It’s a Strain! Constipation

How constipation affects the pelvic floor and core

Personal question time! And not something you maybe expect at the start of a post! BUT – How often do you visit the loo to pass a stool? And what’s the consistency like? Was it smooth and soft and sausage like or was it hard and like pebbles to pass?

Constipation can be an uncomfortable and wearisome condition. It is a dysfunction of the bowel that is characterised by infrequent or hard to pass stools. Common causes will include not eating enough fruit or vegetables, not drinking enough fluid and also being inactive. It can also be caused by reduced motility in the large intestine that slows movement of waste through it. This leads to bloating and abdominal pain. Called Slow Transit Constipation, it has been mainly found to affect women. Not particularly helpful when you are trying to heal a diastasis or improve the connection with your core.

Another cause that both men and women can experience, is a lack of coordination between the abdominal muscles and the pelvic floor. This lack of coordination is called pelvic floor dyssynergia and leads to excessive straining in order to help empty the bowel. It is thought that this problem starts in early childhood. Children that have perched on the toilet without foot support or an inner seat ring have adopted positions that have lead to poor pooping strategies.

Those that are regularly constipated or have to strain to pass a bowel movement cause unnecessary downward pressure on the pelvic floor and supporting ligaments plus also into the abdominal wall. It should be no surprise then that there is a strong connection between poor bowel function and problems with the bladder and vaginal or rectal prolapse. So what can you do to help?

Solutions to Constipation

There are three components to help effectively pass a stool and avoid any issues with the pelvic floor or core.

  • Positioning
  • Improving the coordination between abdominal muscles and the pelvic floor
  • Stool consistency

By positioning your body as shown below it will help make it easier to pass a stool and prevent damage to the ligaments and muscles of the pelvic floor.

Picture credit: Sue Croft from Pelvic Floor Essentials


  • Maintain the curve in your back as you lean forward at the hips. Don’t slump.
  • Place your hands on your knees which should be positioned 30 cm apart.
  • Your knees should be slightly higher than your hips in order to get the best position at your pelvis. You can use a couple of toilet rolls or a little foot stool to place your feet on (keep feet flat where possible). If you don’t have a foot stool available come up onto your toes.

If you are concerned about a lack of coordination with the abdominal and pelvic floor muscles and you have tried the other two solutions and they have not helped, I would arrange to see a women’s health physiotherapist or someone who specialises with bowel health and seek advice here. They can help provide instructions on how to better coordinate these muscles.

Stool Consistency:

This is a general guideline. If you suffer with bowel management issues I would strongly advise seeking the help of a qualified dietician who can provide more bespoke guidance for you.

  • Increase dietary fibre – this helps to produce softer bulkier motions that move more quickly through the digestive system and therefore make it easier to pass. Aim for 2 pieces of fruit and 3-4 vegetables a day. Be cautious of dried fruit as their higher sugar content may bloat you exacerbating the abdominal wall muscles.
  • Drink plenty of water and fluids – for fibre to do its job effectively it is important to consume at least 2 litres of fluid a day. Water is ideal as it contains no sugar. Minimise tea and coffee as they contain caffeine that can irritate the bladder. Decaf options would be a good solution here.
  • Massage your tummy – take one hand and gently rub it clockwise around your belly button. This helps stimulate the digestive system and move waste through.

This chart helps you identify the types of stool you are passing and what it means for your gut health.