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Constipation is a common condition with many possible causes, including medications, poor bowel habits, low-fiber diets, laxative abuse, hormonal disorders, and diseases that affect the colon. While true muscle pains are not likely to be related to constipation, pelvic floor dysfunction, a condition that causes the pelvic floor muscles to tighten instead of relaxing, can lead to constipation. Anismus, or dyssynergic defecation, is a type of pelvic floor dysfunction that makes it difficult to defecate and can cause chronic constipation. Treatment options for constipation due to muscle issues include biofeedback therapy, standard lifestyle changes, laxatives, and pharmaceuticals.
| Characteristics | Values |
|---|---|
| Can muscles cause constipation? | Yes, pelvic floor dysfunction is a common condition that can cause constipation. It involves the tightening of pelvic floor muscles instead of relaxing them, making it difficult to release bowel movements. |
| Types of Pelvic Floor Dysfunction | Anismus or dyssynergic defecation, interstitial cystitis, irritable bowel syndrome (IBS), pelvic organ prolapse (POP), erectile dysfunction (ED), prostatitis. |
| Treatment for Pelvic Floor Dysfunction | Biofeedback therapy, standard lifestyle guidelines, laxatives, pharmaceuticals, botox injections. |
| Other Causes of Constipation | Low fiber and fluid intake, high-fat diet, medications, hormonal disorders, intestinal obstructions, neurological disorders, metabolic and endocrine disorders, bowel cancer, diverticulitis, scleroderma, irritable bowel syndrome (IBS), opioid use, travel, aging, pregnancy, ignoring the urge to defecate. |
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What You'll Learn
Pelvic floor dysfunction
PFD can cause pelvic pain, pressure, pain during sex, urinary incontinence, overactive bladder, bowel incontinence, incomplete emptying of feces, constipation, myofascial pelvic pain, and pelvic organ prolapse. The latter refers to the herniation of pelvic organs through the pelvic organ walls and pelvic floor. When pelvic organ prolapse occurs, there may be a visible organ protrusion or a lump felt in the vagina or anus.
PFD is thought to be more common in women, affecting up to 50% of women who have given birth and about 16% of men. The pelvic floor muscles support the bladder, bowel, and uterus, and prevent incontinence of the bladder and bowel, as well as prolapse. Pregnancy, childbirth, obesity, chronic constipation, and prostate cancer surgery can weaken the pelvic floor muscles, leading to issues related to bladder, bowel, or sexual function.
Therapeutic interventions for PFD should be tailored to the specific needs of the patient. A multidisciplinary approach is often necessary, involving a sex therapist, physical therapist, geriatric specialist, and other specialists. Dietary changes, weight loss, and pelvic floor exercises (Kegel) to strengthen the pelvic floor muscles are also recommended.
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Anismus (dyssynergic defecation)
Anismus, also known as dyssynergic defecation, is a functional defecation disorder that occurs when the muscles and nerves in the pelvic floor fail to coordinate correctly to have a bowel movement. This condition is characterised by inadequate rectal propulsive forces and/or increased resistance to defecation due to a disturbance in neuromuscular coordination.
People with anismus experience symptoms of severe constipation, including less than three bowel movements per week, excessive straining to defecate, hard and painful stools, and a bloated stomach. The condition is estimated to account for 15% to 25% of all chronic constipation cases, affecting up to one-half of patients with chronic constipation. It is more common in women, with a female-to-male ratio of 2.2:1.0, and its prevalence increases with age, particularly after 65.
The diagnosis of anismus involves ruling out other common structural and metabolic causes of constipation through rectal exams, such as digital rectal exams (DRE) and sigmoidoscopy. Anorectal manometry, which measures muscle contractions and relaxations, is also used for diagnosis. Treatment options include biofeedback therapy, laxatives, pharmaceuticals, and experimental botulism toxin injections.
Anismus can manifest in different ways, with the most common form being the failure of the muscles that hold in stool to relax during bowel movements, known as hypertonic pelvic floor. In some cases, these muscles may even tighten instead, a condition called paradoxical contraction. Additionally, some individuals with anismus are unable to coordinate their muscles effectively to generate sufficient force for defecation. Impaired rectal sensitivity is also observed in about half of the cases, resulting in an inability to feel the urge to defecate.
