• Does this story sound like you?

Meet Sarah a lady who is in her 50s who has suffered from constipation issues her whole life. Sarah came to physiotherapy for her urinary issues but also mentioned she had suffered from bowel issues since she was a child.

Sarah learned many different strategies including different foods and drinks that can affect her bowel, how to sit on the toilet properly, cues to help empty her bowels and relaxing her pelvic floor muscle during defecation.

These strategies may seem simple but sometimes it is useful to sit down with a Continence Physiotherapist and help piece together your issues to improve your quality of life.

What is constipation?

When most people think of constipation, they normally think of hard stools that are difficult to pass, however, people who are constipated may show some or all of the following signs:

  1. Fewer than 3 bowel movements per week
  2. Straining
  3. Lumpy or hard stools
  4. The sensation of obstruction in the anal/rectal region
  5. The sensation of incomplete emptying of your bowels
  6. Manual maneuvering requiring you to empty your bowels

Constipation may be considered chronic if you’ve experienced two or more of these symptoms for the last three months.

Causes of constipation?constipation fiber

Often there are multiple causes for constipation and finding out the exact cause can be difficult. Below are some of the causes of constipation:


  • Lack of fiber (not enough fruit and vegetables)
  • Not drinking enough water/fluid

Behavioral factors

  • Spending too much time sitting
  • Medications – many medications may have the side effect of constipation

Irritable bowel syndrome

Dyssynergic defecation

  • Acquired behavioural issues where someone is unable to coordinate the pelvic floor muscle and the abdominal muscles to evacuate stools

Failure to respond to the urge to defecate

This may be due to a variety of reasons such as reduced sensitivity in the rectal area, a change in your rectoanal reflex activity, an increase in your rectal capacity, and rectal motor dysfunction.

Diseases and conditions as a secondary cause of constipation, for example:

  • Mechanical (Colon, rectal or anal stricture/blockage)
  • Psychological (depression, anxiety, eating disorder)
  • Neurological conditions (multiple sclerosis, Parkinson’s disease)
  • Endocrine and metabolic conditions (Diabetes, hypothyroidism)
  • Connective tissue disorders
    • Genetic predisposition
    • Colonic motility and absorption
  • Slow transit through the bowel

What can you do at home?

  1. Stay hydrated (drink 1.5-2L of water a day) and eat plenty of fibre – This will help to keep stools soft
  2. Get moving – as this promotes more bowel movement

Can constipation cause issues with your pelvic floor?

Constant straining with bowel emptying can cause increased pressure through your pelvic floor which, over time, can contribute to pelvic floor weakness, urinary incontinence and prolapse.

What can a Continence Physiotherapist do if you are suffering from constipation?

  1. A thorough assessment of current and past history including a discussion of your bowel habits, diet, medications and psychosocial history.
  2. If you have any of the symptoms below it is best to get checked by your GP first:
    • Any recent changes in your bowel habits (especially if over 50)
    • Acute onset of constipation in older individuals
    • Mixed blood in the stool
    • Unexplained weight loss
    • Inflammatory bowel disease
    • Family history of colorectal cancer
  1. Education on strategies specific to your diagnosis and modifying your lifestyle factors
  2. A pelvic floor assessment using real-time ultrasound or internal examination to see if these are contributing to constipation.


If you have been suffering from constipation, don’t put up with it any longer, come and see Amy Tinetti and she will help you put all the pieces of the puzzle together, to get you some relief. To make an appointment, call (08) 6389 2947 or click here to book online.