As recently as a few years ago, we only really thought of constipation in terms of motility. Unfortunately, we were missing something very important. Motility is important, but it’s impossible to poop if you can’t relax your butt muscles. I don’t mean the glutes/booty/bum. I’m referring to your anal canal and four additional muscles that comprise the pelvic floor. They’re there to prevent incontinence, and thankfully, they usually work pretty well. That barrier is designed to keep our underwear fresh until we’re hovering over a commode and consciously choose to initiate a sequence of synchronized pelvic muscle relaxations that clear a path for a microbial torpedo to launch. Unfortunately, many of us take for granted that when we want to poop, these pelvic muscles will behave the way we’re asking them to. That’s not the reality for many of my patients and perhaps some of you.
There’s a condition called pelvic dyssynergia where the muscles fail to relax when they’re supposed to, and in some cases, they actually contract. This results in a scenario where the only way to poop is to strain and push, often to have a small little nugget slip out. Or, people experience weird poop shapes or feel like they can never completely empty. Another symptom is going once, then returning to the bathroom 45 minutes later to go again. All of these point to pelvic dyssynergia.