Monthly Archives: August 2016

Constipation: What is it and how can physical therapy help?


According to the National Digestive Diseases Information Clearinghouse, someone is constipated if they have a bowel movement less than 3 times a week. This leaves a large range for what is considered “normal” frequency of defecation, from going three times a day (after every meal) to three times a week.

All of us will likely experience constipation at one time or another in our lives. Constipation just means that our food has spent too long in our colon, so more water than usual has been absorbed from the stool leaving it dry and hard to pass. This can be a frustrating symptom, leading to abdominal bloating, gas, increased pressure on the pelvic floor and surrounding organs and back pain. The best treatment is to be aware of the contributing factors and make daily lifestyle changes as needed.

What can lead to constipation?: Factors that may lead to constipation:

  • An imbalance in soluble and insoluble fiber intake, or lack of fiber in your diet
  • Not drinking enough water
  • Not enough physical activity
  • Changes in routine (irregular meal intake, traveling, unusual stress)
  • Ignoring the urge to go to the bathroom
  • Overuse of laxatives
  • Pelvic floor muscle dysfunction (we’ll come back to this later in the post)
  • Sometimes, constipation is a symptom associated with a specific condition such as from suffering a stroke, rectal prolapse, and irritable Bowel Syndrome or IBS. Constipation is common during pregnancy as the abdominal contents must shift and compress to accommodate a growing baby.

Physical therapy for Constipation

  • Help your pelvic floor muscles relax during defecation

When you go to the bathroom, your pelvic floor muscles should relax to “open the gates” and allow passage of stool and urine. Some people lose this normal coordination if they hold tension in their pelvic floor from life stress, or if they’ve had trauma to the pelvis, back, abdominals, or hips (childbirth and surgery). A pelvic floor physical therapist can help your body re-learn proper pelvic floor muscle coordination with biofeedback, manual therapy, and postural education.

  • Perform and teach you manual techniques to stimulate movement through your Intestines

In some cases, performing an abdominal massage can stimulate a bowel movement. Your physical therapist can teach you the massage sequence and appropriate amount of pressure. He/she can also perform visceral manipulation, techniques to restore normal movement in your abdominal organs.

  • Help you become more physically active

Your physical therapist can prescribe exercises to improve your flexibility and strength so that you can be physically active in the community without pain. Establishing a daily exercise routine is an important step in reducing constipation.




Written by: Claire Agrawal, PT
Edited by: Miriam Graham, PT

Not So Sweet

Does this sound healthy? Bagel and orange juice for breakfast, turkey sandwich, apple and chips for lunch, that afternoon latte and pasta for dinner. Have you ever thought about how many carbohydrates you eat everyday? The example daily menu tallied up to a grand total of 279 carbohydrates. Optimal daily recommended carb intake depends on many variables such as age, gender, body composition, activity level, and metabolic health, but moderate carbohydrate intake falls between 100-150 carbohydrates/day. However, people who are physically active and have more muscle mass can tolerate more carbs than those who are sedentary. You’re probably asking why you should care about carbohydrates. After all, haven’t we been told to watch the calories and the fat for decades? Those carbohydrates are sugar. Excess sugar consumption has been proven to directly contribute to weight gain. When you eat sugar, your pancreas releases insulin which brings the glucose (from the carbs) into the cells. This glucose is stored as glycogen in our muscle and liver, but if these glycogen stores are already full, the glycogen is stored as fat. In 2012, the British Medical Journal published a study that combed through the literature regarding how body weight and sugar intake were related and indexed over 15,000 potential studies.[1] Sixty-eight studies made the cut of passing the rigid standards and statistical reliability and they all came to the same conclusion: sugar makes people gain weight.

Sugar also elevates dopamine levels which control the brain’s reward and pleasure centers similar those to drugs such as cocaine, morphine and nicotine. Long-term exposure to sugar lead to a reduction of dopamine levels, causing increased sugar consumption to achieve the same level of reward.

So how are we to get out excessive sugar intake under control? In a study published by international research journal PLOS ONE, found withdrawal from chronic sugar exposure can “result in an imbalance in dopamine levels and can be as difficult as going ‘cold turkey’” from a drug. Hopefully we will not have to resort to drugs to break us from the tight grip sugar has on our taste buds. This summer, opt for water instead of juice and soda, or some string cheese instead of the apple and see if you can see a difference in the way you feel by breaking the sugar habit.


[1] Te Morenga, Mallard S., Mann, J., “Dietary sugars and body weight: systematic review and meta-analyses of randomized controlled trials and cohort studies,” British Medical Journal (January 2012): 345:e7492.


Written by: Heather West, PT
Edited by: Reshma Rathod, PT