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Irritable bowel syndrome (IBS)
IBS is classified as a neurogastrointestinal disorder, but its exact causes are unknown. Diagnosis of IBS begins with a detailed medical history and discussion of symptoms. To rule out other conditions, various tests may be conducted, including blood tests and stool tests. There is no single test for IBS.
IBS can often be managed through medication, diet, and lifestyle changes. It does not damage the digestive tract or increase the risk of colon cancer.
If you are experiencing symptoms of IBS, it is important to consult a healthcare professional for a proper diagnosis and treatment plan.
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Laxative use
Laxatives are typically prescribed for constipation. They contain chemicals that help increase stool motility, bulk, and frequency, thus relieving temporary constipation. They treat constipation by softening hard stools or stimulating your bowels to get moving so you can defecate. Most laxatives are available without a prescription and are generally used to treat occasional or short-term constipation. However, taking them for long periods can cause side effects and even worsen constipation.
There are different types of laxatives, including bulk-forming laxatives, osmotics, stool softeners, lubricants, and stimulants. Lubricant laxatives, for instance, make stools slippery by adding a layer of mineral oil to the intestine walls, preventing the stool from drying out. Lubricant laxatives are highly effective but are best used as a short-term cure for constipation. Over a longer period, mineral oil can absorb fat-soluble vitamins from the intestine and decrease the absorption of certain prescription drugs.
Stimulant laxatives stimulate the lining of the intestine, accelerating the stool's journey through the colon. They also increase a stool's hydration. Popular brands include bisacodyl (Correctol, Dulcolax, Feen-a-Mint) and sennosides (Ex-Lax, Senokot). Prunes (dried plums) are also an effective colonic stimulant. However, stimulant laxatives may cause cramping and diarrhea and should not be used daily or regularly as they may weaken the body's natural ability to defecate and cause laxative dependency.
You may need a prescription laxative if over-the-counter options are ineffective or if you have a chronic condition that causes constipation, such as Crohn's disease, ulcerative colitis, or irritable bowel syndrome (IBS). Prescription laxatives include lactulose (Duphalac, Cephulac, Kristalose), linaclotide (Linzess), lubiprostone (Amitiza), and naloxegol (Movantik).
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Opioid-induced constipation
The Rome IV diagnostic criteria are widely used to define functional constipation and include the presence of two or more of the following symptoms over the last three months: straining during defecation, lumpy or hard stools, a sensation of incomplete evacuation, a sensation of rectal obstruction or blockage, manual maneuvers to facilitate defecation, and fewer than three spontaneous bowel movements per week.
The management of OIC involves both pharmacological and non-pharmacological therapies. Laxatives, such as polyethylene glycol, should be started concurrently with opioids to prevent OIC. Once OIC is established, stimulant laxatives (senna/bisacodyl) or osmotic laxatives (polyethylene glycol) are commonly used. Stool softeners, such as docusate, are also effective in preventing constipation but less so in established cases. For refractory OIC, newer agents such as methylnaltrexone (Relistor) may be used. Methylnaltrexone is the first peripherally acting opiate antagonist that does not cross the blood-brain barrier, avoiding opioid withdrawal symptoms.
Other approved therapies for OIC include lubiprostone (Amitiza), a type-2 chloride channel activator that increases fluid secretion in the GI tract, resulting in enhanced peristalsis and increased bowel movement frequency. Naldemedine, naloxegol, and alvimopan are also approved treatments for OIC, with naldemedine and naloxegol indicated for patients with non-cancer pain and alvimopan for postoperative ileus.
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Frequently asked questions
Yes, pelvic floor dysfunction, a type of muscle dysfunction, can cause constipation. This is because the body keeps tightening these muscles instead of relaxing them, making it difficult to pass stool.
Symptoms of pelvic floor dysfunction include constipation, incomplete bowel movements, frequent bathroom visits, straining or pushing to pass a bowel movement, and erectile dysfunction.
Biofeedback therapy is one treatment option for pelvic floor dysfunction. This involves placing painless electrodes on the skin to sense muscle tension and guide the patient through various muscle-activating and tension-relieving strategies.
Constipation can be caused by a low-fibre diet, lack of fluids, hormonal disorders, neurological disorders, intestinal obstructions, and certain medications.
Laxatives and pharmaceutical treatments can be used to treat constipation. Lifestyle changes, such as increasing fibre intake and staying hydrated, can also help prevent constipation.
