Constipation and the Pelvic Floor: What’s Really Going On and How to Get Relief
- 21 hours ago
- 3 min read
Constipation is one of those things that people assume is a normal part of life. Don't get me wrong, it is natural for our stool to ebb and flow depending on a multitude of factors, from stress to what we ate. But, when it becomes a frequent issue, folks tend to increase their fiber, drink more water, try magnesium, try Miralax, or some type of cleanse.
What most people aren’t told is that constipation is rarely just a gut problem. Yes, your GI tract plays a huge role. Yes, we must look at hydration, fiber, and nutrition. However, having a bowel movement is a full-body event that depends on coordination, pressure management, nervous system input, and how well the pelvic floor can respond in the moment.
Many of the people I work with have perfectly healthy digestion on paper. The issue is what happens when they sit down to actually go.
Let’s unpack what’s really going on.
Constipation is a coordination and pelvic floor issue more often than people think
Having a bowel movement requires several things to happen in the right sequence:
The abdominal wall generates pressure
The diaphragm and ribs move
The pelvic floor relaxes
Stool moves through the rectum
The nervous system feels safe enough to let go
If even one piece of that system gets out of sync, emptying becomes difficult.
Chronic constipation is often associated with some form of pelvic floor dysfunction. In fact, research shows that many people with chronic constipation have pelvic floor dyssynergia, which simply a form of pelvic dysfunction in which the pelvic floor contracts when it should relax.
Your body is using a strategy that just doesn’t work
When someone tells me they’re straining or waiting ten minutes for anything to happen, one of the first things I look at is tension patterns.
Pelvic floor tension can come from:
stress
anxiety
clenching throughout the day
bracing during exercise
guarding after pain
habitual breath holding
long-term constipation itself
This is why you can “go every day” and still be constipated. Frequency doesn’t guarantee full emptying and it doesn't specify effort or structure.
Lifestyle matters too, but not only in the way people think
Most people think about constipation in terms of fiber, hydration, and nutrition. Those absolutely matter and if you haven't looked at optimizing these, you need to. But so do:
sleep
movement
daily walking
how long you sit on the toilet
whether you feel rushed or tense
your bathroom posture
hormonal shifts
If the nervous system feels hurried or unsafe, the pelvic floor is less likely to relax. The gut does not override a stressed-out body. In fact, it responds heavily to how the nervous system is feeling.
So what actually helps?
A good plan usually includes:
1. Breath mechanics
Allowing the diaphragm to move helps the pelvic floor respond instead of guard.
2. Learning to relax instead of strain
A small change, but often the biggest game-changer.
3. Positioning strategies
Foot support, hip angle, rib expansion… simple but powerful. Look into a squatty potty for help here (you can use household items like toilet paper rolls or small boxes to get a similar effect)
4. Addressing tension patterns
If your pelvic floor never lengthens, emptying will always feel difficult.
5. Bowels habits that support the system
Consistent timing, not rushing, understanding urge patterns.
6. Treating the whole system, not one piece
Constipation has layers. Addressing one layer rarely solves it long-term.
When should you get help?
If you’re:
Straining often
Feeling like you're not emptying completely
Spending more than five minutes on the toilet
Dealing with pressure or heaviness
Unsure if you’re coordinating well
Or following all the usual advice without results
Pelvic floor physical therapy can help you understand what your body is doing, why it’s doing it, and how to improve emptying without strain.
You don’t have to keep guessing.
Book a consultation and we can look at the full picture together.
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