Constipation is the infrequent or difficult evacuation of the bowels and affects millions of people worldwide. While there are a variety of reasons constipation can occur some more common explanations may include:

  • weak or tight (or a combination of both) pelvic floor muscles and surrounding musculature,
  • overuse of the pelvic floor muscles,
  • weakness or ineffective use of abdominal musculature,
  • medications that can cause hardening of the stool,
  • diet low in fiber or inadequate fluid intake,
  • poor toileting habits and straining, and
  • stress.

Recommended daily water intake:

MEN – 3000ml

WOMEN – 2200ml

* For each hour spent exercising, add an additional 400-600 ml

water bottle


The therapists at Midwest Physical Therapy Services are experienced in working with patients with constipation. The first visit includes history taking and education about the pelvis and how the bowels work with explanation of which muscles may be involved. We also discuss diet, sleep patterns, fluid intake, toileting habits, and other environmental problems that could be contributing to the problem.

Testing of pelvic floor muscles may be performed with surface EMG and follow up visits may include:

  • The use of biofeedback to demonstrate pelvic floor and abdominal muscle motor activity for assessment and instruction in muscle use;
  • Abdominal and bowel massage;
  • Methods for encouraging the urge to have a bowel movement;
  • Properly using intra-abdominal pressure to aide in evacuation: motor retraining involving coordinating muscles of pelvis during simultaneous use;
  • Stretching and strengthening the pelvic floor and surrounding musculature;
  • Strategies for successfully having a bowel movement: including positioning on toilet, use of imagery, relaxation techniques;
  • Use of heat on abdominals for relaxation;
  • Discussion of diet, fluid intake, and medications that may be affecting bowels.