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Solutions for Chronic Constipation | Image Courtesy of Tim Mossholder via Unsplash

Let's Discuss Some Solutions for Chronic Constipation

"Chronic constipation can have detrimental effects to daily life..."

Constipation is an extremely common symptom that has been reported to affect 63 million people in North America.1 Chronic constipation can have detrimental effects to daily life and is known to increase psychological distress and impair health related quality of life. Most commonly, individuals who are struggling with constipation often intervene with laxative use and dietary changes to increase fiber intake. These interventions fail to improve symptoms in about 50% of patients whom they are prescribed.2 If you find that you continue to struggle with constipation, there are many lifestyle changes one can adopt that can have a profound effect on symptoms including decreased frequency, straining, and pain with bowel movements.

Lifestyle Changes to Treat Symptoms of Chronic Constipation

Increase water intake throughout the day - Your bowel movement consistency is directly correlated with what you’re ingesting throughout the day. If you have issues with hard, painful bowel movements, take a look at how much water you’re drinking per day. Ideally, for optimal bowel health, we want to take in about half our body weight in ounces per day.

Establish a routine - Your bowels are 3x more active in the morning. Capitalize on that by doing things that can stimulate an urge to have a bowel movement first thing in the morning. Drinking a warm beverage and having a small breakfast that you can chew can help to stimulate your digestive system. Sit on the toilet for a few minutes, 20-30 minutes after breakfast as this is when you are most likely to see some activity.

Improve your mechanics - Consider purchasing a squatty potty, or use a footstool, garbage can, stack of old books under your feet to elevate your knees above your hips when sitting on the toilet. This is going to relax your pelvic floor muscles, unkink your colon, and allow for the smooth passage of stool.

The way you push matters! - Try to avoid pushing with your breath held as this encourages straining, making it harder for you to have a complete bowel movement. Instead, think “big belly, big cheeks.” Start by taking a big breath into the belly, thinking of breathing down into your pelvis, then purse your lips and fill your cheeks like you are blowing out a candle while you push. This will allow for the right amount of pressure and ensure that your pelvic floor stays open and relaxed.

Try performing bowel massage - Performing massage over your colon has been shown to stimulate movement in your large intestine, and is one of the best solutions for chronic constipation. Here is a step by step guide for bowel massage:

  • Get your body ready: Find a comfortable position. Ideally, lay on your back on your bed or the couch. A reclined position in a chair will also work. Start by taking some slow, deep breaths into your abdomen. Imagine your belly softening with each breath you take.
  • Imagine the path of your large intestine: Your large intestine starts in the lower right corner of your belly, travels up along the right side of your abdomen towards your ribs, across the top of your stomach, below your diaphragm, down the left side, and ends in the lower left corner of your abdomen. This is the path we will trace with our massage.
  • Start in the lower right hand corner, just inside the right point of your hip. This is the start of your ascending colon. Using one or two hand pressure, perform firm, yet comfortable circles moving up towards your ribcage.
  • Move across the upper part of your belly, under your rib cage with the same pressure and small circular pattern to massage your transverse colon.
  • Once you reach the left side, start to move down towards your left hip point to stimulate the descending colon.
  • Repeat these steps for about 10 minutes

You can use this massage to alleviate chronic constipation as a part of your daily bowel routine. Using lotion can help your hands glide over the skin more efficiently and improve comfort. You may even hear some gas sounds as you perform this technique. This just means you are being effective!

To get more help with solutions for chronic constipation, or if have any questions regarding the information above, consider scheduling an appointment with one of our pelvic health physical therapists.

Article by: Debbie Dy, PT, DPT, Orthopedic Clinical Specialist and a Doctor of Physical Therapy at Femina Physical Therapy in Los Angeles


  1. Oh, Sun Jung MD1; Fuller, Garth MS2; Patel, Devin MD1; Khalil, Carine PhD2; Spalding, William MS3; Nag, Arpita PhD, MBA, MS3; Spiegel, Brennan M. R. MD, MSHS1,2,4,5,6; Almario, Christopher V. MD, MSHPM1,2,4,5. Chronic Constipation in the United States: Results From a Population-Based Survey Assessing Healthcare Seeking and Use of Pharmacotherapy. The American Journal of Gastroenterology 115(6):p 895-905, June 2020. | DOI: 10.14309/ajg.0000000000000614
  2. LaCross, Jennifer A. PT, DPT, PhD(c)1; Borello-France, Diane PT, PhD2; Marchetti, Gregory F. PT, PhD2; Turner, Rose MLIS3; George, Susan PT, DPT4. Physical Therapy Management of Functional Constipation in Adults: A 2021 Evidence-Based Clinical Practice Guideline From the American Physical Therapy Association's Academy of Pelvic Health Physical Therapy. Journal of Women's Health Physical Therapy 46(3):p E59-E84, July/September 2022. | DOI: 10.1097/JWH.0000000000000244

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** This information is for educational purposes only and is not intended to replace the advice of your doctor. **

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