No more straining: what really helps with constipation

Does this sound familiar? You are sitting on the toilet, but… nothing happens. Or only with difficulty and a great deal of straining. Constipation is not only physically uncomfortable; it often affects your mood too. You feel irritated, bloated and uncomfortable and wonder: What is actually wrong? Do not worry, you are not alone: Around one in five people in Germany regularly struggle with constipation. But that does not mean you have to accept it. There are effective ways to get your bowel moving, and you may be surprised by what plays a central role: your pelvic floor.

Constipation (also known as obstipation) is far more than simply “infrequent bowel movements”. It describes impaired bowel emptying in which stool is passed too infrequently, is too hard or can only be passed with intense straining. What exactly happens in the body can be clearly explained in three areas:

1. Bowel movement slows down

Normally, the bowel moves its contents through rhythmic muscle contractions known as peristalsis. With constipation, this movement is slowed or uncoordinated. As a result:

- The food pulp remains in the large bowel for longer. - Too much water is removed from the stool. - The stool becomes hard, dry and bulky, making it difficult to pass.

2. Defecation becomes mechanically more difficult

A functioning bowel movement is a finely coordinated process involving abdominal straining, the diaphragm, rectum, sphincter muscles and, not least, the pelvic floor. The pelvic floor plays a central role here because:

- It must relax in a targeted way at the right time so that the rectum can open. - At the same time, certain muscle groups actively support elimination, e.g. through the so-called lowering of the pelvic floor when straining.

Pelvic floor dysfunction can lead to the following problems:

- Uncoordinated tension: The pelvic floor remains tense and “blocks” the exit. - Reduced sensitivity: The perception of the urge to have a bowel movement is impaired. - Weakness: The supporting force needed to pass stool safely is lacking.

3. Bowel movements become a strain

Many people affected try to force the process by straining more intensely. This can be problematic over the long term because:

- Excessive straining greatly increases the pressure in the abdominal cavity. - This can overload the pelvic floor, with possible consequences such as haemorrhoids, anal fissures or pelvic floor descent. - A vicious cycle develops: straining leads to greater tension, and greater tension makes emptying the bowel even more difficult.

Constipation is not merely a “bowel problem”, but is often the result of complex dysfunction in the interaction between different areas of the body. The pelvic floor is a key player here and, at the same time, a possible key to the solution.

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When the bowel goes on strike, people often think first of the usual suspects: not drinking enough, a diet too low in fibre and too little exercise. And yes, these factors play a major role. But they are far from the only causes of sluggish digestion. Many people overlook the fact that stress, hormones, medication and, not least, the pelvic floor can also play a major role. The less well-known but common triggers:

1. Chronic stress and the nervous system

The bowel is closely connected to the autonomic nervous system, particularly the so-called enteric nervous system, which is also known as the “second brain”. Under persistent stress, the body switches to “tension” rather than “digestion”. This can slow bowel movements and even bring them to a complete halt. At the same time, muscle tension often increases throughout the pelvic area, including the pelvic floor.

2. Impaired pelvic floor function

A healthy bowel movement is a complex, coordinated process involving different muscle groups. If the pelvic floor is not functioning properly during this process (often without the person noticing), it can lead to chronic constipation. Possible pelvic-floor-related causes:

- Hypertonicity (persistent tension): The pelvic floor does not relax sufficiently when using the toilet, and the rectum remains effectively “closed”. - Dyssynergia: Coordination between the pelvic floor and abdominal straining is impaired, e.g. due to incorrect breathing technique or an uncoordinated straining pattern. - Sensory impairment: The sensation of fullness and the urge to empty the bowel is reduced, e.g. after childbirth, surgery or due to neurological conditions.

3. Hormonal changes

Women in particular may experience constipation during certain stages of life:

- During the second half of the menstrual cycle (after ovulation), progesterone has a relaxing effect, including on the bowel. - During pregnancy, hormonal changes and increasing pressure on the pelvic floor often slow digestion. - During menopause, muscle tension, tissue structure and hormone levels change. This can also affect bowel activity.

4. Medication with “hidden” effects

Many medicines have constipation as a side effect, often without patients being informed. These include:

- Painkillers (especially opiates) - Iron supplements - Antidepressants - Blood-pressure-lowering medication - Diuretics

5. Habits such as holding back bowel movements

Whether due to lack of time, embarrassment or bad experiences with public toilets: anyone who regularly suppresses the natural urge to have a bowel movement disrupts the body's rhythm. The rectum becomes accustomed to holding back, and the urge diminishes. The stool becomes firmer and more difficult to pass – creating a vicious cycle.

Constipation is rarely a purely “mechanical” problem. It is often a signal that something in the body or lifestyle has become unbalanced. The role of the pelvic floor in particular is frequently underestimated. Taking a targeted look at these connections can help identify the actual cause and address it specifically.

When constipated, most people first think of home remedies, diet and more exercise, and rightly so. But what many do not know is that the pelvic floor plays a central role in effective bowel emptying. Understanding this connection can help you address constipation in a more targeted and sustainable way.

