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How Constipation Worsens Pelvic Pain

Posted Jan 15 2009 7:42pm 5 Comments

Today my amazing physical therapist, Julie, is filling in for me with a spot-on explanation of a subject near and dear to me, constipation! TV commercials poke fun at constipation, but for women with pelvic pain, constipation is no laughing matter. Recently, my issues with constipation gave me a terrible flare up. Julie has a doctorate degree in physical therapy and is the director of the UC Irvine Medical Center Women's Health Physical Therapy Program. Take it away Julie!

Constipation plays a huge role in chronic pelvic pain. It can cause a woman’s existing chronic pelvic pain to flare or it can be the root cause of the pelvic floor dysfunction (PFD) that causes the chronic pelvic pain in the first place.

There are two different types of constipation. The first, is referred to as “general constipation,” and is caused by a lack of motility in the large intestine. The large intestine a.k.a. the colon is designed to carry out a contracting and squeezing motion that propels matter through it. This action can become impaired causing matter to move excessively slow or not much at all. A variety of things can lead to this first type of constipation such as poor diet, lack of fluid intake, lack of exercise or a sluggish colon that may or may not be associated with irritable bowel syndrome. Also, many kinds of medication, like those taken for pain can cause general constipation.

The second type of constipation is what is known as “outlet constipation.” Outlet constipation occurs when stool sits in the rectum and is difficult to eliminate. In other words, the train makes it to the station, it just won’t leave! This can be due to either tight pelvic floor muscles or a situation where the “posterior wall,” the wall that separates the vaginal and rectal canals, is weak causing fecal matter to become stuck.

When it comes to outlet constipation, dysfunctional pelvic floor muscles are often the cause. When a muscle becomes tight, it becomes shortened and has too much tension when at rest—this is also known as a muscle spasm. When the pelvic floor muscles are in spasm, they often cannot lengthen and relax sufficiently enough to allow stool to pass through the external sphincter with ease and without pain. A common response to such a scenario is for a woman to bear down and push in an effort to pass the stool. This act of straining only makes the situation worse; the more the woman pushes, the angrier the muscles become causing even more spasm to form. And over time, this can cause the posterior wall to become weak, further exacerbating the woman’s constipation. Now, not only is stool having a hard time getting through the external sphincter, it’s getting stuck and pocketing in a weak posterior wall.

Whatever its cause, it is essential to put an end to constipation.

So, what can you do if you suffer with constipation?

First, work with your doctor to figure out where the problem is—is it high up in the colon or further down in the rectum or both? A good Urogynocologist or Colorectal doctor can do a thorough work-up on you to figure this out if needed. Be sure and ask your doctor if any of the current medications you are taking can be the cause of your constipation. If medication you are taking for your chronic pelvic pain is the cause, discuss whether this medication can be swapped for another without a constipation side effect.

If it’s general constipation you are dealing with getting enough exercise is important. Additionally addressing deficiencies in your diet is essential. Consuming enough fiber—adding flax seed into your diet is a good way to increase your fiber intake—and drinking 6 or more glasses of water can be helpful. Also, taking a Magnesium supplement combined with a Vitamin C supplement can kick start your system. But, before you begin taking these supplements, be sure and discuss it with your doctor to make sure they will not interfere with any current treatment or medication you are on.
If these basic steps are not enough, your MD can work with you suggesting things such as stool softeners or fiber supplements such as Citrucel or Metamucil.

Performing a daily colon massage is another excellent way to get your colon moving. Ask your physical therapist to show you how to do this. Finally, a complementary and alternative approach to general constipation is acupuncture. (Stay tuned for an upcoming blog on how acupuncture can be an all-around help in treating your pelvic pain issues.)

In regards to outlet constipation, physical therapy is a must when the muscles are responsible for the problem. Working with an experienced pelvic floor physical therapist who can do transvaginal and/or rectal myofascial release and trigger point release to the pelvic floor muscles can decrease or eliminate this problem altogether. Your therapist will likely also teach you techniques, such as self treatment with dilators and the “squat stretch” technique to aid in decreasing or eliminating your outlet constipation issues.

Please feel free to post any questions or comments you might have about this post!

Keep movin',
Comments (5)
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Wow thank you so much for this article I thought that I was going crazy!!! I have IBS sooooo bad. I swing from one pendalim to the next. This last exposed was horrible constipation, all of a sudden my right lower back and hip was killing me. I thought it had something to do with being constipated because of the straining which I detest doing because of all the yucky things that come with it. but the pelvic out of place thing is a new one...well maybe not now that I think about it I just didn't put two and two together.  I did end up going to a chiroprator, which definitely confirmed I was out of alignment. I will definitely seek out a therapst!! to help keep me in check

Any suggestion for my yoyo IBS problem??? I'm all ears :)


Signed S. Awad 


I have used the Dr. Max Powers 15 Day Cleanse about 3 months ago and I just finished my second 15 day cleanse last week. After having regular constipation sometimes for 4 or 5 days leading to strenuous stools. I'm male and mid 30s. For the first week or two no big changes in stool however I immediately noticed better sleep and dreams. The changes in stools started around 3 weeks after when I finished the first Dr. Max Powers 15 Day Cleanse. Softer more regular stools. Now about 1 week after my second 15 Day Cleanse (again, using the Dr. Max Powers product) I'm completely regular going 1 - 2 times a day. This product also has pro biotics in the capsules as well. I personally recommend this product to anyone dealing with constipation or even problems sleeping as something natural. Plus, it's not a challenging cleanse to do - I keep mine in my medicine cabinet and take 1 before I brush my teeth before bed. In short, works for me, hope it does for you if you've been as uncomfortable as I've been for years. I had some trouble finding them online - but here is the website

Recovering from hospitalization due to UTI.  I had thought my constipation created alot of my bladder problems and believe this article has helped me diagnose bladder pain which gets worse after straining to have a bowel movement. Maybe by treating my constipation I will be able to control my bladder spasms.  Hope to get more information from you.

varies based on the causes and at times due to the unavailability of the cause, treatments are never proper. Not much can be done except trying to temporarily ease out pain using hot water bags or even drinking lot of water and exercising.
varies based on the causes and at times due to the unavailability of the cause, treatments are never proper. Not much can be done except trying to temporarily ease out pain using hot water bags or even drinking lot of water and exercising.
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