Physical Therapy Management of Constipation

Physical Therapy Assessment and Management of Constipation

• Constipation is an acute or chronic condition characterized by infrequent bowel movements or hard, dry stools that are difficult to pass.
• Adults who haven't had a bowel movement in three days, or children in four days, are considered constipated.
• Other criteria for constipation include: at least 25% of bowel movements associated with straining, lumpy or hard stools, incomplete bowel evacuation, anorectal obstruction, and less than 3 bowel movements per week.

Causes of Constipation

• Bowel obstruction
• Cancer
• Dehydration
• Hospital admission
• Endocrine disorders (hyperparathyroidism, hypothyroidism, chronic renal disease)
• Neuromuscular disorders (Parkinson's disease, MS)
• Electrolyte imbalances (hypercalcemia, hypokalemia, hypermagnesemia)
• Pregnancy
• Depression
• Reduced mobility and balance problems
• Medications (including opioids)

Symptoms and Consequences of Constipation

• Nausea and/or vomiting
• Abdominal and rectal pain
• Flatulence
• Loss of appetite
• Fatigue
• Depression
• Nausea and reduced appetite may lead to weight loss
• Behavioral disturbances in dementia may result in increased use of psychotropic medications.

Quality of Life

• A systematic review by Belsey et al (2010) shows that constipation negatively impacts quality of life in adults.
• The study notes the impact on various aspects of life.

Types of Constipation

• General constipation: Problems with peristalsis (muscle contractions) in the large intestine slow or stop waste movement.

  • Factors include limited fluid and fiber intake, diet imbalances (too much sugar and animal fat), lifestyle changes (prolonged sitting, pregnancy, travel), certain medications, and a sluggish colon.

• Outlet constipation: Stool is stuck in the rectum due to dysfunction of the pelvic floor muscles.

  • Tight pelvic floor muscles prevent stool from passing.
  • Can cause straining, leading to further muscle tightening.

Physical Therapy Management for Constipation

• Dietary Management: Aim for 25-35 grams of fiber daily. Choose fresh fruits, vegetables, and whole grains over processed foods. Increase your fluid intake to 6-8 glasses of water daily.

• Toilet Positioning: Position knees higher than hips on the toilet seat. Use a footstool if needed. Lean forward, supporting elbows on knees. Expand your abdomen as you exhale, gently pressing stool out.

• Exercise: Regular exercise, like walking, lower trunk rotation, stationary bicycling, and pelvic floor exercises, helps speed up transit time through the digestive tract.

• Biofeedback Therapy: A physical therapist inserts a probe into the anal sphincter and places pads on the abdomen to detect muscle movement. Visual feedback helps patients learn how to coordinate bowel movements effectively.

• Pelvic Floor Strengthening: Strong pelvic floor muscles are crucial for bladder and bowel control. Constipation straining may lead to muscle weakening, impacting bladder function and causing accidental leaks.

• Abdominal Massage: Gentle massage technique applied to the abdomen along the colon's path. This helps stimulate peristalsis to release stool.

• Hot Rolls: Use hot rolls on the abdomen following the direction of the colon, to stimulate peristalsis and relax spasming muscles.

Additional Information

• Constipation can worsen bladder function due to the rectum's close proximity to the bladder. Overfull rectum can press on bladder, reducing its capacity.
• Constipation can lead to fecal incontinence due to weakened pelvic floor muscles. The stool may leak out.