Signs of constipation:

• Bowel motions are less frequent
• Stools are dry or hard
• Straining to empty
• Abdominal pain, cramping, swelling or bloating
• Sensation of incomplete emptying of the bowel after you have left the toilet

Causes of constipation:

Constipation occurs when food is sitting in the digestive tract for too long which leads to the colon absorbing too much water from your food. The end result is that your stool become dehydrated and hard.

• Low fibre diet – fruit, vegetables, wholemeal breads, high fibre cereals
• Insufficient water consumption
• Sedentary lifestyle
• Pregnancy, breastfeeding
• Overweight or obesity
• Medication
• Delaying the urge to open your bowel (holding on)
• Anorectal pain due to haemorrhoids, fissures (microtears in the anal sphincter) or birth trauma
• ‘Sluggish bowel’

What should I do if I have constipation?

• Drink more water – the amount that you should be drinking depends on various factors such as diet, lifestyle, exercise and working environment however, the average amount an adult should consume is 2 litres of fluid per day
• Increase fibre in diet – consume fruit such as pears or prunes and vegetables such as beans, broccoli and brussels sprouts
• Try a stool softener or laxative such as metamucil, benefibre or movicol. Discuss this with your health care professional first however as different laxatives have different effects.
• Exercise
• Go to the toilet to open your bowel when your feel the urge – Don’t hold on!
• Sit properly on the toilet when opening your bowels
• See your GP or pelvic floor physiotherapist

How should I sit on the toilet?

Think back… primitively, we were all squatting on the ground to empty our bowel (and bladder for us girls!) we weren’t sitting upright on a white porcelain bowel! There is a muscle in the pelvic floor – the puborectalis that hooks around the bowel effectively causing a kink which is referred to as the anorectal angle. When you are sitting upright or standing, this muscle is activated hence the bowel is kinked – naturally designed to stop stools from coming out when were out and about. When you lean forward into a squatting position the puborectalis muscle relaxes which allows the bowel to straighten and effectively allows the stool to pass.

The golden rules when sitting on the toilet:

1. Knees higher than hips
2. Whole body leans forward from the hips
3. Back straight
4. Relax, belly breathe or ‘hiss’ like a snake – this has a relaxation effect on the pelvic floor muscles

Some people have difficulty emptying their bowel completely as the natural propulsive action of the bowel is ‘sluggish’. If you think that your bowel isn’t emptying properly, you can try the following things when sitting on the toilet:

• Gentle abdominal massage
• Lean forward furthermore or apply gentle pressure to the lower abdominal wall by hugging your tummy or leaning forward onto a small pillow on your thighs
• Rock forward, backwards and side to side to assist with the propulsive mechanism of the bowel

What are the effects of long term constipation?

• Incontinence – faecal and urinary
• Prolapse
• Haemorrhoids, anal fissures
• Pain and discomfort
• Weak pelvic floor
• Back pain
• Urinary urgency and frequency

What should my stools look like?

Your stools should be soft, formed and easy to pass. The best way to describe how your stool should look is – smooth and soft like a sausage!

Have a look at the Bristol Stool Chart to see where your stools are. Ideally your stools should be a Type 4.

Take home message for a healthy bowel (and bladder):

1. Eat well
2. Drink well
3. Exercise regularly
4. Maintain a healthy and toned pelvic floor
5. Sit properly when on the toilet

If you are suffering from constipation or have any concerns with your bladder, bowel or pelvic floor health, please don’t hesitate to contact us in clinic to make an appointment with Alice or Robin. (07) 5441 4764.