Constipation can be influenced by how well the pelvic floor muscles coordinate relaxation and support during bowel movements. When these muscles remain too tense, emptying the bowels can become difficult, uncomfortable, or incomplete.

Healthy bowel function relies on a balance between pelvic floor relaxation, breathing, hydration, fiber intake, and daily movement. Small adjustments in posture, breathing patterns, and targeted exercises can help the body release stool more comfortably.

When symptoms persist despite lifestyle changes, pelvic floor pt can help identify coordination issues and guide individualized strategies that improve bowel function and reduce strain.

While many topics related to pelvic health have been discussed more openly in recent years (we love to see it!), one topic that can still feel a bit ‘TMI’ to bring out into the open are bowel routines - namely, constipation. 

Before we dive into the question of the day: can pelvic floor exercises help with constipation? We have a bit of clarifying to do first: 

Constipation is not just beingunable to empty your bowels (i.e., you’re only constipated until you’ve emptied - not so). Let’s see if these examples ring any bells for you: 

• having to strain or ‘push’ while you’re trying to empty your bowels
• going to the bathroom frequently because you’re only emptying the bowels a little bit at a time and never feeling truly emptied
• having pain or discomfort with bowel movements. 

If any of these sound familiar to you, read on - you’re in the right place! 

So…what is the role of the pelvic floor in bowel movements?

Like any other muscle in our body - the pelvic floor can contract and it can relax. In regards to bowel movements, the role of the pelvic floor is to contract to prevent stool leakage while we’re going about our daily routines, exercising, etc. And then the inverse, the relax and let us empty our bowels when we need to. If the pelvic floor muscles are unable to contract when needed or relax when we are ready then we may end up with stool leakage or constipation. Many of the patients we see at Pelvic Pride struggle with the inability to relax their pelvic floor which can result in constipation. 

Since we are complex beings, constipation is not only driven by the pelvic floor. Movement, water intake and fiber intake are also huge contributors to our ability to go. However, you can be a total rockstar in the fiber and hydration department, but if your pelvic floor is too tense or can’t coordinate relaxation effectively when you’re on the toilet - you’re going to continue to experience discomfort. 

Sign the Pelvic Floor is Not Relaxing Properly

So how do you know if your pelvic floor is not fully relaxing? In addition to signs such as incomplete bowel emptying or having to strain when you’re trying to have a bowel movement, other signs that your pelvic floor may have difficulty relaxing can include (but are not limited to) feeling like stool is ‘stuck’ in your rectum, taking a long time trying to empty the bowels in the bathroom, or continuing to struggle with constipationdespite adjusting your water and fiber intake levels. Additionally, tailbone pain, hip and glute pain, low back pain, and/or pelvic discomfort with insertion activities such as using menstrual products or with pelvic exams can be signs that your pelvic floor may be having difficulty coordinating effective relaxation. 

Pelvic Floor Exercises for Better Bowel Coordination

So, what should we actually be doing to help our pelvic floor muscles relax when we’re trying to go? Can exercises even help that? The short answer: Absolutely!

As I mentioned earlier, the coordination between strength and relaxation of the pelvic floor muscles is key when it comes to maintaining healthy bowel habits. To see where pelvic floor exercises fit in, let’s first break down the mechanics of toileting.

First you need to be able to sit down on the toilet with your feet flat on the floor, or a step stool. Next you need to be able to sit up tall (although some patients find it easier to go if they lean forward slightly), let go of your pelvic floor muscles, and breathe out (or blow as you go). So what exercises help with this?

1. 
   Squats - or any other mobility exercise to ensure your hips and knees have the range needed to sit down on the toilet and place your feet flat
2. Abdominal exercises - strength in our core in essential to being able to sit on the toilet in an upright position while we go
3. Pelvic floor lengthening - think the exact opposite of a kegel. We don’t want to squeeze the pelvic floor, we want it to let go and relax. Some of our go-to’s include child’s pose, happy baby, or deep squat.
4. Breathing exercises - you will often hear us tell patients in the clinic ‘blow as you go’ as a mechanism to help manage the pressure in the belly and provide a blood pressure safe way to give the bowels and the pelvic floor a little more support
5. Abdominal massage - ILU massage is one of our favorite exercises at Pelvic Pride to help get the gut motility going (motility - contraction of the muscles in the digestive tract)

Now I know what you may be thinking: isn’t only one of those a pelvic floor exercise? Actually, they are all pelvic floor exercises with different goals around supporting the pelvic floor. Exercises don’t all need to engage the muscles you are working and don’t need the goal to be strength. Many exercises are utilized to work on coordination, working together in a system, and even lengthening the muscles involved. 

When Kegels May Make Constipation Worse

Maybe you tried kegels because it was the first pelvic floor exercise you heard of. It’s highly likely that it hasn’t helped make your bowel movements better, in fact it probably has made your constipation worse. This is because when you kegel you are telling the pelvic floor to contract or tighten up - the opposite of what we need. When the external anal sphincter (muscle around the butt hole) is tight it is not relaxing to let poop out - it is holding it in, or at the very least making it painful to come out. 

If your pelvic floor is already a bit too tense at rest, focusing on strengthening is only going to increase that tension rather than facilitating the gentle coordination between activated and relaxed that we need in order to empty when it’s time. 


Other Strategies that Support Easier Bowel Movements

In addition to the gentle exercises mentioned earlier, there are plenty of other strategies to support healthier bowel emptying including:

• Create a consistent bowel routine (i.e. having a warm beverage around the same time each morning and planning to visit the bathroom around approximately the same time each day) 
• Ensure you are eating a variety of soluble and insoluble fibers. And don’t be afraid to supplement by adding something like psyllium husk into your smoothie, yogurt, oatmeal, or coffee in the morning. 
• Stay hydrated! The body will literally steal the water from your poop if you are not hydrated enough - so the more well hydrated you are, the easier it is to go. 
• Try adding calm, deep breathing into your bathroom time to allow intra-abdominal pressure help you out
• Adjust your posture on the toilet! Ever seen a Squatty Potty or a small stool in someone’s bathroom? Elevating your knees above the level of your hips while sitting on the toilet automatically helps to lengthen the pelvic floor muscles that wrap behind the rectum making it easier to poop