The Hidden Culprit Behind Your Constipation That Most Doctors Miss: Pelvic Floor Dysfunction
By Dr. Sara Koehl, PT, DPT | Pelvic Health Physical Therapist
“I’ve tried everything—more fiber, gallons of water, all the supplements on the market—and I still can’t go regularly. What am I missing?”
This was the question from Sarah, a 38-year-old mom of two who had been struggling with constipation for over a decade. After countless doctor visits and “solutions” that never quite solved the problem, she was at her wit’s end.
The answer? It wasn’t in her diet. It wasn’t in a pill bottle.
It was in her pelvic floor muscles—and she had no idea they were working against her.
The Bathroom Battle: When Constipation Signals Pelvic Floor Dysfunction
Let’s face it—constipation isn’t the most glamorous topic. But when you’re the one spending 20 minutes on the toilet, feeling bloated and uncomfortable day after day, it becomes a central concern in your life.
Most people—including many healthcare providers—think of constipation purely as a digestive issue. Something to fix with more fiber, more water, more prunes, more exercise.
But what if the root cause isn’t in your gut at all?
Millions of people struggle with chronic constipation despite trying fiber supplements, drinking more water, and other common remedies. What many don’t realize is that their pelvic floor muscles might be working against them, causing a condition called dyssynergic defecation.
Your Body’s Hidden Gatekeeper
Think of your pelvic floor as the gatekeeper of elimination. These muscles form a hammock-like structure at the base of your pelvis with three critical jobs:
1. Support your pelvic organs (bladder, uterus, and rectum)
2. Control the release of urine, stool, and gas through coordinated contracting and relaxing
3. Stabilize your core system along with your diaphragm and deep spinal muscles
Here’s what most people don’t realize: To have a successful bowel movement, these muscles need to relax and lengthen.
But for millions of people, the muscles do the exact opposite—they tighten, creating a dysfunction called dyssynergic defecation. Imagine trying to push something through a door while simultaneously holding it shut. That’s essentially what’s happening in your body when pelvic floor muscles can’t properly coordinate during elimination.
The Lightbulb Moment: “This Is Not Normal”
James, a 42-year-old executive, had been constipated for so long he thought it was just “his normal.”
“I thought everyone had to strain,” he told me during our first session. “I thought everyone felt like they never fully emptied. I had no idea my muscles were working against me.”
After just three sessions of pelvic floor therapy, James experienced his first effortless bowel movement in over 15 years.
5 Signs Your Chronic Constipation Is Actually a Muscle Problem
If you’re nodding along to any of these, your pelvic floor might be causing your chronic constipation:
- You strain excessively during bowel movements, sometimes feeling like you’re “pushing against a brick wall”
- You frequently feel incomplete emptying—like there’s more, but you can’t empty bowels completely
- You’ve resorted to manual methods (pressing on your perineum or vaginal wall) to help stool pass
- Your constipation symptoms worsen with stress or anxiety
- Other areas are affected too—maybe you have urinary urgency, painful sex, or persistent low back pain
Why do these problems cluster together? Because the same muscles are involved in all these functions.
The Surprising Risk Factors No One Talks About
Pelvic floor dysfunction doesn’t discriminate—it affects men, women, and even children. But certain life experiences make it more likely:
- Childbirth: Particularly after vaginal delivery or significant tearing
- Chronic Straining: Years of pushing against resistant muscles creates a vicious cycle
- Desk Jobs: Sitting for hours weakens these muscles and reduces overall gut motility
- Past Trauma: Emotional or physical trauma can manifest as chronic pelvic tension
- High-Impact Athletics: Runners, CrossFitters, and gymnasts often develop overactive pelvic floors
Jessica, a 29-year-old runner, was shocked to discover her “elite athlete core” was actually working overtime, preventing normal bowel function.
“I thought I was doing everything right with my fitness,” she said. “I never realized my super-strong pelvic floor was actually problematic for this basic bodily function.”
Why Traditional Constipation Relief Methods Sometimes Fail
When you report constipation to your doctor, you typically get standard advice: more water, more fiber, more exercise, maybe a stool softener.
These recommendations aren’t wrong—they’re just incomplete.
If your pelvic floor isn’t coordinating properly, adding more bulk to your stool without the ability to evacuate it is like adding more cars to a traffic jam. It only makes the problem worse.
This explains why some people actually feel MORE constipated after increasing fiber intake.
How Pelvic Floor Therapy Provides Natural Constipation Relief
Pelvic floor physical therapy can be transformative for people with constipation tied to muscle dysfunction. Here’s my approach:
- Evaluate the Root Cause: Through detailed history and, if appropriate, gentle internal assessment to evaluate muscle coordination and identify pelvic floor tension
- Retrain Muscle Patterns: Using biofeedback for constipation and specialized techniques to teach your pelvic floor to relax during elimination
- Optimize Bathroom Mechanics: Simple positioning changes can dramatically improve bowel movements (hint: your knees should be higher than your hips)
- Address the Mind-Muscle Connection: Chronic stress directly impacts pelvic floor tension and bowel function
The Life-Changing Shift: Beyond Regular Bowel Movements
When Lynn, a 65-year-old retiree, came to me after 30 years of constipation, she was skeptical that “exercise for her pelvic floor” could help where decades of laxatives had failed.
Six weeks later, she wasn’t just having regular bowel movements—her entire quality of life had transformed.
“I never realized how much mental energy I was spending worrying about bathroom issues,” she told me. “Now I travel without fear. I eat foods I enjoy. I feel like I got my life back in ways I never expected.”
It’s Time to Ask Different Questions
You don’t have to accept constipation as your normal. But solving it might require looking beyond your diet and into the complex interplay of muscles that control elimination.
Ask yourself:
- Has conventional constipation advice failed me despite my best efforts?
- Do I feel like I’m fighting my own body during bowel movements?
- Could my pelvic floor be working against me rather than with me?
The most profound solutions often come from asking different questions entirely.
Your Next Step
Constipation isn’t just an inconvenience—it’s your body communicating that something needs attention. When your pelvic muscles aren’t working in harmony with your digestive system, your entire well-being suffers.
The good news? Pelvic floor dysfunction is highly treatable. With proper evaluation and a personalized care plan, most people experience significant, lasting relief—often after years or even decades of struggling.
If this resonates with your experience—or someone you care about—consider reaching out to a pelvic floor physical therapist. The solution might be simpler than you think.
Want to learn if pelvic floor therapy could resolve your chronic constipation issues, bladder symptoms or postpartum recovery? Schedule a discovery session with one of our pelvic health specialists. We’re here to help you find natural constipation relief and feel at home in your body again—starting from the bottom up.
KeysWords
Constipation causes, Chronic constipation, Pelvic floor dysfunction, Pelvic floor therapy, Constipation relief, Bowel movement problems
Dr. Sara Koehl specializes in pelvic health physical therapy, helping patients resolve issues from constipation to incontinence, pelvic pain, and postpartum recovery. With a compassionate, whole-person approach, she helps patients understand the connection between their pelvic floor function and overall quality of life.