By: Dr. Tanvi Maharaja PT, DPT at Signature Healthcare.
We don’t appreciate the small things in life until we don’t have them anymore. Such as bowel movements.
While some of us are blessed in this department, others are miserable: some more periodically so than others. We don’t really think much of it unless it becomes a real problem. And this is why it is important to understand what normal is.
As a pelvic PT, I routinely screen patients for constipation. And very often patients do not know they are constipated despite meeting the criteria for functional constipation. Let us delve into this a little more.
As moms, we may be familiar with the following chart that pediatricians often show us to identify stool types in infants.
This chart applies to adults, too. It is worth reviewing. Hard lumpy stools that are typical in constipation can become really problematic, especially in women, because when constipation becomes chronic, and the stool type is from 1 to 3 for a prolonged period of time, it can lead to pelvic health issues such as pelvic organ prolapse. The ideal stool type is about a 4.
Other parameters indicative of healthy bowel movements are not needing to strain to have a bowel movement, frequency of bowel movements between 3 times a day to 3 times a week (less than 3x/week is not ideal), and feeling done when you are done.
In fact, there are specific criteria established by the Rome Foundation, a leading international organization that brings scientists and clinicians from around the world together, to figure out gastrointestinal dysfunctions.
These dysfunctions are known as Disorders of Gut Brain Interactions (DGBI’s). Constipation is a type of DGBI, and the following are the diagnostic criteria for Functional Constipation:
- Must include two or more of the following over the past 3 months:
- Straining to defecate (>25% of the time): huffing and puffing to poop
- Lumpy or hard stools (Bristol Stool Form Scale 1-2) (>25% of the time)
- The sensation of incomplete evacuation (>25% of the time): not feeling done when we are done, feeling backed up
- The sensation of anorectal obstruction/blockage (>25% of the time)
- Manual maneuvers to facilitate (>25% of the time): having to use hands to support pelvic floor or to evacuate
- Fewer than three soft BM per week
- Loose stools are rarely present without the use of laxatives
- Insufficient criteria for irritable bowel syndrome (IBS)
**FC does not include opioid-induced constipation (OIC); however, these two conditions may overlap.
In my next blog post, I’ll review what causes constipation, and what are some of the treatment options. But the first step is to figure out whether or not one is constipated. If you meet at least two of the above criteria, you may be suffering from functional constipation, which is more than just an annoyance. It can have some long-term health consequences.
Doctors at Signature Healthcare are trained in diagnosing and treating constipation, and pelvic floor physical therapists can be an important part of your healthcare team.
Dr. Tanvi Maharaja PT, DPT
Board-Certified Specialist in Orthopedic Physical Therapy
Pelvic Health PT (male/female, peds, cis/transgender)
Pregnancy and Postpartum Corrective Exercise Specialist
Yoga Life Coach
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