Constipation and the Function of the Pelvic Floor
by Renee Quiring
September 2020
Why is the gut, digestion and regular bowel movements important for pelvic health? Pelvic Health is well known to treat urinary incontinence but many people forget that the bowel and bladder occupy the same real-estate in the body. If the bowels are not functioning well, neither will the bladder. I often hear my clients say that they have been constipated since they were a child and have not been able to change that. You’re never too old to change!
Meet my Mother in law, Katie. Katie is an 85-year-old retired nurse so does not mind talking about pooping. Katie came to live with us last fall after her husband passed away. They were married for 60 years and had lived in the same house for 56 years. Katie also has Parkinson’s Disease which slows all the muscles in the body down and contributes to constipation. She tells me she has been constipated her whole life. She had every type of laxative in her medicine cabinet and felt like they had hardly helped. She has struggled with urinary urge incontinence as well. Constipation and incontinence are related because the abdomen is a closed pressure system. If there is too much stool in the abdomen the bladder can hardly expand and hold what it is supposed to. Katie had resigned herself to wearing pads for her leakage and always feeling bloated. When she moved in with us, she agreed to try these following suggestions to have a daily bowel movement to help both her bowels and function better!
Chew, Chew, Chew! The mouth is the first gateway to the gut. Teeth are meant to break down the food into smaller digestible pieces. When you have dentures like Katie, certain foods can be a challenge. Even though nuts have good fiber and fats which help digestion, they would get caught in her teeth. Making high fiber muffins with ground nuts was our solution to this problem. We were creative in finding high fiber softer foods that she enjoyed.
Eat a rainbow of colours! Eating a large variety of fruit and vegetables helps with fiber intake and feeds the gut microbiome. We wanted to keep the rules simple and just stayed away from everything white. Katie loves white bread and was awesome at making homemade buns in her day. She also loves ice cream and cookies and for the time we were working on this, those were off the table. However, chocolate was not because cocoa without processed sugar is a great! Cocoa helps to create a good microbiome in the gut. Black Bean Brownies are a must-try!
Drink more water! Because Katie has urge incontinence and Parkinson’s, getting up and walking to the bathroom is cumbersome so cutting back on how much water she took in made sense to her. She also thought that would help with her incontinence. Katie loves her coffee and pretty much only drank coffee throughout the day. This makes constipation and urge incontinence worse! She stuck with one coffee a day and switched to more herbal teas and just plain water which helped increase hydration.
Move your body! With Parkinson’s and being 85 years of age, it is hard to be motivated to move. Katie loves to sit and watch TV. We recruited outside help and besides asking her Neurologist to increase her Parkinson’s medication, Katie agreed to go to the NeuroRehab Program at Freeport Hospital to work with Physiotherapy, Occupational Therapy and Speech Pathology to increase her safety and mobility. She walks slowly with a walker but any movement helps to get the bowels moving. She also contributes to the family work economy and empties the dish washer daily and occasionally folds laundry. This standing and functional movement helps the bowels move.
Use the Gastro-Colic Reflex! This reflex is initiated a half hour after any large meal. As the stomach is enlarged with food peristalsis is stimulated to make room for the new meal to be digested. Katie would go and sit on the toilet for 5-10 minutes after every meal, even if there is no urge to go. She tells me she previously she would often ignore the urge. Last fall we were out waiting in a lab to get a blood test. She told me she had the urge so I helped her to the bathroom. She later reported to me that it was the first time she had pooped in a public toilet. She had always been embarrassed to leave the smell behind so she would hold her bowel movement until she got home. This withholding contributes to constipation as well.
Do a top down or bottom up cleanout! We needed to use the appropriate laxative daily for at least 12 weeks to initiate and keep her bowels moving. For a lot of people, Restoralax is a safe, non addictive way of keeping the stools moving. Katie responded better to Metamucil, so she had a daily regime for 12 weeks. We titrated the correct amount that would let her have a bowel movement every day. Keeping the stool at a Type 4 on the Bristol Stool chart allows it to empty daily. I often work on toilet-positioning and encourage clients to use a Squatty Potty. Katie could not use it safely due to her limited mobility. We did work on breathing and how to bear down to evacuate properly. If Restoralax or Metameucil or Senokot does not help, then sometimes an occasional enema or suppository can help get things moving. This is considered a bottom up cleanout. We needed to use the suppository occasionally at the beginning but quickly moved away from using them on a regular basis.
Manage Stress! A lot of changes happened for Katie in a short time. She lost her husband after a short illness and moved to another city to live with us. Katie has always been somewhat anxious and we thought she may become depressed. We tried to create a stress-free and loving environment for her. Our four children come home often and interact with her regularly. She is involved in a city day program for social interaction. Even though she has journeyed through grief she is surprisingly content and happy! It has also been shown that having a good gut microbiome affects our mental health and we believe this has contributed to Katie’s peace.
Katie is so thrilled that she now poops every day without any laxatives! We have not used any laxatives now for six months. And, even though this was not a goal, she lost 40 pounds! Her urge incontinence is no longer an issue and she can make it to the bathroom without any leakage. She no longer wears pads. She now is back to having her occasional cookie and ice-cream and of course continues to have cocoa! If Katie can do this with a little help, support, and guidance, you can too!