Nobody Talks About This, But Constipation Might Be a Pelvic Floor Problem

Let's talk about something that doesn't get nearly enough airtime: constipation. Not the occasional kind that clears up after a few extra glasses of water, but the chronic kind. The kind where you're straining, feeling incomplete, or going days without relief. The kind that has become so normal to you that you've stopped mentioning it to anyone.

Here's what I want you to know: chronic constipation is not just a digestive issue. And it's not something you should have to silently manage with fiber gummies and hope.

For a significant number of women, constipation is a pelvic floor problem. And pelvic floor physical therapy can help.

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What Your Pelvic Floor Has to Do With It

Your pelvic floor muscles don't just support your bladder and uterus. They also wrap around your rectum, and they play a direct role in whether you can effectively and comfortably empty your bowels.

When you have a bowel movement, the process should be coordinated: the muscles of your pelvic floor relax and open, while your abdominal and diaphragm create gentle downward pressure. It should feel effortless.

But when your pelvic floor muscles are too tight, or when they contract instead of relax during a bowel movement (a condition called dyssynergia or non-relaxing pelvic floor dysfunction), that coordination breaks down. The result? Straining, incomplete emptying, hard stools, hemorrhoids, and over time, a cycle that gets harder and harder to break.

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Signs Your Constipation Might Be Pelvic Floor-Related

You don't have to have all of these to benefit from pelvic floor PT, but these patterns often point to pelvic floor involvement:

• You strain significantly to have a bowel movement, even when stools aren't hard

• You feel like you never fully empty

• You have to press on your perineum or use a finger to help with bowel movements

• You experience pain, pressure, or tension in your pelvis, tailbone, or rectum

• Your symptoms are worse during stress or hormonal shifts (like your period)

• You also have bladder symptoms, pelvic pain, or pain with sex

That last one is particularly telling. Pelvic floor dysfunction rarely shows up in just one area. Constipation that co-occurs with any of these other symptoms is a strong signal that the pelvic floor is involved.

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The Posture Nobody Taught You

One of the first things I address with patients dealing with constipation is toileting mechanics, meaning, how you sit on the toilet matters.

Our modern toilets were not designed with human anatomy in mind. The seated position keeps your puborectalis muscle partially contracted, which actually kinks the rectum and makes it harder to pass stool. The optimal position for a bowel movement is a squatting position, with your knees higher than your hips.

A simple squatty potty-style footstool under your feet can make an immediate and meaningful difference. Leaning slightly forward with your hands on your thighs, letting your belly be soft, and taking a full breath before you bear down are also part of what I teach in treatment.

No straining. No holding your breath. No white-knuckling through it. Your body knows how to do this. Sometimes it just needs a little retraining.

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What Treatment Actually Looks Like

Pelvic floor physical therapy for constipation focuses on restoring coordination and relaxation in the pelvic floor, and then reinforcing that with your whole system.

That might include:

• Internal and external manual therapy to release tension in the pelvic floor and surrounding musculature

• Dry needling to address trigger points that contribute to pelvic tension

• Breath work and down-training techniques to help your nervous system shift out of a guarded, contracted state

• Bowel retraining strategies and toileting mechanics

• Coordination work to restore the push-and-relax pattern your body is designed to use

Constipation might feel like a bathroom problem. But it's a whole-body problem with a whole-body solution.

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You Don't Have to Normalize This

I hear it all the time: "I've always been like this." Or: "I thought it was just IBS." Or: "My doctor just told me to eat more fiber."

Fiber is great. But it does nothing to address a non-relaxing pelvic floor. If you've been managing constipation with supplements, dietary changes, and sheer willpower without lasting relief, there's a good chance you're treating the symptom and missing the source.

You don't have to keep white-knuckling your way through this. There is help. And it starts with a conversation.

Ready to take the first step? Book your free consultation at https://app.pteverywhere.com/woven/bookingonline. Woven Pelvic Health and Wellness is located in Denver, CO and serves women throughout the Denver metro area.

Dr. Ashley Castellanos, PT, DPT is the owner and founder of Woven Pelvic Health and Wellness in Denver, Colorado. She specializes in pelvic floor physical therapy for women across all stages of life, with advanced training in manual therapy, dry needling, orthopedics, and trauma-informed care.