to the increase in urinary leakage she noticed in the previous weeks. The bladder and the colon are close neighbors, and as the colon expands to accommodate more stool, the bladder has less room. When the bladder gets too crowded and can’t expand, it’s ability to hold urine decreases and we are more likely to experience urinary leakage as a result. We’re also more likely to strain when we’re constipated and this puts more strain on the bladder and pelvic floor muscles (the muscles that help keep our bladder and bowel in the right places), leaving us vulnerable to leakage.
Pelvic floor therapy can be helpful for managing constipation, and its many side effects, in numerous ways. Most notably, pelvic floor therapists work to ensure that the pelvic floor muscles can relax enough to allow us to have bowel movements. They also help individuals cultivate optimal toileting posture and breathing mechanics to reduce strain on these muscles while helping them to understand all of the ways in which they can promote better bowel health.
If you’re currently experiencing constipation, consider making an appointment with a pelvic health specialist. Please feel free to contact us at Grace Physical Therapy and Pelvic Health. We are always here to support, educate, and guide you.
Dr. Lindsay Saunders received her Doctorate in Physical Therapy from The University of North Carolina at Chapel Hill and holds a Bachelor of Science degree in Health and Exercise Science from Wake Forest University. Dr. Saunders has pursued advanced training pelvic health through the Herman and Wallace Pelvic Health Rehabilitation Institute, including in pediatric bladder and bowel dysfunction. She also has experience working with patients with a variety of orthopedic and post-surgical concerns. Dr. Saunders has worked with children in a variety of settings and is also passionate about offering patient-centered and LGBTQIA+ inclusive care. Her treatment incorporates a functional approach to rehabilitation with a holistic approach to overall health and wellness. She is accepting patients at Grace Physical Therapy and Pelvic Health.
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