The past few weeks have been a change from many of our “norms” and routine. Have you been feeling “backed up” when it comes to your toilet time? Our bodies get accustomed to our routines just like when we feel hungry our bowels also have timing and a routine.

With increased time spent sitting and transitioning to working from makeshift home offices, and eating interesting combinations and amounts of food...it’s no wonder you may be finding yourselves feeling lethargic, stiff and constipated.

Did you know 4 million Americans have frequent constipation according to the NIDDK. There are two different types of constipation; idiopathic and functional constipation. We’ll be focusing on the functional constipation (FC) as it relates to lifestyle modifications and my wheelhouse as a pelvic floor physical therapist and nutrition coach.

Here’s a mini lesson about the GI system. It begins at the mouth with the chewing of our food. The food now termed bolus, enters the stomach where it is broken down more due to the acidic climate of our stomach acid. It then enters our small intestine where the nutrients and minerals are absorbed. Then the bolus enters the large intestine. We have an ascending colon, transverse and descending colon which becomes the rectum where we defecate. We’ll touch more on the aspects of the colon later in this blog, so stay tuned.

Our colon is fantastic at recycling and reabsorbing water to reuse in other functions of our body.
But given a multitude of factors, constipation occurs when the colon absorbs too much water and/or the colon contraction is slow or sluggish delaying transit time.

FC is primarily caused by lifestyle choices and poor dietary habits. Some common causes of constipation include:

• Not enough fiber in daily food consumption
• Lack of physical activity
• Medications
• Milk
• Dehydration
• Abuse of laxatives
• Ignoring the urge to go
• Travel
• IBS
• Pregnancy, luteal phase of menses
• Aging
• Specific disease or conditions (stroke, anorexia)
• Colorectal problems
• Intestinal dysfunction

How is constipation classified? Practitioners may use the Rome IV Diagnostic Criteria for FC.

Symptoms of constipation may include:

• Headache
• Bad breath
• Decreased appetite
• Bloating/gas
• Skin eruptions/acne
• Flatulence
• Depression

An interesting fact regarding the potential symptoms of depression and constipation. Current research is finding a link between serotonin and the gut via the brain-gut axis. Serotonin is a neurotransmitter made in the brain with 90% of our serotonin supply is actually found in the digestive tract (aka the gut!) Serotonin’s supply and availability to function impacts our mood, cognition, sexual desire and function, appetite, sleep, memory and learning to name a few.
The reduced levels of serotonin may be contributing to the mood and cognition changes as well as the impact of reduced gut motility and poor gut health lead to constipation.

So what can we do to address symptoms?

Many people will recommend “increase your fiber intake” which I believe can be helpful, but we must also be intentional about it and not overload the GI system with loads of fiber. The target fiber intake recommendation is 35g/day. On average most people only get 14-15g/day. A large culprit to this is the standard American diet (SAD) which includes increased amounts of refined sugars and processed food consumption.
I recommend beginning slowly with a gradual increase of 10-15g/day to allow the body to get accustomed to the higher fiber intake.

There are two types of fiber; soluble and insoluble.
Soluble fiber dissolves partially in water, forms a gel-like soft texture in the intestines.
Examples: oatmeal, oat bran, nuts, seeds, legumes, apples, pears, berries

Insoluble fiber does not dissolve in water.
Examples: whole grains, barley, brown rice, bulgur, wheat bran, carrots, cauliflower, cabbage, root veggies.

Here’s a list as a heads up for constipating foods. Mind you everyone is unique and how their body digests foods and amount of foods. This list is most compiled of most common constipation causing culprits.

• Processed foods
• BRAT diet (bananas, (white) rice, apples, toast)
  *BRAT diet commonly recommended when experiencing loose stool/diarrhea to “bulk things up”.

Now you know more about what causes constipation and have probably experienced constipation in your life at some point.

What can we do about it?

How can we take better care of ourselves, our daily habits and improve our health by our getting mojo back in our gut motility?

5 Steps You Should Be Doing to Combat Constipation

1.Bowel Body Mechanics

Our body mechanics play a role in the ease of defecating as crazy as it sounds, but if you’ve heard of the squatty potty or have used one, it might not seem so crazy after all. There’s a muscle within the pelvic floor called the puborectalis that aids in our bowel function with proper body mechanics. The puborectalis muscle provides a ring of support around the anal canal at the small end of the funnel made by the levator ani muscle. It has a “U” shaped configuration creating an angle between the anal canal and the rectum. Under resting conditions this angle is 90°, but during straining and moving your bowels this angle moves to 135°. If these angles are not correct, it may become more difficult to have a bowel movement.

Sit (hip angle >90 degrees) with both hands over front of stomach
Draw up pelvic floor muscles
Relax pelvic floor muscles, noting how stomach muscles relax and bulge forward
Concentrate on making the anus wide, noting how the stomach muscles bulge forward
Moving one hand to your waist, relax pelvic floor muscles and widen anus, noting how the hips widen.
Keep your jaw relaxed with your lips open and teeth apart. Breathe out.
Pull up on anorectal muscles as you finish emptying to improve closing reflex

Helpful bowel habit routine ideas:

• Squatty Potty/Step Stool
• Belly Big-Belly Hard Technique to avoid straining
• “Shhh” technique or “moo” when you poo to keep the jaw relaxed.
• Relaxing environment
• 10minutes on toilet, no longer

2. Movement is key.

Establish a daily walking program to encourage movement and fight against the sedentary lifestyle habits we may have. Start with 10 minutes a day and gradually increase toward 30 minutes a day. Our bodies crave movement, your bowels will also thank you.
Pelvic floor muscle stretches for bowel management
Diaphragmatic breathing
Complete for 5 minutes.
Inhale through your nose and into your lower hand and allow the diaphragm to expand. The pelvic floor muscles will gently descend and relax on the inhale. Upon the exhale blow out through your mouth while engaging the pelvic floor to contract “up and in” and deep abdominals (Transverse Abdominis) to gently contract.

Happy Baby Stretch

Complete 3 rounds for 30 seconds.

Deep Squat Hold

Bodyweight or with weight. Maintain a deep squat while diaphragmatically breathing. Complete 3 rounds for 30 seconds. Key is to allow the pelvic floor muscles to relax on the inhale.

3. Abdominal Wall Massage (ILU)

Sometimes we need to provide a little extra love to facilitate a bowel movement, or if you’re feeling discomfort from bloating or gas and want to get things moving along. Try an ILU massage to your abdomen. Remember how the colon has an ascending, transverse and descending colon? Well this massage is targeted to this region and gives our body the suggestion for motility and taps into the “rest and digest” Parasympathetic nervous system.

ILU Instructions: First complete light strokes in clockwise direction. Start at ascending colon on lower RIGHT side of abdomen and proceed up then across and down to the sigmoid on the lower LEFT side. Repeat 10-15 times.

4. Eat a variety of whole foods.

Make your plate as colorful as you can with an array of vegetables, fruits and protein sources.

5. Stay hydrated, strive for a goal to drink at least ½ your body weight in ounces of WATER.

If you live in a dry/hot climate or are very active or breast feeding, you may need to be consuming more water to stay hydrated.

Here you go friends, by starting with these 5 steps to combat your symptoms of constipation you will be able to feel good, move more and give a crap about your GI health so you can actually take a crap. You’d be surprised how “being regular” with your bowels can help transform your mood, mindset and how you show up for others in your day.

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