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  • Writer's pictureRobin R Varghese, PT.

"Do I really need to know about Constipation?"

Updated: Jul 17, 2023

What best describes constipation?

  • It is a condition in which you may have fewer than three bowel movements a week; stools that are hard, dry, or lumpy; stools that are difficult or painful to pass; or a feeling that not all stool was passed.


  • Dysfunction of the nerve pathways in the gut

  • Disturbances of the gut microbiome

  • Side effects from certain medications

  • Anatomical issues

  • Reduced calorie intake

  • Pelvic floor dysfunction


  • Fewer than three bowel movements a week

  • Stools that are dry, hard, or lumpy

  • Stools that are painful or difficult to pass

  • A feeling like not all the stool came out

  • having to push or strain to go

  • taking up to 60 minutes on the toilet


  • These uncoordinated pelvic floor dynamics are usually diagnosed with a test called anorectal manometry, which uses a thin tube to measure pressures, sensations, and reflexes in the rectum and anal sphincter.

Anatomy of Bowel function

  • Stool enters the rectum (2) from the colon (1).

  • There are two major muscles the stool must pass through to exit the body, the internal sphincter muscle (3) and the external sphincter muscle (4).

  • The internal sphincter muscle is “involuntary”. It automatically relaxes and opens at the top of the anal canal to allow stool to pass through.

  • As the stool enters the upper anal canal, it is “sampled” by the sensitive nerve cells. People with normal nerve sensation have the urge to have a bowel movement.

  • The external sphincter muscle is a “voluntary” muscle; you have control over this muscle. It assists in keeping the stool in the rectum until you are ready to have a bowel movement.

  • In fact, squeezing the external sphincter muscle pushes the stool out of the anal canal (5) and the rectum relaxes.

  • The urge to have a bowel movement is gone until the next colon contraction hits the rectum. Frequent holding of stools can cause constipation and desensitization of nerve cells.

  • The longer the stool remains in the colon and rectum, the more fluid is absorbed, and the harder the stool becomes. This is why it is important to move your bowels when you feel the urge to have a bowel movement.

Muscles of bowel function

  • The two major muscles of the pelvic floor are the levator ani muscle and the puborectalis muscle.

  • The levator ani muscles supports the anal canal, the urethra and in women, the vagina.

  • The puborectalis muscle provides a ring of support around the anal canal at the small end of the funnel made by the levator ani muscle.

  • It has a “U” shaped configuration creating an angle between the anal canal and the rectum. Under resting conditions this angle is 90°, but during straining and moving your

bowels this angle moves to 135°.

  • If these angles are not correct, it may become more difficult to have a bowel movement.

  • The levator ani and the puborectalis need to coordinate properly in order to expel contents from the anal canal.

  • For this, there should be good control of the pelvic floor muscles.

  • Any failure in this or frequent spasm of these muscles can lead to constipation.

  • They can block the anal canal, making it very difficult to have a bowel movement.

  • This can be called an outlet obstruction and pelvic floor / rectopubalis dyssynergia. It is like pushing through a closed door.

Watch out for this space for our next blog on how physical therapy can help you with constipation.

At Valley Healing Hands, Brownsville, Texas we provide the best physical therapy treatment for Constipation. Our highly qualified therapists will assist you with a programme well suited to get you know your bowels and its mechanism. They will teach you how to rectify the affected muscle and help you get back to having a happy and less stressful bowel. Our patients are very much satisfied with our services and you may learn about what they have to say about us here and get connected to us here. Our patients love us and you too, will!!!


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