Constipation & Dyssynergic Defecation: Types of Bowel Dysfunction and Treatment

Constipation is one of the most common digestive and pelvic floor complaints, yet it’s often misunderstood and undertreated. Many women experience chronic constipation, pelvic floor constipation, or functional constipation, which can interfere with daily comfort, gut health, and overall well-being. For some, bowel dysfunction extends beyond infrequent bowel movements and includes issues like dyssynergic defecation, anismus, or outlet obstruction, constipation, where the muscles of the pelvic floor and rectum do not coordinate properly.

At Femina Physical Therapy, we understand that constipation is not just about diet or hydration—it’s also about the pelvic floor. Our approach to constipation therapy focuses on restoring balance between the muscles, nerves, and tissues that support healthy bowel function. With advanced training in pelvic health physical therapy, our team provides individualized care for women struggling with difficult bowel movements, postpartum constipation, or complex conditions that require a tailored treatment plan. This page will guide you through what constipation and dyssynergic defecation are, their types, causes, and symptoms, and how constipation treatment with pelvic floor therapy at Femina PT can help you regain comfort, confidence, and control.

What is Constipation & Dyssynergic Defecation?

Constipation is generally defined as infrequent, hard, or difficult-to-pass stools, but the condition is more complex than simply “not going enough.” For many women, constipation becomes a chronic condition, leading to bloating, discomfort, and even pelvic pain. When the pelvic floor muscles and rectal muscles fail to coordinate during bowel movements, this is called dyssynergic defecation—a form of defecatory dysfunction that makes passing stool especially difficult. Dyssynergic defecation occurs when the muscles that should relax during a bowel movement instead contract, creating resistance and making evacuation incomplete or painful. This often leads to straining, prolonged bathroom time, and feelings of incomplete emptying. Unlike standard constipation caused by slow digestion or low fiber intake, dyssynergic defecation is primarily a pelvic floor dysfunction. For many women, pelvic floor constipation overlaps with other pelvic issues such as pelvic organ prolapse, urinary dysfunction, or postpartum changes. Recognizing and addressing this muscular and neuromuscular imbalance is key to successful treatment, which is why pelvic floor therapy is a cornerstone in managing these conditions.

Types of Constipation & Dyssynergic Defecation

Constipation can take different forms, and identifying the type is essential for finding the right treatment:

1. Chronic Constipation – Persistent difficulty with bowel movements lasting for weeks or months. Often linked with dietary, neurological, or muscular factors. It may involve hard stools, infrequent frequency, or incomplete evacuation, and often requires a combined approach of diet, pelvic floor retraining, and lifestyle changes.
   
2. Pelvic Floor Constipation—Caused by overactive, tight, or uncoordinated pelvic floor muscles that prevent proper elimination. This often presents with straining, incomplete emptying, or the need for manual assistance, and is highly responsive to pelvic floor physical therapy
   
3. Functional Constipation—A diagnosis made when no structural or medical cause is found, but bowel function remains impaired. Stress, habits, or subtle muscular imbalances often play a role, making behavioral and pelvic floor therapy essential.
   
4. Dyssynergic Defecation—A type of defecatory dysfunction where the pelvic floor muscles contract instead of relaxing, blocking stool passage.
   
5. Outlet Obstruction Constipation—Caused by mechanical or muscular obstructions, such as rectocele, pelvic organ prolapse, or tight pelvic muscles. It can lead to chronic straining, hemorrhoids, or feelings of incomplete evacuation and is often improved with biofeedback and muscle coordination training.
   
6. Anismus—A specific type of dyssynergic defecation involving involuntary tightening of the anal sphincter during attempted defecation. This paradoxical response makes evacuation extremely difficult but often improves with relaxation training and pelvic floor retraining techniques.
   
7. Postpartum Constipation—Common after childbirth due to weakened, stretched, or overactive pelvic floor muscles and scar tissue from tears or C-sections. Hormonal shifts, pain, or fear of re-injury can also contribute, making postpartum-specific pelvic therapy an important part of recovery.
   

