Constipation can vary from infrequent stools, hard to pass stools, or hard small stools. Patients may also recount a feeling they have to use the bathroom, but they can’t fully empty or get the stool out.

There are many reasons, some of which can be helped by physical therapy. One reason may be a non-relaxing anal outlet or pelvic floor. Another scenario is pelvic floor dyssynergy, a confused pelvic floor that tightens when it should be relaxing during bowel movements. Usually this condition develops after a period of painful bowel movements from fissures, hemorrhoids, or perineal tears with birth. However, we sometimes find in in individuals without any precursors.  Sometimes patients have slow transit:  bowels that just take a lot longer to move through their GI tract.  Generally, it is said that nothing helps this condition.  However, we have had reduced transit times with most of our patients using Barral Visceral manipulation in its purity combined with internal techniques and retraining the pelvic floor.

We have been specially trained at Mayo Clinic to learn the program for constipation outlet problems that was only available at Mayo Clinic and John Hopkins.  We have modified the program to make it more accessible.  Rather than doing twice daily visits at Mayo for a cost that nears 5 figures, I train the patient in hand held equipment and check in regularly, as well as using manual visceral and pelvic techniques with the retraining.   We have found this to be highly effective as well as less cost prohibitive.

We use systematic muscle retraining techniques, in progressive positions of the body, biofeedback, and finally we progress to training with passing different volumes of mini balloons with air or water, to learn to keep the anal outlet relaxed with passing bowels. Additionally, we address the non relaxing musculature with manual therapy to help it lengthen and function better. Finally, we address the restricted fascia in the abdomen with manual therapy. If patients still have abdominal or rectal pain with bowel movements, this is usually treatable pain.

In other situations, abdominal surgeries, radiation, pelvic surgery, or endometriosis may have left the bowels unable to have the motility and mobility they once did. This can cause slowed motility. Visceral work can often help that as well.