Constipation: Tips for the Provider

Constipation is a condition where bowel movements become difficult, painful, and infrequent. Normal bowel movements can occur anywhere from 3 times/day to 3 times/week. Constipation is influenced by a multitude of factors including an overactive pelvic floor, a diet low in fiber, improper hydration, and certain medications. Other risk factors associated with constipation include history of trauma, history of depression, females, lower socioeconomic status, regular use of constipation medications, and decreased activity.

An overactive pelvic floor hinders normal bowel movement. The pelvic floor surrounds the colon and rectum, aiding in the conscious control of elimination of feces. If the pelvic floor muscles are hyperactively contracting, passing a bowel can be difficult leading to pain, straining, hemorrhoids, anal fissures, fecal impaction, or rectal prolapse. Someone with a history of trauma, postural problems, and psychological/emotional factors can experience an overactive pelvic floor. While this handout can help to teach ways of relaxation of the pelvic floor, it will also be important to treat the underlying causes.

Diaphragmatic Breathing

Diaphragmatic breathing is a good way to bring about general relaxation of the mind and body as well as relaxation of the pelvic floor. It stimulates the parasympathetic nervous system (rest and digest) and relaxes the sympathetic nervous system (fight or flight). The parasympathetic system promotes movement of the GI tract, and relaxation of the sympathetic system aids in relaxation of the surrounding back, pelvis, and trunk muscles which may be tense and causing pain. Teaching diaphragmatic breathing can be easy using DASS–Deep, Abdominal, Slow, and Smooth.

  1. Have patients lie comfortably with eyes closed. Have them focus on their breathing and eliminate any outside or stressful thoughts.
  2. Have them place one hand on their abdomen and the other on their chest, and have them observe which hand moves more with breathing. Guide them to focus on breathing primarily with the abdomen.
  3. Breathe in slowly through the nose, deep to the abdomen so it expands with inhalation. Hold for a second or more, and then exhale slowly through pursed lips, allowing the abdomen fall inward.
  4. The entire movement should be smooth instead of choppy. If they are experiencing choppy breathing, it may be helpful to breathe more slowly. Try having patients breathe in for 2 counts, then out with three. Numbers can be changed as needed but generally exhalation should be longer than inhalation.
  5. This can be done for 3-4 minutes at a time, multiple times each day.

Abdominal Self-Massage

Teaching patients to massage themselves at home can be an effective way to move stool along in the colon. The massage will follow the path of the colon.

  1. Have patients lie in a comfortable position on their back either with knees flexed or extended.
  2. Direct patients to the right side of their abdomen just above the iliac crest of the hip. Gently massage the abdomen, moving straight up from the hip until reaching the ribcage.
  3. Next, have patients move straight across the abdomen until reaching the left side of the ribcage.
  4. Then massage down the left side of abdomen from the ribcage until reaching the left iliac crest of the hip.
  5. Finish massaging by moving from the left hip until they reach you reach the center of the abdomen.
  6. Repeat this pattern for about 10 minutes at a time.

Tips for Massage:

  • Use fingertips to move in a circular motion. The pressure can be gradually increased as tolerated.
  • Spend about 1 minute moving through each direction.
  • Always start on the right side and go in a clockwise direction, as the direction that feces travel through the colon.

Additional Lifestyle Tips for reducing constipation:

1. Diet:

  • Drink lots of water and tea to help soften stool for easier bowel movements.
  • Limit consumption of drinks like soda, coffee, and alcohol. These can remove water fromyour bowels and cause stool to harden. 
  • Eat food rich in fiber like vegetables, ripe fruits, grains, and nuts.

2. Toilet Posture:

  • Use a step-stool or box under your feet to bring your knees higher than your hips. This will put the body in an easier position for passing bowel movements.

3. Exercise:

  • Moderate aerobic activity such as walking, biking, and swimming can help stimulate the bowels to move.


Shared by the Center for Victims of Torture, December 2019
Created by Melissa Bauer, doctoral physiotherapy student at the University of Minnesota, USA


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