Constipation | Managing Bowel Dysfunction with Physiotherapy
Physiotherapy is undergoing rapid growth and development to widen its horizons. A wide variety of diseases are being treated by physiotherapists. One of them is the management of constipation. Constipation occurs when the colon's muscle contraction is slow or sluggish which delays transit time. This results in hard and dry stool that can lead to straining and pain during a bowel movement. It is very important for our health and overall well-being to move our bowels regularly and with ease. In case of constipation if proper treatment is not taken at the initial stage, then it might even lead to life-threatening risks. Exercises to relieve constipation both in the short and long term are found to be effective and without any side effects. Exercises help to increase muscle activity in the intestines and with peristalsis i.e. wavelike movements that push the contents of the digestive tract forward for proper transit in the colon. In this blog, we have discussed physiotherapy management for patients suffering from constipation.
Constipation
Constipation is a symptom rather than a disease, the patient suffering from constipation feels bowel frequency fewer than 3 times a week, needs to strain more than 25% of the time during defection, can also have lumpy or hard stools for more than 25% of bowel movements. There is a sensation of anorectal blockage or incomplete evacuation for more than 25% of bowel movements. Constipation can occur due to hormonal changes, neurological problems, rectocele, hyposensitive rectum, stenosis of the internal anal sphincter, irritable bowel syndrome (IBS), colon cancer, sedentary lifestyle, older age, even certain medications, mental health, eating disorders, etc.
Physiotherapy Management:
Physiotherapy treatment involves lifestyle modification and regular exercises. The patient is educated about the toileting techniques, to avoid straining during a bowel movement to decrease the risk of developing pudendal nerve dysfunction. These techniques include:
- While sitting on the toilet, the patient should lean forward with feet positioned on a step stool this position decreases the anorectal angle, thus easing the evacuation of stools.
- Another technique helps to move bowels more easily by attaining a squatting position when the knees are higher than the hips.
- The patient is asked to perform huffing or forced respiratory expiration during defecation, this helps to activate the abdominal oblique muscles, which assist in the propulsion of stools.
Propulsive abdominal bowel massage:
Propulsive abdominal bowel massage is a safe, non-invasive technique and can be performed by the patient independently. This technique promotes bowel mobility throughout the colon, this helps in increasing peristalsis in the gut. The patient applies constant moderate pressure to the abdomen with 2 or 3 fingers. Initially small, clockwise circular movements at the right anterior superior iliac spine, located at the base of the ascending colon are recommended. Further progression is made by moving up the ascending colon towards the base of the rib cage, the place where it meets the transverse colon. The circular movements are applied across the transverse colon toward the left upper quadrant of the abdomen and then down over the descending colon toward the left anterior superior iliac spine. This massage should be performed for 10 minutes on daily basis.
Pelvic Floor Exercises:
Pelvic floor exercises help to relax and tighten the muscles in the pelvis. Relaxing the pelvic floor muscles at the right time during defecation can help to pass stool more easily. A catheter is inserted into the rectum to measure muscle tension. The physiotherapist guides through the exercises to alternately relax and tighten the pelvic muscles. Relaxing the pelvic floor muscles at the right time during defecation can help to pass stool more easily.
Breathing Exercise:
Stress or anxiety can be the major reason for constipation, to relieve it breathing exercises can help relax the mind and relieve stress or depression. There are a wide variety of breathing exercises like diaphragmatic breathing alternate nostril breathing, 4-7-8 breathing, or even the simplest normal breathing can be done by just inhaling and exhaling slowly.
Cardio Exercises:
Cardiac exercise is a type of aerobic exercise that can help the cardiovascular system. These exercises increase blood flow, build endurance, and improve bowel movement. These exercises are simple and easy to do and tremendously help get relief from constipation. Common cardiac exercises are walking, running, jogging, cycling, jump- rope and swimming.
Bird Dog:
The person is asked to attain a dog posture by placing the hands and legs on the floor. Then asked to raise the left arm and right leg backward in a way such that they are parallel to the floor for a few seconds and then return to the starting position. The patient is then asked to change and raise the right arm and left leg in a similar way for 30 seconds. This exercise should be done 10 times.
Bridge:
The patient is asked to lie on the back while the legs are outstretched. Then bend the knees so that both the knees are pointed up with feet on the floor. The patient is then asked to extend the arms along the body's sides with palms facing down. Further, the arms and feet are pushed down while lifting the cheek. This posture should be maintained for 30 seconds.
Deep Squat:
Deep squatting exercises have incredible results because it imitates the natural defecation posture of humans. These exercises are done 10-15 times. Initially, the patient is asked to start slowly by raising and lowering the body gently. The squatting posture is held for 10- 15 seconds.
Forward Lunges Exercises:
The patient is asked to stand straight with the torso tightened, shoulders and back relaxed. Keep the neck straight and stable while exercising, take a step in the forward direction with one leg, bending both the legs downwards. As the patient lands forward, the knees should make a straight line with the ankle. While the back knee shouldn't be touching the floor. Try shifting the weight on the heels instead, but don't take the strain on the knees. Hold this position for 5 to 10 seconds and then come to the starting position. Repeat the same with the opposite leg. do 10-15 repetitions with each leg.
Wind Relieving Pose:
The patient lies on the floor on the back and hands by the sides. Then bends one of the legs and brings it towards the chest such that the knee is touching the chest. Once the leg is brought close, hold and pull the leg with a gentle hand. Hold this position for 10 to 30 seconds and then release the leg and return to the starting position. Repeat the exercise with the opposite leg.
The best time to do the exercises is in the morning. Exercising creates adrenaline. It is the type of chemical that is a good remedy for stress, makes the body more relaxed. Keeps the body in a good mood, ready for action. Though some people can exercise in the evening, adrenaline can them keep awake during the first half of the night, as the effect of adrenaline goes after 4-5 hrs. If the patient feels any discomfort or irritation around the abdominal area, then he/she should stop doing exercise.
