Bowel Dysfunction and Constipation

Jun 16

Written By

Reviewed by Cheryl Long, AHPC-registered physiotherapist, Goji Physio

Bowel dysfunction — including constipation, straining, incomplete evacuation, urgency, and accidental bowel leakage — is more common in women than is often recognised, and its connection to the pelvic floor is frequently missed. The pelvic floor is directly involved in both the storage and evacuation of stool. When pelvic floor coordination is disrupted — whether by pregnancy, birth, surgery, or chronic straining habits — bowel function suffers. Physiotherapy addresses these neuromuscular and structural contributors.

How does pregnancy and birth affect bowel function?

Pregnancy affects bowel function through multiple mechanisms. Progesterone slows gastrointestinal motility, contributing to constipation during pregnancy. The growing uterus puts pressure on the colon and rectum, altering the mechanics of defecation. After birth:

Fear of pain with the first bowel motion (particularly after perineal tear or episiotomy) can lead to voluntary withholding and subsequent worsening of constipation
Opioid-based pain relief (commonly prescribed after Caesarean) reduces gut motility
Third- and fourth-degree perineal tears affect the anal sphincter directly, and may cause urgency, reduced control, or incomplete sphincter closure
Pelvic floor muscle changes after birth can affect defecatory dynamics — the coordinated relaxation of the pelvic floor and sphincter that is required for comfortable, complete evacuation

What is defecatory dysfunction?

Defecatory dysfunction refers to difficulty with the act of defecation, even when stool consistency is normal. It often presents as straining, a sense of incomplete emptying, needing to digitally assist evacuation, or excessive time on the toilet. A key underlying cause is paradoxical puborectalis contraction (also called pelvic floor dyssynergia) — where the pelvic floor contracts when it should be relaxing during defecation. This is a neuromuscular coordination problem, not a structural one, and responds well to biofeedback and physiotherapy.

What does a session at Goji involve?

Our physiotherapist will ask about your bowel habits in detail — such as frequency, consistency, presence of straining, whether you feel fully evacuated, and whether you have any urgency or leakage. The physical assessment may include:

External perineal and pelvic floor assessment: observing resting tone, sphincter reflexes, and the ability to voluntarily contract and relax the pelvic floor on command
Internal pelvic floor assessment: offered when appropriate, explaining what is being assessed and why. This provides the most accurate information about pelvic floor coordination during defecation mechanics and is not required.
Behavioural and positional assessment: toilet posture, straining habits, and fluid/fibre intake — all of which have a significant impact on bowel function

Treatment may include pelvic floor downtraining (if overactivity is present), defecation dynamics education, toilet position and positioning device advice, and a graded bowel retraining programme.

When should I see a GP or specialist rather than a physio?

Physiotherapy addresses the musculoskeletal and neuromuscular contributors to bowel dysfunction. You should see your GP first — or in addition to physiotherapy — if you experience:

Blood in the stool or on wiping
A significant change in bowel habit that has persisted for more than 2–3 weeks without an obvious cause
Unintentional weight loss
Pain in the abdomen that is worsening
Suspected anal sphincter damage following a third- or fourth-degree perineal tear

For confirmed anal sphincter damage, Goji works alongside colorectal surgeons and specialist continence teams as part of a coordinated care pathway.

Frequently asked questions

Is it normal to be constipated after having a baby?

Constipation is very common in the immediate postnatal period and often resolves within the first few weeks with dietary changes and adequate hydration. If it persists beyond 6–8 weeks, or is causing significant straining or pain, a physiotherapy assessment is worthwhile — particularly if pelvic floor dysfunction may be contributing.

I accidentally leaked stool. Is that something physio can help with?

Accidental bowel leakage (faecal incontinence) in any amount can result from sphincter damage, pelvic floor weakness, or urgency. Physiotherapy is effective for cases where sphincter damage is absent or mild, and for managing urgency. For significant sphincter damage following a third- or fourth-degree tear, specialist colorectal assessment is recommended alongside physiotherapy.

Can stress and anxiety cause bowel problems?

Yes. The gut-brain axis is real and well-established. Psychological stress activates the enteric nervous system in ways that affect bowel motility, sphincter tone, and visceral sensitivity. Physiotherapy addresses the physical contributors; if psychological factors are significant, our physiotherapist may recommend working alongside a psychologist or mindfulness-based approach in parallel.

Could my bowel symptoms be related to my pelvic floor, not just diet?

Yes — and this is frequently overlooked. The pelvic floor is directly involved in defecation mechanics. A pelvic floor that is overactive, poorly coordinated, or significantly weakened can affect evacuation even when diet and stool consistency are optimal. This is why a bowel assessment at Goji includes pelvic floor evaluation.

I had a third-degree tear two years ago and still have urgency. Is that treatable?

Urgency following a third-degree tear can have both sphincter and pelvic floor components. Physiotherapy can address the neuromuscular and coordination aspects; if sphincter integrity is the primary issue, a colorectal surgeon assessment and possibly surgical review may be needed. Our physiotherapist will discuss the appropriate pathway based on your history and assessment findings.

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Reviewed by Cheryl Long, BSc (Hons) Physiotherapy, AHPC-registered
Clinical Director, Goji Physio — Women's and Family Physiotherapy, Lentor, Singapore