Causes of Constipation & Dyssynergic Defecation

Constipation and bowel dysfunction have multiple contributing factors, often overlapping between digestive and pelvic health. Common causes include:

1. Pelvic Floor Dysfunction: Overactive or weak pelvic floor muscles prevent coordination during bowel movements. At FeminaPT, this is often linked with dyssynergic defecation, where the muscles contract instead of relaxing, making it harder to pass stool.
   
2. Postpartum Changes: Vaginal birth, perineal tears, or C-section scars can alter muscle function, leading to postpartum constipation. These changes can also affect tissue mobility and nerve signaling, which may disrupt normal bowel emptying.
   
3. Pelvic Organ Prolapse: Prolapse can create mechanical blockages, worsening outlet obstruction constipation. This often overlaps with straining or incomplete evacuation symptoms addressed in pelvic floor therapy.
   
4. Scar Tissue or Adhesions: Following surgery or childbirth, scar tissue can restrict movement in the pelvic and abdominal region. This restriction may alter organ mobility and disrupt bowel coordination, leading to chronic dysfunction.
   
5. Nerve Dysfunction: Neurological issues can affect how the pelvic floor communicates with the rectum and colon. In some cases, conditions like pudendal neuralgia or spinal injury play a role in impaired bowel reflexes.
   
6. Behavioral Patterns: Habitual straining, delaying bowel movements, or chronic stress can alter muscle coordination. Over time, these patterns reinforce poor mechanics and can heighten pelvic floor tension or weakness.
   
7. Dietary Factors: Low fiber intake, dehydration, or food intolerances can worsen symptoms of functional constipation. Optimizing nutrition and hydration is often combined with pelvic therapy to improve stool quality and ease of passage.
   

Symptoms of Constipation & Dyssynergic Defecation

Women with constipation and defecatory dysfunction may notice a range of symptoms, including:

1. Infrequent or difficult bowel movements
   
2. Straining or pain during defecation
   
3. Sensation of incomplete emptying
   
4. Bloating, abdominal pressure, or discomfort
   
5. Pelvic floor constipation sensations, such as pelvic heaviness or rectal pressure
   
6. Need for manual assistance (e.g., pressing on the perineum or vaginal wall to pass stool)
   
7. Worsening of pelvic organ prolapse or urinary issues
   
8. Discomfort or tearing with postpartum constipation
   

Recognizing these constipation pelvic floor symptoms is the first step toward finding effective, lasting relief through targeted therapy.

How Pelvic Floor Physical Therapy Can Help

Pelvic floor and orthopedic physical therapy offer effective, noninvasive treatments for chronic constipation and dyssynergic defecation—a condition where pelvic floor muscles fail to relax properly during bowel movements. At Femina Physical Therapy, these therapies are tailored to help individuals regain normal bowel function and improve quality of life.

How pelvic floor & orthopedic physical therapy can help in treating constipation & dyssynergic defecation:

1. Rehabilitates Pelvic Floor Coordination: Therapists employ biofeedback and manual techniques to retrain the pelvic floor muscles, promoting proper relaxation during defecation and reducing symptoms like straining and incomplete evacuation. 
   
2. Enhances Abdominal and Diaphragmatic Function: Incorporating breathing exercises and abdominal muscle training can help generate effective intra-abdominal pressure, facilitating smoother bowel movements. 
   
3. Addresses Pelvic Floor Muscle Tightness: For individuals with hypertonic pelvic floor muscles, therapy focuses on reducing muscle tension, alleviating associated symptoms like pelvic pain and discomfort during bowel movements. 
   
4. Improves Sensory Awareness: Therapy techniques aim to enhance the awareness of rectal fullness and the urge to defecate, aiding in better timing and coordination during bowel movements. 
   
5. Prevents Long-Term Complications: By addressing the underlying dysfunctions, therapy helps prevent issues like pelvic organ prolapse, which can result from chronic straining during bowel movements. 
   
