How Constipation Can Cause Dribble Dilemmas

By: Dr. Rachel Gelman 

It’s a New Year (yes, February still counts as a time of new beginnings)! If you’re like me, your resolution may have been easier said than done. I wanted to start working out before work, but sleep is so nice, so I changed it to get more sleep! That’s not cheating, right? As a pelvic floor therapist, I spend a lot of my day talking to people about changes they can make in their life to improve their pelvic health. One recommendation I make to all my patients, friends, family and if warranted strangers, is the importance of pooping!

Many people shy away from talking about  pooping, but that children’s book said it best: Everybody poops. Yes, everybody, even Beyonce! I can’t speak for Queen Bey, but I can say most people have had a problem pooping at one point in time. If you have lucked out and have never had a issue going number two, don’t stop reading. Unless you have psychic abilities, you probably can’t predict the future and this info may be beneficial down the road.

The most common defecation difficulty is constipation. Constipation can impact more than just your rectum. To understand this, it is important to know the anatomy inside your pelvis. You may be familiar with the term pelvic floor, which is a muscular bowl within the pelvis. If you were born with female anatomy, your pelvic floor supports your bladder, uterus and colon.

Although these organs function in different body systems, they have a closer relationship than one would expect, as they live in the same neighborhood--in fairly close quarters. It’s like an anatomical reality TV show, three strangers are picked to live in a house, and have their lives judged taped.  If all is well in the house and all the whole cast gets along, the show would probably be canceled. Whereas, if there was epic drama going on, more people would pay attention and the colon would have 2.5 million followers on Instagram.


But the pelvic floor doesn’t want to be Instafamous. In fact, it probably wants you to delete all social media, go on a meditation retreat and drink more water. It wants you to say #nodrama this year. If the pelvic floor is dysfunctional, either it has become restricted, overactive, weakened or injured it can lead to things like pelvic pain, pain with sex, urinary urgency, frequency and incontinence. Now what can lead to pelvic floor dysfunction? You guessed it: constipation!  According to The Rome Foundation, a non-profit that studies functional gastrointestinal disorders, the criteria for constipation is having two of the following symptoms over three months:

  • Fewer than 3 bowel movements per week
  • Straining
  • Lumpy or hard stools
  • Sensation of anorectal obstruction (aka it feels like something is stuck in your butt)
  • Sensation of incomplete defecation
  • Manual maneuvering required to poop (yes, that means you're having to use your fingers...don't worry, you're not alone)

Basically, if the last time your pooped was as hard to get out as your feelings: you’re constipated. If you can’t remember when your last bowel movement was or you just went and it feels like something is stuck in your butt: you’re constipated. If you have or feel the need to use your fingers to get things moving: you’re constipated and not alone. Patients are often shocked when I ask such detailed questions about their pooping habits, and are often surprised to find out what they thought was “normal” is just common and can be improved!

Some of the symptoms listed above may be due to the fact that a person has gotten into a habit of ignoring the urge to poop. No one likes being ghosted, especially your colon. So if you feel the urge to go, you should listen to your body and make your way to the toilet pronto. If poop hangs out in the rectum, that can add more weight for the pelvic floor to hold. More work for the pelvic floor means it can fatigue (kinda the same way you feel after pulling an all-nighter for a major project.)  If your bladder is full on top of that, the pelvic floor can’t control the urethra, which could lead to leaking.  

Sometimes fecal matter gets stuck because the muscles are hypertonic (too tight) or the back part of the vaginal wall has lost some of its stability. This instability can create a pocket in the colon where poop can get trapped. This can be why someone feels the need to push or strain to have a BM. However, straining can put more pressure on the pelvic floor muscles, which can make matters worse leading to further muscle guarding or weakening if the vaginal wall. Again, if the pelvic floor muscles are dysfunctional and/or there is laxity in the vaginal wall that can lead to other symptoms like urinary or sexual dysfunction or pelvic pain.

Now there is no need to become terrified of the toilet. There are some things you can do to put your constipation woes behind you or prevent it from becoming a problem in the first place!

  • First, stay hydrated. I am talking about drinking plenty of good old H2O. The amount of water you need depends on several factors including your weight, diet and activity level. Did you know that in 2004, The National Academy of Sciences reported that the average women needs 91 ounces of water a day? Again, that is just a recommendation.
  • Consult with a healthcare provider or dietician if you are unsure what is right for you. They can also help you determine what to potentially add or exclude from your diet, as lack of fiber or food sensitivities can also lead to poop problems. 
  • Another toileting tip that can perfect the way you poop is proper positioning. As human beings we were meant to squat to defecate. Back in the day, it was like Naked and Afraid, no porcelain thrones. Simpler times indeed. The pelvic floor is in a better position when one pops a squat, which allows defecation to occur with the greatest of ease. To get yourself in a squat position you can put a step stool under your feet to get your knees higher than your hips or there is a product called the squatty potty that does the trick.

At the end of the day if you are struggling with constipation or any type of the symptoms listed above, consult a healthcare provider or your friendly pelvic floor physical therapist to determine if your muscles need some TLC.

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Dr. Rachel Gelman is a Bay Area native who has received her bachelor’s degree in Biology from the University of Washington in Seattle and her Doctorate in Physical Therapy from Samuel Merritt University. Rachel practices as a clinical specialist at the Pelvic Health and Rehabilitation Center in San Francisco where she is also the branch director. She specializes in the physical therapy management of numerous pelvic pain disorders, including bowel, bladder and sexual dysfunction. Rachel is passionate about women's and men's health and strives to promote quality education regarding pelvic and sexual health both in the clinic and in the community.