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Being Backed-up: how constipation is related to the pelvic floor

Everyone dreads being constipated. It’s never fun to be backed-up to the point of difficult, often painful bowel movements. How we often think of constipation, and what constipation can look like may not always be the same!

Constipation is often described as having 2 or fewer bowel movements in a week. These bowel movements will often be difficult to evacuate or require effort. So anything outside of this (more frequent, and easy to get out) would be considered normal… right?

Not necessarily! Our ability to consistently evacuate the bowel may not mean that you aren’t constipated! Some individuals that are constipated evacuate the bowel several times a day. BUT HOW?! In this instance, usually we are getting out several smaller stools throughout the day, and not completely emptying the bowel. These stools may in fact be “easy” to pass, and for some people they will find that they will sit down to go pee, and some stool will come out as well, without any urge to go number 2 in the first place.

So beyond the “usual” signs of constipation, what else should we be watching out for?

  1. Large diameter stools: for adults and children we should not be thinking “whoa! I hope that doesn’t plug the toilet” or “I can’t believe it’s THAT BIG!”
  2. Cracked or dry stools: bowel movements that look cracked or dry, or like little bunches of small balls stuck together
  3. Urge to go with no results: if you have the urge to evacuate, get to the bathroom and just nothing seems to come out… this could be a sign
  4. You wipe and wipe and it never gets “clean”: this could mean that you aren’t fully evacuating the rectum
  5. It feels like there is still some in there: likely that the bowel is not being fully evacuated
  6. Belly aches and bloating: can be signs of constipation
  7. Itchy rear-end (or the wiggles) is common to see in children as well

Being constipated will put a strain on the pelvic floor, as often evacuating the bowel will require effort in the form of pushing of some sort. Sometimes we are spending significant amounts of time sitting on the toilet attempting to get stool out. Development of hemorrhoids, pelvic pain, and pelvic floor dysfunction can be a result of persistent or chronic constipation.

 

Constipation starts young for many people “I have always been like this for as long as I can remember”. With seeing many children with constipation, they have struggled with bowel movements often since starting solids, or when they began potty training. Often other issues start to arise such as bed wetting as well.

 

Helping people to re-educate the pelvic floor to improve coordination, improve evacuation, and go through bowel hygiene tips are all part of our pelvic health assessments. Some things you can start thinking about now:

 

are you getting enough water?

when you go are your feet well supported with knees above hips?

do you take enough time (but not too much!)?

when you get the urge to go, do you make time?

 

These can be some things to consider with your bowel hygiene to help you begin to get things sorted. Determining the abdominopelvic coordination and function, overall pelvic floor muscle strength and ability to relax, as well as a variety of other technical factors will be what we want to dive into with you.

Issues with constipation isn’t just a problem for children, but also men and women alike!

Book in Saskatoon                                                                       Book in Warman (Kendra, Maja)

Haylie has been practicing pelvic health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Officially adding to her practice pediatric pelvic floor therapy in 2017. She has been advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms ultimately brought her to open her family-friendly clinic. At Warman Physio clients are encouraged to bring their infants and children to treatment. Warman Physio has been nominated as a finalist for the 2018, 2017, & 2016 WMBEXA, is a WMBEXA award recipient of 2017 New Business Award, and a finalist in the ABEX 2018, 2017 & 2016, and Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017, and has been nominated for the 2019 SABEX and WMBEXA Awards.
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Bed Wetting: it just won’t stop!

Bed wetting can be an extremely frustrating problem to have, for kids and their parents. Why does it happen? What might be causing it? How can physio help?

Pediatric pelvic health physiotherapy is an integral part of the care team for children that are experiencing persistent bed wetting aka nocturnal enuresis. Many children go through daytime potty learning, and just seem to never really quite get the night-time down pat. For others, they breeze through daytime and night-time dryness, and then at some point the night-time problems start and just get worse over time. If you are struggling with potty learning check out our blog.

So why does bed wetting happen?

Evaluating movement and coordination is critical in identifying underlying reasons for bed wetting

Bed wetting can in some instances simply be a result of a deep sleeper and an immature bladder. These are kids that will eventually just grow out of it. Many children, however, fit into the “underlying contributing factors” category. Our ability to be continent (hold our urine) at night can be impacted by a number of factors. Here we will go through two main issues:

  1. Constipation
  2. Daytime urinary dysfunction

Constipation

Often times we think of constipation as children going days on end without bowel movements, having extreme difficulty evacuating the bowel, tears, and an overall dramatic experience (which definitely may be the case). BUT some of the time constipation looks like multiple bowel movements a day, quick trips to the washroom, and stool being evacuated without having an actual sensation of the “I need to poop”

The question is how does constipation impact bed wetting? During appointments we take the time to sit down and draw out the relationship (clients get signed copies to take home because the artistic talent is top notch!) – but imagine that the bladder is a balloon, and the abdomen is like a Tupperware container. If the bowel is a long skinny balloon that also fits into the container there is only a certain amount of space in there. When we start to stuff the bowel with some extra stool, it will take up more space in the container. This will leave less space for the bladder, and it will get squished before it can send a signal of “I’m full go pee!” resulting in bed wetting. Biggest take away?

Really the child has no signal that they need to go!

Discussing bed wetting can be challenging especially as a child ages, but making children comfortable and confident is the goal

Daytime Urinary Dysfunction

When a parent comes with their child for an appointment and the only reason is “bed wetting” there is a good chance that it isn’t JUST bed wetting. In order for the problem to be strictly nocturnal enuresis, it needs to be present in the absence of any daytime abnormalities. Many children that come in have several daytime issues going on, and often the parents don’t even realize it! Here are a few things that often come up during discussions with children:

  • decreased urinary frequency during the day (<4x/day)
  • increased urinary frequency during the day (>7x/day)
  • leaking urine during the day
  • altered sensation to void (not sensing the urge to go, or having the urge and being unable to go)
  • voiding difficulties (feeling the urge to go and not being able to)

We struggle especially with school aged children as we often don’t know what their bathroom habits are! Our society tends to significantly limit our bathroom involvement with our kids after they have potty learned, even though they may need parent support until age 5 to ensure they are building positive bowel and bladder hygiene routines!

 

If you have a child that is holding their bladder all day, you can imagine that might impact night-time dryness. If they are having any sort of daytime dysfunction, the night-time wetting will have difficulty resolving independently, since our kids are sleeping (hopefully!) at night, the greatest impact we can have on bed wetting is by working on the daytime dysfunction and/or constipation!

 

Ultimately, bed-wetting in many instances is not something that the child is wanting to do or has control over (despite what many of our friends and relatives will tell us). If you have a child that is wetting at night at any age, it may be worth it to think about some of these factors. When in doubt, give us a shout!

 

Book an assessment for your child!

Haylie has been practicing pelvic health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. She officially added to her practice pediatric pelvic floor therapy in 2017. Haylie has been advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms ultimately brought her to open her family-friendly clinic since opening in 2014. She now adds to this education and treatment provision her knowledge and experience in pediatric pelvic health providing workshops and presentations in addition to assessment and treatment. At Warman Physio clients are encouraged to bring their infants and children to treatment. Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017, the ABEX Young Entrepreneur Award Recipient in 2018, and a finalist in the 2019 SABEX and WMBEXA Awards.
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