What generally helps (the “basics”)

Before we turn to the pelvic floor, here are the measures that have been shown to have a positive effect on bowel activity:

- Sufficient fluids (at least 1,5–2 litres daily): Supports stool transit through the colon. - A high-fibre diet (e.g. linseed, oats, vegetables, fruit): Stimulates bowel motility. - Regular exercise: Promotes natural intestinal peristalsis. - Stress reduction & routine: Rituals such as going to the toilet at the same time every day train the autonomic nervous system.

These strategies can help, but they are often not enough for chronic or functional constipation. This is where the pelvic floor comes into play.

Why the pelvic floor is often the “missing factor” in constipation

The pelvic floor is a deep muscle group that stretches like a hammock between the pubic bone, sitting bones and coccyx. Its functions during a bowel movement are highly complex:

- It closes the rectum in everyday life and ensures that we remain continent. - During a bowel movement, it must relax deliberately and completely so that the bowel contents can pass. - At the same time, it stabilises the pressure in the abdomen and therefore also the effectiveness of bearing down.

What often goes wrong:

- Constant tension (hypertonia): The pelvic floor can no longer be consciously released, and the bowel outlet remains blocked. - Incorrect straining: Many people strain in an uncoordinated way, using too much force without relaxing the sphincter muscles. - Impaired sensation: Awareness of fullness or the urge to empty the bowel is reduced. The person responds too late or not at all.

In medicine, these functional disorders are grouped under the terms “anismus” or “dyssynergic defecation” and are much more common in people with chronic constipation than is generally assumed.

Why pelvic floor training can be a real turning point

Targeted pelvic floor training helps identify and regulate these disorders. It is not only about strengthening, but above all about coordination, awareness and relaxation. Good training teaches:

✓ Body awareness: What does my pelvic floor feel like at rest and under tension? ✓ Targeted relaxation: How can I release the muscles when necessary? ✓ Breathing technique and bearing down: How do I use the strength of the diaphragm and abdominal wall correctly without causing harm?

A 2021 study examined the effect of pelvic floor exercises with biofeedback on participants with dyssynergic defecation. The result: Symptoms resolved or improved significantly in approx. 68 % of patients, and over 55 % showed normalisation of pelvic floor/bowel coordination [1].

This is precisely what training programmes such as MyPelvi pelvic floor training teach. Instead of biofeedback, MyPelvi uses a technology that works without skin contact. This means that electromagnetic waves can also activate the deep muscle layers of the pelvic floor:

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Anyone who thinks only of diet and laxatives when it comes to constipation overlooks a crucial factor: the pelvic floor. Without its healthy function, the bowel cannot perform its task optimally. Pelvic floor training is therefore not a “niche tip”, but a central component, especially in functional or chronic constipation.

Constipation is often harmless, but it can also indicate underlying disorders. You should not ignore these signs:

- No normal bowel movement for more than 3 weeks - Severe abdominal pain or cramps - Blood in the stool or when wiping - Alternating constipation and diarrhoea - Sudden weight loss without an identifiable cause - Newly occurring complaints in people over 50 - Constant feeling of not having emptied the bowel completely - Family history of bowel conditions (e.g. bowel cancer, inflammatory bowel diseases)

Important: You should also seek medical advice for persistent constipation without an identifiable cause. Especially if there is no improvement despite lifestyle changes.

Soft, well-formed stools are essential for relaxed bowel movements. These simple measures can help in the short term:

- Warm water first thing in the morning on an empty stomach gently stimulates bowel activity. - 1-2 teaspoons of ground flaxseed or psyllium husks: Take with plenty of water, as they swell and help regulate stools. - Prunes or dried fruit contain natural bulking agents and sugar alcohols that can have a laxative effect. - Movement after eating promotes bowel activity. Even a short walk can help. - Relaxation & breathing exercises: Support conscious relaxation of the pelvic floor, which is important for bowel movements.

Important: Always make sure you drink enough fluids; otherwise, fibre can be counterproductive.

Not everything that tastes good is good for the bowel, and vice versa. Anyone experiencing constipation can provide targeted support with the right drinks and foods:

- Water, water, water: preferably still and spread throughout the day (1,5–2 litres). - Warm water in the morning gently gets the bowel moving. - Prune juice (natural) contains natural sugar alcohols that can bind water in the bowel. - Buttermilk, kefir or sauerkraut juice contain lactic acid bacteria that may support the intestinal environment. - Coffee (in moderation) stimulates bowel activity in some people.

- Classic high-fibre foods such as wholemeal bread, oats, flaxseed, psyllium husks, or vegetables such as carrots, broccoli and fennel can get the bowel moving.

Tip: Introduce new foods into your diet gradually so that your bowel can adjust without rebelling.

Of course, constipation can be physically and mentally distressing. But the good news is that you are not helpless. With some knowledge about your body, a few targeted changes to your everyday routine and the right approach to your pelvic floor, such as MyPelvi pelvic floor training, you can make a significant difference yourself.

After all, well-functioning digestion is no accident. It is the result of diet, exercise, relaxation and a pelvic floor that knows when to hold on and when to let go. If you learn to use your pelvic floor in a targeted way and make your routines bowel-friendly, you can not only alleviate symptoms but also do something beneficial for your body in the long term.

Learn the right technique with guidance — free of charge at your MyPelvi studio.