6. Provides Personalized Treatment Plans: Femina Physical Therapy offers individualized therapy sessions, including assessments and tailored exercises, to meet the specific needs of each patient. 
   

If you’re experiencing chronic constipation or dyssynergic defecation, consulting with a specialized pelvic floor and orthopedic physical therapist can provide effective solutions tailored to your needs. FeminaPT offers expert care to help you achieve optimal pelvic health and improve your quality of life.

Treatment Options at Femina Physica Therapy

At FeminaPT, we specialize in treating constipation through a pelvic health lens. Unlike general recommendations that only address diet or laxatives, we focus on correcting the muscle coordination issues at the root of dyssynergic defecation and pelvic floor constipation. Our approach is holistic, combining manual therapy, neuromuscular retraining, education, and lifestyle strategies to restore natural bowel function. Every treatment plan is individualized based on your unique symptoms and contributing factors.

Here are some of the ways our pelvic health therapists address constipation and bowel dysfunction:

1. Pelvic Floor Muscle Training—Teaching the muscles to relax and coordinate correctly during bowel movements. This helps reduce straining, improves efficiency, and retrains proper muscle activation patterns.
   
2. Biofeedback Therapy—Using visual or auditory feedback to help retrain pelvic floor coordination for smoother bowel movements. Visual or auditory feedback is used to retrain pelvic floor coordination for smoother bowel movements. Patients learn to recognize when they are contracting instead of relaxing and practice correcting these patterns in real time.
   
3. Manual Therapy—Hands-on techniques to release tight muscles, scar tissue, or fascial restrictions contributing to constipation. This improves mobility in the pelvic floor, abdomen, and hips, which can restore normal bowel mechanics.
   
4. Myofascial Release—Gentle release techniques targeting connective tissue to reduce restrictions in the abdomen and pelvis. Releasing these areas can improve organ mobility, reduce tension, and support more natural bowel movements
   
5. Behavioral & Postural Retraining—Guidance on optimal toileting positions and habits to improve elimination. Simple adjustments, like foot placement or posture, can make elimination easier and reduce strain on the pelvic floor.
   
6. Breathwork & Core Training—Coordinating breath with core and pelvic floor relaxation for more effective defecation. His approach reduces abdominal pressure and encourages natural bowel emptying without straining.
   
7. Education on Bowel Mechanics—Teaching strategies to minimize straining and encourage healthy stool passage. Education may include timing, positioning, and muscle relaxation techniques tailored to each person’s needs.
   
8. Postpartum Constipation Care—Targeted rehabilitation for mothers recovering from delivery-related pelvic dysfunction. Therapy may address scar tissue, pelvic floor weakness or tightness, and coordination issues caused by pregnancy or childbirth.
   
9. Lifestyle & Nutrition Guidance—Support in managing fiber intake, hydration, and activity to complement physical therapy. These changes work alongside pelvic floor treatment to improve stool consistency and bowel regularity.
   

Each treatment is designed to restore balance, reduce straining, and improve long-term bowel health without dependency on medication.

Frequently Asked Questions

1. What is dyssynergic defecation?
– Dyssynergic defecation is when the pelvic floor muscles contract instead of relaxing during a bowel movement, making stool passage difficult or incomplete.

2. Can physical therapy really help with constipation?
– Yes—especially for pelvic floor constipation and dyssynergic defecation, where the root cause is muscle dysfunction rather than diet alone.

3. How is pelvic floor constipation different from regular constipation?
– Pelvic floor constipation occurs when the muscles fail to coordinate, while regular constipation may be caused by slow digestion, dehydration, or low fiber intake.

4. Is constipation therapy safe during postpartum recovery?
– Absolutely. At Femina PT, we specialize in postpartum constipation care, tailoring treatments to be safe, gentle, and effective after childbirth.

5. How long does it take to see results?
– Many patients notice improvement within a few sessions, though chronic or complex cases of defecatory dysfunction may require longer treatment for full recovery.