Everyone is different, but women normally have bowel movements every other day and no more than twice daily. Having a bowel movement fewer than three times per week, along with straining to produce a hard bowel movement, is called constipation.
ABOUT CONSTIPATION
Constipation affects about one in three women. Symptoms of constipation vary. They may include:
• Pain or abdominal discomfort.
• Blood in the stools.
• Gas.
• Bloating.
• Straining.
• Hard/firm stool. Lumpy or hard stool. A sense that the rectum does not completely empty after having a bowel movement.
CAUSES
There are many reasons for constipation. Diet is only one of them. Changes in nerve or pelvic floor muscle functioning can affect the bowels. Lifestyle choices, medicines to supplements, pelvic floor dysfunction, and other health problems may also impact bowel movements.
LIFESTYLE FACTORS
A common cause of constipation is not eating enough fiber or drinking enough fluids. This can cause bowel movements to become hard or irregular. The typical American diet is low in fiber. Foods like white rice, pasta, or white bread are more likely to lead to constipation. Not drinking enough water results in hard bowel movements. Additionally, an inactive lifestyle may contribute to irregular bowel movements.
MEDICINES AND SUPPLEMENTS
Constipation may be a side effect of medicines and supplements. Medicines that treat bladder urgency, depression, blood pressure, and pain affect bowel movements. Iron and calcium supplements can cause constipation. Talk with your medical provider about the side effects of your medicines. Ask about alternative medicines without constipating effects.
NERVE OR MUSCLE PROBLEMS
For some women with constipation, the cause is a problem with the colon’s nerves or muscles. This slows bowel movements as they travel through the colon.
PELVIC FLOOR DISORDERS
Pelvic pain may prevent relaxation of pelvic floor muscles leading to problems having bowel movements. Straining excessively with bowel movements may lead to pelvic floor disorders. Rectoceles (A bulging of the rectum’s front wall into the vagina caused by a weakening of the pelvic support structures and thinning of the rectovaginal septum–the tissues separating the rectum from the vagina). Do not cause constipation. Prolapse, including rectoceles and rectal prolapse, can make constipation worse.
OTHER HEALTH PROBLEMS
Other medical conditions that can impact the bowels include irritable bowel syndrome, kidney disease, colitis, thyroid disorders, neurological conditions (such as multiple sclerosis or spinal cord injuries) and cancer. Talk to your provider if you have these conditions or are concerned about them.
DIAGNOSIS
It is normal to feel embarrassed to discuss bowel problems with your medical provider. Consider talking about bowel problems with your primary medical doctor or your urogynecological specialist. This includes constipation and trouble controlling the stools (accidental bowel leakage). Your provider may ask you to describe your bowel movements using a bowel diary or with the Bristol Stool Scale (see image above).
A pelvic exam can assess if the pelvic floor is among the causes for your irregularity. You may need to see a specialist, such as a gastroenterologist (GI) or colorectal surgeon. If you have red blood in your stools, you should have a colonoscopy. A colonoscopy is a procedure in which the bowels are examined with a small camera to look for polyps, cancer, hemorrhoids, and other issues.
TREATMENTS
Lifestyle Changes
- Lifestyle changes include increasing dietary fiber, fluid intake, and activity level. For example, eating whole grains, legumes, fruits, and vegetables helps you get enough fiber. Your goal should be 25 to 30 grams of fiber a day. This may require a supplement. Gradually increase fiber to keep bloating at a low level.
- As you increase fiber, you also need to increase your water intake.
- Also, get out there and get moving! Even just a short walk can help your bowels move better.
- Changing your position when you sit on a toilet can make a difference. Put your feet on a small stool at the base of the toilet. This position helps to relax the pelvic floor muscles and make it easier for a bowel movement to pass from the body.
- Ask your provider if pelvic floor physical therapy would help. Physical therapists can teach you how to relax your muscles using massage techniques that help release bowel movements. Some women find it helpful to press on the perineum or inside the vagina to help get all the stool out.
- You may require a constipation medicine called a laxative. These drugs soften stool and stimulate bowel movements. There are many different types. Ask which one is best for you.
LEARN THE TERMS
Constipation: Having a bowel movement fewer than three times a week, along with straining to produce a hard bowel movement.
Pelvic floor disorders (PFDs): Conditions that affect the muscles of the bottom of the pelvis (called the pelvic floor), including pelvic organ prolapse (POP), urinary incontinence, and bowel control difficulties.
Pelvic organ prolapse (POP): Dropping of the pelvic organs–such as the bladder, uterus, and rectum–caused by a loss of vaginal support.
Perineum: The space between the vagina and the anus.
Rectum: Portion of the bowel near the outlet (anus) that stores bowel movements before they are evacuated.
Rectocele (posterior vaginal wall prolapse): Rectum bulges upward into the vagina because of a weakened vagina wall and perineum. More specifically, a bulging of the rectum’s front wall into the vagina caused by a weakening of the pelvic support structures and thinning of the rectovaginal septum–the tissues separating the rectum from the vagina.
Rectal prolapse: Rectal tissue protrudes from the anal opening.
Accidental bowel leakage: Leakage of stool (fecal incontinence) or leakage of stool and gas (anal incontinence).
THREE TAKEAWAYS
1. Constipation means straining to pass hard, lumpy stools less than 3 times a week.
2. Simple changes can help. Eat high-fiber foods, drink plenty of water, and get moving. Ask your provider about medicines that might be part of the problem.
3. Talk to your provider about your symptoms to learn about options for improving or solving your constipation problem.
