Constipation causes more than tummy discomfort – it can actually damage the pelvic floor. And a problem that was previously thought to be limited to mothers who’ve given birth and women going through menopause is increasingly a problem among young men and women due to poor diet and lifestyle.
Experts at the Pelvic Floor Program at Cleveland Clinic in Abu Dhabi say they are seeing patients as young as 18 with pelvic floor disorders due to chronic constipation caused by bad habits.
The pelvic floor consists of muscles and ligaments located at the bottom of your torso. They act like a sling to support the bladder, rectum and uterus (in women) and prostate (in men) and also enable bladder control and bowel movements. Normally, the body can tighten and relax the pelvic floor muscles at will, rather like the way you would tighten your biceps when lifting something heavy. But when the body just keeps tightening those muscles, going to the toilet becomes a problem.
“We are seeing more and more young patients with this issue,” says Dr Lameesa Tabaja, a colorectal surgeon at Cleveland Clinic’s Digestive Disease Institute. “The problem is that constipation is so common that people come to accept it as part of their life and over time the straining can cause pelvic floor dysfunction. As they age, it can lead to further problems, including pelvic pain.”
Recent research shows that constipation in childhood can lead to chronic pelvic pain in adulthood.
Causes of pelvic dysfunction include pregnancy and childbirth, menopause, surgery and being overweight. But it can also be caused by excessive straining due to constipation. Weak pelvic muscles can lead to accidental bladder and bowel leakage, incontinence and prolapse, which is when organs in the pelvis slip down from their normal position. For women, pelvic floor dysfunction can make sex painful. For men, it can lead to erectile dysfunction.
There are in fact two kinds of constipation.
General constipation occurs when the muscles in the large intestine – the colon – don’t work properly, meaning waste gets moved through the body very slowly or not at all. The condition can be caused by not drinking enough, not eating enough fiber, eating too much sugar and animal fats, sitting too much or a change in lifestyle, such as pregnancy or travel. A sluggish colon can also be related to irritable bowel syndrome (IBS). Some medicines taken for other conditions can also cause constipation, as can using too many laxatives.
Outlet constipation is when a stool gets stuck in the rectum because the muscles there are too tight. This leads to straining during a bowel movement, but the more you strain and push, the more the muscles tighten up.
Although pelvic floor problems can be complex, physiotherapy is the solution for around 80 percent of cases, says Dr Tabaja.
Cleveland Clinic’s Pelvic Floor Program uses biofeedback, a portable device that uses sensors and a computer monitor to show muscle activity.
“This is important because the patient can see which muscles are being worked and we can teach them proper contraction and relaxation,” says senior physiotherapist Elif Dalkilinc. “Biofeedback training is very efficient in improving pelvic floor muscle control.”
As well as devising an exercise regime for patients to follow at home, she also works on their hip and spine mobility, general body alignment and posture and teaches them proper techniques for going to the toilet.
Changes in diet and lifestyle are also crucial to alleviating constipation:
- Increase fiber intake to 25 to 35 grams a day. Fiber bulks up and softens body waste, making it easier to pass stools. Eat fresh fruit and vegetables – including the skins – choose bran and wholemeal bread and cereals and avoid processed food. Read the labels on packaged foods as fiber content varies. Aside from fresh fruit and veg, the following are high in fiber: wheat bran, seeds (such as chia and flax), popcorn, brown rice, prunes, oat bran, oatmeal, barley and rye. You may feel bloated or gassy but that will disappear within a few weeks as your body gets used to the extra fiber. If the gas and bloating don’t go away, see a doctor.
- Drink more – at least six to eight cups of water a day to keep the fiber moving through your system.
- If your doctor suggests taking a fiber supplement, bear in mind that they can take weeks or even months to become fully effective.
- Take your time in the morning. Our bowels are inactive when we’re asleep so they need time to wake up. The body’s emptying reflex starts working about 30 minutes after eating a meal or drinking a hot beverage and usually happens in the morning, so try to get up in time to have some breakfast and a hot drink. Some mild to moderate exercise, such as walking, helps, too.
- Adopt the proper position. When sitting on the toilet, ensure your knees are higher than your hips (use a footstool if necessary) and lean forward with your elbows on your knees. This position allows your pelvic floor muscles to relax. Stick your tummy out as you exhale and use your abdominal muscles as a pump to gently push everything out.
As to how often you should be going to the toilet, that varies from person to person and from three times a day to three times a week. However, most people tend to go once a day at roughly the same time of day.
• For more information or to book an appointment at Cleveland Clinic Abu Dhabi, call 800 8 CCAD (2223) visit Clevelandclinicabudhabi.ae or download the Cleveland Clinic Abu Dhabi app.
Anna Pukas has reported from all over the world as a foreign correspondent for British media. She is now an editor based in Abu Dhabi.