Chronic Constipation Treatment in Clapham

Constipation isn’t just about how often you go. You may be constipated if you:

• Go less than three times a week, or less often than is usual for you
• Pass poo that is hard, dry or lumpy
• Need to strain or push hard to empty
• Feel you haven’t fully emptied, even straight after going
• Need to press around the vagina or perineum, or change position, to help a bowel movement
• Have bloating or tummy discomfort

Needing to press to empty can be a sign of a bowel prolapse (rectocele), which physiotherapy can also help with.

Constipation usually has more than one cause. As well as diet, fluids and activity, the pelvic floor plays a bigger role than many people realise.

Pelvic floor dyssynergia

Also called dyssynergic defecation, this is when the pelvic floor muscles tighten instead of relaxing as you try to empty. It’s like trying to push through a closed door, and it often explains why constipation hasn’t improved with diet changes alone.

Pregnancy and after birth

Hormonal changes, iron supplements, pain relief and a sore or healing perineum all make constipation common in pregnancy and after birth. Postnatal physiotherapy can help you empty comfortably while you heal.

Menopause

Hormonal changes around perimenopause and menopause can affect bowel habits and pelvic floor function.

Diet, fluids and lifestyle

Not enough fibre or fluids, low activity, ignoring the urge to go, stress and some medicines, including certain painkillers, can all contribute.

After surgery

Pain relief, reduced movement and changes to the pelvic floor make constipation common after operations such as a hysterectomy.

Physiotherapy focuses on how your pelvic floor, breathing and tummy muscles work together when you empty. Your plan is tailored to you, but may include:

• Pelvic floor retraining: learning to relax the pelvic floor at the right moment, rather than tighten it
• Breathing and emptying technique: how to use your breath and tummy muscles to empty without straining
• Toilet position: setting you up so emptying is as easy as possible
• Bowel massage: abdominal massage techniques you can use at home to help move things along
• Bowel habits and diet advice: routine, fibre and fluids that support regular, comfortable bowel movements

The best toilet position

Sit with your feet on a low stool so your knees are higher than your hips, lean forward with your elbows on your knees and keep your back straight. This straightens the angle of the bowel and makes emptying easier, which is why the NHS recommends resting your feet on a stool.

Don’t strain

Relax your tummy and let it bulge gently forward as you breathe out, rather than holding your breath and pushing. Straining puts pressure on the pelvic floor over time.

Go when you feel the urge

Putting off the urge to go makes poo harder and drier. Many people find a regular time after breakfast works well.

Fibre, fluids and movement

Gradually increase fibre, drink plenty of fluids and stay active. If these haven’t helped, that’s often a sign the pelvic floor needs looking at.

Your first appointment lasts 60 minutes and takes place in a private, judgement-free room at our Clapham clinic. Olivia will:

• Talk through your bowel habits, symptoms, diet, medical history and goals
• Assess your posture, breathing and how your tummy and pelvic floor work together
• With your consent, carry out an internal examination to assess how well your pelvic floor relaxes and coordinates. It’s always optional and fully explained beforehand
• Explain what she has found and agree a treatment plan with you

You may be asked to keep a short bowel diary, which helps show patterns and track progress.

Many women notice easier, more comfortable emptying within a few weeks of starting treatment. Retraining a pelvic floor that has been tightening for a long time can take a few months, and Olivia will review your progress at each appointment.

See your GP first if you have blood in your poo, have lost weight without trying, notice a sudden or lasting change in your bowel habits, feel extremely tired, or have severe tummy pain. Also speak to your GP if constipation isn’t improving with treatment, as some medicines and medical conditions can cause it. Olivia will refer you on if anything in your assessment needs medical review.