Pooping, Pelvic Floor, and Back Pain?

Aug 15, 2022

For this week’s blog, I'm going to talk a little bit about why your bowel movement could be connected to how your low back feels, your SI joint feels, and how your pelvic floor is functioning. So those are the things that I feel like we don't often talk about. I feel like women's health is getting a lot more out there when it comes to urinary incontinence, and we're becoming more aware of that. But I think some of the things that people don't like to talk about still would be the fecal involvement. Your pelvic floor also affects the anus, same as the urinary opening and the vagina.


Pelvic Floor Dysfunction And Issues With Stool


So with pelvic floor dysfunction, not only can we have urinary leakage, urinary incontinence, pain with sex, pain with inserting a tampon, those kinds of things, but we can also have issues with stool, and that can be anywhere from constipation, chronic constipation to fecal smearing. Now, that wouldn't be the same as I've heard that termed with a behavioral issue with kids. This would be more like a fecal leakage which is the same as urinary leakage.

If you're noticing that you have fecal matter in your underwear and that kind of thing, you can't get a clean wipe afterwards, that would be more of what we're talking about. It’s not something that people want to talk about, but it is a clue that there might be an issue with your pelvic floor.

People don't like to talk about how often they go to the bathroom or anything like that, but that can also be an indicator of how our pelvic floor is functioning and how our body is functioning as a whole.

There is a great chart to use to assess yourself in just what your poop looks like - which sounds super weird - and some people probably never look in the toilet, but it might be a good idea if you're having some chronic issues that you aren't getting relief from. Because sometimes, that weird symptom that you think has nothing to do with something else or with your stool could be affecting your pelvic floor. And while you don't have classic pelvic floor symptoms, it might be showing up as chronic low back pain or SI joint pain, or a hip issue.

So this stool chart, it gives you a range of one through seven types of stool, and you simply just compare it. It goes anywhere from tiny little hard lumps to lumpy stool to a little bit more fully formed to that regular sausage-shaped - which is what would be the best kind of stool form, and then you get the looser end.

So it's trying to determine and help you determine how your body is processing food and also, how often do you go. Ideally, you should you be going every day, and a lot of people go days and days without going. This is not just from a pelvic floor issue, as this could tell us some things about your abdominal cavity and things that are going on in there. If we don't have really good breathing patterns, sometimes we get some stagnation of those abdominal organs, so that means not great lymph flow, not great blood flow, and that can affect our bowel habit.

That would also be an indicator that maybe we need to breathe better, do some abdominal massage to get better blood flow to those organs, and get better lymph flow. Remember, stagnant lymph is like a dirty fish tank. We want nice, circulated lymph for our organs to be bathed in, and that is going to decrease our inflammation. Because stagnant lymph equals inflammation.


Why A Good, Healthy Stool Pattern Is Going To Affect You

So there are multi-facets to why a good and healthy stool pattern is going to affect you physically and musculoskeletal as well. With the pelvic floor stuff, the old school version of “let's fix our pelvic floor” was to do a bunch of Kegels, and strengthen it, it must be weak if you're having leakage. That is kind of gone by the wayside, and we realize that we need to treat it like other muscles where we learn to get it to fully relax before we can get it to adequately contract and do the job that we want it to do.

The other thing to keep in mind with the pelvic floor is that it's not just one muscle that simply contracts and relaxes. You've got three openings coming out through there. If we look at it, we've got that urethrovaginal opening, so the urethra is coming in through there and the vaginal opening, and then we have the anal opening. For those of you reading this, we are looking at the pelvis model, and we're looking at the pelvic floor, and we're looking at the most superficial layers of muscles, and you can see the sphincter around the anus and the sphincter around the urethrovaginal opening.

When you peel that first layer off, we're looking at the vaginal opening, the urethra opening, and the rectal opening. And we're looking at that levator ani layer of muscles - the deeper layer that should lift. There are many fibers and different portions of the pelvic floor, so it doesn't all act as one, and you can have one portion of the pelvic floor be tighter than the other.

So if you're having an issue where you're having hip pain on one side, it might be an indicator that you have some asymmetry left to right in your pelvic floor. If you're having a constipation issue and not able to fully relax that area where you're having maybe some incontinence in the urethral area, you could have possibly some asymmetry front to back in the pelvic floor. So it doesn't work all as one. It can be varied, and the same goes for anywhere else in your body.

