As pelvic floor physical therapists we educate people about how to go to the bathroom, EVERY DAY.  As PT’s, one of our primary roles is to educate patients about the evacuation process.  Our therapy sessions are then focused on teaching patients to become aware of their pelvic floor and to RELAX these muscles.  Most of our patients are baffled that humans have screwed up such a natural process and relaxation is a key to a good poop!  Constipation is a symptom of a more complicated system.  Your muscles are one important variable but we spend quite a bit of our time, providing education about other variables involved in this process.

Here we highlight overall constipation, and a few of the important variables that are involved.

Constipation can be defined as less than 3 bowel movements per week and/or having difficulty with passage of stool that is often hard and dry. Chronic straining and bearing down on the pelvic floor due to constipation can have damaging effects on the important muscular and fascial region in the pelvis.  Constipation can occur for a variety of reasons.

Making simple changes may help relieve your constipation symptoms:



Many of us are dehydrated, so this is often the best and most simple place to start. As stool moves through the colon, water is absorbed. Drinking adequate amounts of water will keep your stool softer and easier to pass. The amount of water each person varies, but we typically recommend drinking about 6-8 cups of water slowly throughout the day. Try carrying around a water bottle, drinking more herbal teas, or even bone broth for added minerals and gut soothing gelatin. My favorite recipe is from Rachel Katz’s book “The Cancer Fighting Kitchen” and can be found here.


Our sedentary modern lifestyle has a profound impact on our digestive health. Check in with how much you actually move throughout the day. How can you fit in more daily movement? How can you fit time into your schedule to simply go for a walk? If you’re sitting at the computer all day, try the 30- 30 rule. For every 30 minutes of sitting, do 30 seconds of movement   For example, try doing some squats in and out of your chair, or seated spinal twists using your arm rests for leverage. The key is to get moving to naturally promote movement! Fitness tracker watches can be a great place to start.  Even 1 hour of great exercise per day with the remainder sitting at the computer is not good. Frequent movement is ideal.  It doesn’t have to be high intensity exercise.  Just get out of your chair.


Magnesium is a vital mineral, and many of us, due to our modern food supply and for various other reasons, are deficient. One important function of this mineral is that it literally helps us to relax! Magnesium causes blood vessels to dilate and decreases muscle cramping. This relaxing mineral can be found in green leafy vegetables, legumes, nuts, seeds and whole grains. If you suspect you may be low, talk to your doctor about finding the supplement that is right for you. Relaxing Epsom salt baths are also great!


An effective way to stimulate the colon is through abdominal massage. We often recommend doing this self-massage in the morning after drinking a warm beverage like lemon, honey, and ginger hot water (if it doesn’t bother your bladder).  For added fiber, it may also help to drink a shot of prune juice the evening before.

Start by gently pressing over the right abdomen. Slowly, make your way up the right border of your abdomen (along the path of your ascending colon), across the upper abdomen (along the transverse colon), and then down the left border of the abdomen (along the descending colon) (Always moving in this clockwise direction) After the gentle presses, try soft strokes in the same direction, followed by small vibrations.


There are many people who suffer from various dysfunctions in the gut.  It is a complicated environment and we are learning more and more everyday about this area as a gateway to good health.  Many doctors and nutritionists can help you explore your specific needs.  You may benefit from eliminating certain foods or adding supplements to help your stomach and digestive tract heal to allow for normal bowel movements.  We highly recommend seeking professional help for further investigation by a professional who specializes in this area.  For example, dairy is known to be a constipating food and many people do not process it well.  What you eat and how you eat may be setting you up for failure.  How we eat also matters.  When we are relaxed, more circulation is drawn to help digestion.  If you eat when you are stressed, the body processes this food differently than if you are calm.  How many of us eat a quick breakfast or lunch?

Here is the ideal scenario.  You calmly eat with your friends or family, NO RUSH.  The gut has increased circulation and stimulation, you get the signal to poop (because it usually occurs after eating) and you CALMLY LISTEN and go to the bathroom.  Sounds lovely right!  We are not designed to hurry.  Build in 10 minutes of calm time in the AM, it can work wonders.

Now, Relax the Pelvic Floor Muscles

Once you look at all the habits which relate to normal bowel movements, you now have to look at the muscles. Puborectalis and the External Anal Sphincter. These muscles relax to allow for stool to evacuate.

When you INHALE properly, the ribs expand, diaphragm descends to allow for the lungs to expand, and the essential pelvic floor muscles RELAX.

  • Sit on the toilet in a squat position
  • Knees above hips in a slight V position
  • Feet are supported with stools or Squatty Potty
  • Straight back and slight hip hinge forward (do not slump). Your tailbone should not be tucked under but slightly sticking out for a neutral position of the spine.
  • Don’t Strain. Calmly Sit, Inhale and Relax your pelvic floor. Open the Door.

You can give a slight abdominal pressure with exhale but keep the door open (pelvic floor relaxed) and don’t tuck your pelvis.