Physiotherapy Management of Constipation

Constipation is a common but often overlooked issue affecting people of all ages. While many associate its management with dietary changes and medication, physiotherapy can offer an effective, evidence-based approach to relieve symptoms and improve bowel function, through education, movement, manual therapy, and pelvic floor rehabilitation to name a few.

What is Constipation?

Constipation is generally defined as infrequent bowel movements (fewer than three per week), difficulty or pain during bowel emptying, or a sensation of incomplete emptying. Chronic constipation can significantly impact a person’s quality of life, causing discomfort, bloating, and sometimes emotional distress.

Common Causes of Constipation

• Poor fiber or fluid intake

• Poor toileting habits or posture when emptying

• Sedentary lifestyle

• Pelvic floor dysfunction

• Neurological conditions

• Side effects of medications

Identifying the underlying cause is key to effective management, therefore your physiotherapist will spend time in your first appointment asking questions to help piece together your causative factors.

How Can Physiotherapy Help?

1. Pelvic Floor assessment and rehabilitation

One of the most common causes of constipation is pelvic floor dysfunction, particularly dyssynergia, where muscles around the rectum don’t relax properly during a bowel movement. 

This can be achieved by the following:

• Assess the coordination and strength of pelvic floor muscles
• Teach techniques to improve muscle relaxation and control
• Teach optimum bowel emptying sitting position, also known as defecation dynamics

2. Abdominal Massage 

Abdominal massage can be a helpful tool to use at home, and helps by:

• Stimulating peristalsis (intestinal movement)

• Relieving abdominal discomfort or bloating

• Promoting relaxation of the gut

3. Exercise 

Regular physical activity is vital for maintaining bowel regularity. Physiotherapists can develop tailored exercise programs that include:

• Core strengthening

• Stretching and mobility work

• Aerobic activities like walking or swimming

Even gentle movement can stimulate digestion and encourage more regular bowel movements.

4. Postural Education and Toileting Techniques

Proper toileting posture is often overlooked. Physiotherapists educate patients on:

• Optimal positions for defecation (e.g., knees above hips using a footstool)

• Breathing techniques and relaxation strategies during toileting (eg. Blow to go, Moo to poo)

• Avoiding straining, which can worsen pelvic floor dysfunction and lead to haemorrhoids

5. Lifestyle and Behavioural Advice

Although our scope of practice is limited in this area, physiotherapists can still provide some advice on:

• Hydration and fiber intake

• Establishing regular toileting routines

• Stress management techniques (stress can directly affect gut function)

We can also liaise with your GP to make onward referrals if required.

To summarise…

Constipation is more than just an inconvenience, it can affect your physical, emotional, and social well-being. Physiotherapy offers a safe, non-invasive, and effective approach to managing constipation by addressing the root causes, not just the symptoms. Whether you’re looking for pelvic floor rehabilitation, better toileting strategies, or a guided exercise plan, physiotherapy can be an essential part of your care.

If you need any help in this area, please do not hesitate to book in with one of our Women’s Health Physiotherapists today and let us help YOU.