PTSS: Poop Traumatic Stress Syndrome
Funny? Got your attention? And perhaps now you are thinking “Hmmm…could that be me??” Sadly, for those living with constipation, this isn’t so funny!
This acronym was coined by one of my patients. And I think it’s a great one! There is currently, and almost always has been, a lot of stress related to Pooping. Having a BM. Evacuating the colon. Whatever you choose to call it! More importantly, there is a lot of stress related to NOT Pooping. Or not pooping the way that you believe you are supposed to. Or ot pooping when you believe you are meant to! And stress related to Pooping is NOT a helpful thing because it can contribute to the constipation and irregularity cycle!!
So…what’s the big deal with regularity? Why is (persistent or chronic) constipation a problem?
Well, for one thing, being full of poop (literally!) does not feel good! Chronic constipation can affect our appetite, which in and of itself can be a problem because we need the gastrocolic response to get the GI and colon moving!! Constipation can affect our mood. It can contribute to anxiety and likewise, our stress response can contribute to constipation. When the bowel is not happy, the brain is not happy!
The rectum sits on top of the uterus and bladder (if you do not have a uterus, just take it out of the picture!) and is supported by the pelvic floor muscles and ligamentous structures. Carrying a load of poo can contribute to pelvic organ prolapse, urinary incontinence and frequency or urgency (the bladder does not like to be squished!), and hemorrhoids. We also can see back and SI joint pain (makes sense, doesn’t it…the colon is sitting right there!). In short, it’s not fun, it’s not comfortable. And these are reasons that your Pelvic Health PT is asking you all of the questions related to bowel habits.
Now, it’s likely that almost everyone reading this has had some irregularity and short term constipation. It happens! Stress and life changes can throw our GI system for a loop! As can surgeries and medications, illness and decreased mobility (the GI system LOVES movement!!). A history of endometriosis, laparoscopic surgeries or other abdominal surgeries can impact on the colon. Travel, schedule changes, and eating different foods can definitely make a difference, as can pregnancy with hormonal and space changes as the baby grows….although not all pregnant people experience constipation!! AND, many women experience some irregularity around the time of menstruation. There are many contributing factors to consider in constipation and GI problems!
It’s when constipation becomes chronic, a day to day or week to week experience and begins to rule our life that it’s a problem. Ads, social media, family members all have answers! Tons of advice (aka helpful versus unhelpful information) about what you should eat, what you definitely should not eat…fiber, no fiber…fluids…medication or supplements…pro and prebiotics. Positions you should be in to poo, those you should not. Ways to strain and bear down, and “no!!! Never strain and bear down!” Whew!! No wonder we get stressed about it! And when stressed, sometimes we just stay put where we are because making changes are confusing, and honestly, can take a bit of time!
So, how often should you poop?? Average bowel frequency is from 3 times/day to 3 times/week and pretty much everything in between. Most people who are not experiencing constipation know what their regular bowel cycle is. They are able to rectify (almost pun intended!) irregularity with food, activity, and fluid. Ideally, your stool is softy formed (think softish banana) and easy to evacuate. You feel good, and all is well.
It’s when things change or are outside of these numbers that there might be a concern. Has there been a change? Are you not able to poop? Needing to strain and breath hold? Pain before, with or after a BM? Not getting urge for a BM for days, feeling full, bloated, and heavy? Pelvic pressure of urinary leakage? These are things to talk about! And if you are having bleeding or a sense of increased pelvic pressure with a BM, also something to address!
If you believe, or know, you are constipated, what are the next steps?
A few thoughts…First, realize that there is help!
Next, stop and take a breath! Climb into “child pose” do a few trunk rotations and twists. Remember, the colon comes all the way up to the diaphragm…so every breath you take can help to move it! Same with twists and other gentle movement! I am attaching a colon massage at the end of this. It is a really nice way to BEGIN to promote motility and to begin to have a different communication between the colon and the brain (and the colon is the second brain, so it can get bossy!). If you do not like to touch your belly, use a small stress ball to roll, or a soft cloth between your hand and your belly (or sweet talk someone into doing it for you!!).
Talk with your MD. Often people are reluctant to do so as they believe that they will be directed towards laxatives or other medications and they hope to avoid those. It’s important to rule out anything “more serious” than frustratingly persistent constipation, though, and your doctor is the person to help with this!
Talk with your friendly Pelvic Health PT. Yes, we work with constipation and GI issues. The anorectal system works along with the rest of the pelvic floor organs, musculature, and pressure system, including the abdominals, and diaphragm. Your Pelvic Health PT is able to assess if your muscles are holding too much, not enough (and making it difficult to fully evacuate), how the system is working, and many of us have specialized training in visceral mobilization to assess and help to create mobility in the GI system and trunk! At Embody, we utilize the Rehabilitative Ultrasound to help to assess (and if indicated retrain) the pelvic floor and anorectal system. We also utilize Low Pressure Fitness and Therapeutic Yoga to help with GI and pelvic floor movement, motility, and efficiency. It all depends on the client!
The colon is termed the “second brain” and indeed it is! Our goal? To help you feel better. To have less pressure. To not feel ruled by your colon and to improve the communication that the brain and the colon are having!
***The information provided here is not meant to take the place of medical advice or treatment. If you are experiencing constipation, abdominal pain and bloating, bleeding with BM or other concerns, please contact your MD. If you are ready to speak with PT about making changes, contact Rebecca Meehan PT at info@infoembodyptcom
Rebecca Meehan PT WCS PYT is founder and owner of Embody Physiotherapy & Wellness. She holds specialty certifications in pelvic health and in medical therapeutic yoga, and has training in visceral and soft tissue assessment and mobilization as well as Low Pressure Fitness. Rebecca takes an individualized and whole body approach to each of her clients and patients. You are like no other, and your treatment should be geared towards your needs!