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  • Writer's pictureJesse Lewis


Let’s talk about pooping. Or, more importantly, not pooping. One of the more common symptoms I see as a pelvic floor physical therapist is constipation. The causes behind constipation can be diverse, including diet, physical activity, hydration, stress and pelvic floor issues. Because there are so many causes, it can be a pretty frustrating condition. When chronic constipation persists despite dietary modifications, hydration adjustments, and over-the-counter remedies, it's worth examining the role of the pelvic floor in these cases.

How does the pelvic floor affect constipation?

The gastrointestinal or digestion process involves a complex series of steps, most of which happens without you even thinking about it. The latter stages of this process involve the coordinated effort between your abdominal muscles and your pelvic floor muscles (that you might not even know are there), aiding the movement of stool from the colon through the rectum and ultimately out of the body. Basically, your ab muscles need to contract while your pelvic floor muscles relax. Constipation can happen when these two are not coordinated. The good news is that this can be rectified through acquiring proper breathing techniques and the effective relaxation of the pelvic floor muscles.

How can breathing affect constipation?

Ideally, when you are performing relaxed breathing, your diaphragm lowers, allowing the lungs to fill with air. This results in increased pressure in your abdomen, which then leads to your pelvic floor lowering, which it needs to do to perform bowel movements. If your pelvic floor can’t lower, the bowel movement becomes harder.  Often, people who have constipation actually end up performing a maneuver called the Valsalva maneuver. Most people refer to this as “bearing down”. This is when you are forcefully trying to breath out but keeping your mouth closed, coupled with a strong contraction of the abdominal muscles. If you find yourself straining while unable to hold a conversation, you might inadvertently be performing the Valsalva maneuver. If you are bearing down, this causes the pelvic floor to contract and squeeze, which then makes it harder to poop. So, by trying harder to push out, you are sometimes only making the problems worse.

What exercises can help with constipation?

Diaphragmatic, abdominal, or belly breathing plays a crucial role in addressing pelvic floor dysfunction, because it can relax, elongate, and lower the pelvic floor. 

For individuals who have developed tightness of the abs or pelvic floor over time, unlearning these patterns and relearning the right coordination between your abs and breathing can be really challenging. 

One of the most common ways we help people as pelvic floor physical therapists is to work on belly, or relaxed breathing. This can be incredibly challenging at first, but is often the first step towards relieving constipation. Since it is so hard at first, it can be really frustrating, and we have a lot of ways of coaching people through how to get more out of their breathing. But, one of our most common tips is to try less hard. The harder you try to breathe relaxed, the harder it is.

From there, it’s often helpful to do various stretches and other exercises to improve the flexibility of your abs, pelvic floor, and sometimes hips. 

If you are having constipation, one of the most helpful things to do is to start paying attention to your breathing pattern. From there, try to work on a more relaxed pattern to allow the pelvic floor muscles to relax.

If you find that you’re struggling with your breathing, or just want one of our pelvic floor experts to help, we’re here for you! We help people with constipation all of the time and we know how frustrating it can be. Feel free to reach out to us here, email us at or text/call us at 202-022-7331.

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