The Overlooked Causes of Constipation: Pelvic Floor Dysfunction & Faulty Toilet Strategies

Here’s the final post in the Constipation Series with some actionable solutions.

For many people struggling with constipation, the problem isn’t just what they eat or how much water they drink—it’s how their body eliminates waste. If the pelvic floor muscles aren’t functioning properly, or if someone is using ineffective toilet strategies, even the healthiest diet won’t be enough to maintain regular bowel movements.

In this final post of our constipation series, we’ll dive into two often-overlooked contributors to chronic constipation: pelvic floor dysfunction and faulty toilet habits. We’ll also explore practical strategies to restore proper bowel function—including how treatment at Pelvic Health Solutions can help.

The Pelvic Floor’s Role in Constipation

The pelvic floor is a group of muscles at the base of the pelvis that support the bladder, rectum, and reproductive organs. These muscles must not only relax fully during a bowel movement to allow stool to pass easily, they must also descend a bit. If they remain tense or uncoordinated, elimination becomes difficult and straining becomes habitual.

Signs of Pelvic Floor Dysfunction

•    Feeling like you can’t completely empty your bowels

•    Frequent straining despite soft stool consistency

•    The need to change positions or apply pressure to your abdomen/perineum to pass stool

•    Lower back, pelvic, or rectal pain

•    Urinary urgency or leakage

Pelvic floor dysfunction (PFD) can develop due to chronic stress, scar tissue (from surgery, childbirth, or injury), prolonged sitting, excessive straining, or even poor toilet habits.

How Pelvic Health Solutions Can Help

At Pelvic Health Solutions, trained pelvic floor physical therapists assess and treat the underlying muscular and neurological imbalances contributing to constipation. Here’s how they can help:

✅ Pelvic Floor Muscle Assessment: Using gentle manual techniques, a therapist evaluates whether your pelvic floor muscles are too tight, weak, or uncoordinated—all of which can contribute to constipation.

✅ Manual Therapy for Muscle Release: If pelvic floor muscles are too tight, hands-on internal and external release techniques can reduce tension and improve bowel function.

✅ Biofeedback Training: If muscle coordination is the issue, biofeedback can help retrain proper pelvic floor relaxation and prevent excessive straining.

✅ Scar Tissue Mobilization: If past surgeries (C-sections, abdominal surgeries, perineal tears, or episiotomies) have caused restrictions affecting bowel movements, manual scar release techniques can improve tissue mobility and ease elimination.

✅ Toilet Posture & Breathing Training: A therapist will coach you on proper body positioning, breathing techniques, and relaxation strategies to make bowel movements effortless.

By working with a pelvic floor therapist at Pelvic Health Solutions, you can address the root cause of your constipation rather than just treating symptoms.

Correcting Faulty Toilet Strategies

Many people unknowingly use inefficient and even harmful elimination techniques that contribute to constipation. If you’re routinely straining, holding your breath, or using poor posture on the toilet, it may be time to rethink your approach.

Mistakes That Worsen Constipation

❌ Straining Too Hard – Excessive pushing increases pressure in the abdomen and can weaken pelvic floor muscles over time, making constipation worse.

❌ Holding Your Breath – The correct way to pass stool is to exhale gently rather than holding your breath and bearing down. Holding your breath engages the Valsalva maneuver, which can make elimination more difficult.

❌ Sitting at a 90-Degree Angle – Western toilets put the body in a position that closes off the rectal passage (causing an acute anorectal angle), making elimination harder than it needs to be.

How to Fix Pelvic Floor Dysfunction & Improve Toilet Habits

1. The Squat Position: A Natural Bowel Movement Hack

The easiest way to improve elimination is to mimic a squatting position by using a footstool (like a Squatty Potty) when sitting on the toilet.

🔹 Why It Works: Squatting naturally straightens the anorectal angle, relaxing the puborectalis muscle and allowing stool to pass with minimal effort.

🔹 How to Do It:

•    Place a small stool (6-12 inches high) under your feet when sitting on the toilet.

•    Lean forward slightly with elbows on knees.

•    Take slow, deep breaths to help relax the pelvic floor.

2. The "Exhale to Eliminate" Technique

Instead of holding your breath and straining, try this:

1️⃣ Inhale deeply into your belly before attempting to pass stool.
2️⃣ Exhale slowly through your mouth as you gently push.
3️⃣ If stool doesn’t pass easily, pause, breathe, and try again rather than forcing it.

This method prevents excessive intra-abdominal pressure and allows the pelvic floor muscles to relax naturally.

3. Pelvic Floor Exercises for Better Bowel Movements

Strengthening and relaxing the pelvic floor can improve stool elimination and prevent straining.

✔️ Diaphragmatic Breathing – Deep belly breathing relaxes the pelvic floor and encourages peristalsis. The breathing diaphragm and the pelvic diaphragm (pelvic floor) are synchronized in their motion. A deep breath in makes both diaphragms move in a downward direction…hence causing pelvic floor descent.

✔️ Reverse Kegels – Unlike traditional Kegels (which contract the pelvic floor), Reverse Kegels focus on relaxing the muscles. To practice:

•    Inhale deeply, imagining your pelvic floor expanding downward.

•    Exhale slowly, letting go of any tension.

✔️ Perineal Massage – Massaging the area between the anus and genitals can help release tension and improve bowel movements.

4. Manual Techniques: The ILU Abdominal Massage

A simple self-massage technique can stimulate the colon and help encourage bowel movements.

🔹 How to Do It:

•    Using gentle pressure, trace an I, L, and U shape on your abdomen with your hand.

•    Start on the lower right side (I), move across under the ribs (L), and down the left side (U).

•    Repeat for a few minutes before trying to eliminate.

5. Enemas: A Last-Resort Option

Enemas can provide quick relief in emergency situations, but they should not be used frequently, as they can cause the rectum and pelvic floor muscles to become dependent on hyperstimulation to function. If constipation is severe and unresponsive to other treatments, occasional enema use may be helpful—but always as a short-term solution. (short term gain, long term loss). Enemas also disrupt the colonies of healthy bacteria that take time to become established in the bowel constituting a healthy microbiome.

Final Thoughts: A Holistic Approach to Overcoming Constipation

Constipation isn’t just about fiber and hydration—it’s a complex issue influenced by scars, nervous system balance, pelvic floor function, and toilet habits. By addressing these factors holistically, you can restore natural, effortless bowel movements and break free from chronic constipation.

Recap of the 4-Part Series:

✅ Part 1: Understanding the Root Causes of Constipation
✅ Part 2: Scar Tissue & Its Hidden Impact on Digestion
✅ Part 3: The Nervous System’s Role in Bowel Movements
✅ Part 4: Pelvic Floor Dysfunction & Toilet Strategies

If you’ve been struggling with constipation despite making dietary changes, it may be time to explore scar treatment, nervous system balance, pelvic floor coordination, and proper toilet techniques for lasting relief.

Visit pelvic-health-solutions.com to begin your journey