We would do a lot of core work in the office, and often, I will find that some women get very overactive and tight transverse abdominus at the top part of their abs, so the upper part of that muscle, and then at the lower part - maybe postpartum or just from having a baby or definitely if they've had a C-section - that lower part of the transverse abdominus can be underactive while the upper part can be overactive. It doesn't have to be a blanket statement for the whole muscle. The same goes for the pelvic floor.  You need to really hone in on what area of the pelvic floor is tighter than the other.


Doing The Half Happy Baby Yoga Pose – A Great Little Check-In With Yourself

I love that video that I posted a few weeks ago on half happy baby because it's a great way to feel which area feels more restricted left to right. If you're not a yoga person and you don't know what happy baby is, that's all right. It is where you are lying on your back and reach up to grab both feet, and you draw the thighs down towards your ribcage, and you get an opening in through the groin adductor area. Half happy baby is just doing one side at a time. You can have the other leg bent or straight out - we'll link that exercise below - but you can see, when you have the right leg up, and you're holding it open, you're trying to visualize the bowl that is the pelvic floor opening up more so to that right side. 

So you're getting more of a stretch along that right side. Then you would do it with the left leg, and you would see how you feel more of an opening and a stretch on the left side of the pelvic floor. And then you can kind of assess which side feels more restricted to you. It's a great little check-in with yourself. And then hopefully, as you practice it and do some release work and that kind of thing, you are able to feel them even out as you get better at fully relaxing both sides so that they're more symmetrical and more even. And then that helps with the musculoskeletal stuff that's attached around it like hip pain.

If you have been reading my past blogs, you’d know that would be what I struggled with last year. I had a hip issue, and I'm pretty certain it was a labral fraying or tear type of a thing. I had a lot of asymmetry in that way in my pelvic floor. And once I worked on it, then it started to even out, and I could feel that, and then the hip pain resolved.


Accessing The Back Half Of The Pelvic Floor

With the pelvic floor, when we're talking about bowel movements and constipation or leakage, we're talking more about the posterior or the back half of the pelvic floor. The back half of the pelvic floor, if you divided it, the sphincter around the anus, but also the levator ani, coccygeus, all of those muscles in the back half, to access that, what I love to start with is some release of the structures right around that border.

So if we look at the border of the pelvic floor, we've got the four points that make the borders. We've got your pubic bone in the front, the two bones that we sit on - if you're sitting in a chair, a hard chair, and you feel that bony prominence that sticks down, that is the part of your pelvis, it's called your (inaudible) tubes, and that's what we sit on. And then in the back half, we've got your coccyx, and it is that little bony point at the very end, and it really tucks under, and it doesn't just stick straight down. So it does have a curve to it. Everyone's curve is unique some people's curve is much more pronounced, and some people’s are not. We are not all proportioned the same. So just keep that in mind.

When I give people release work to do from the coccyx or the tip of your tailbone to the bone we sit on, I often see them try the move with a ball. I use a yoga tune-up ball, or you could use a tennis ball at home. I see people put it up in the fleshy part of their butt. So up higher. And I want you to think of where your pelvic floor is - that bowl that holds everything up. That is going to be way on the underside of your carriage. So think of that back half of the pelvic floor as circling around your anus. That is where you're headed. That is where the back half of the pelvic floor is. So it is very up close and personal into that space.

So when we access the sacrotuberous ligament, that would be from the bone you sit on to the sacrum, they just tell where the ligament's going from what to what. And then we also have sacrospinous, which is littler and along the side here. So when we're accessing that to try to get that backside border of the pelvic floor, we want to make sure we're way up and under into the bowl of the flesh of the pelvic floor. And it's going to be very midline because it's attaching almost right to that midline spot of the tailbone, the coccyx.

So you don't want to put a ball right up onto your tailbone and jam it straight in, but it's pretty midline. And then you just shift it towards whichever side you're working on, left or right, and then you're rocking the ball in towards essentially the anus, towards the belly of the pelvic floor, and then back out and then shift it in and then back out and in and back out. So that's a great way to access that back half of the pelvic floor.

Something to keep in mind is that you always want to tiptoe into this area, especially if you're having issues with it. If you're having issues with it, chances are it's going to be super sensitive, and you don't want to go in really heavy-handed, have it be super painful, and then you end up tightening up against it. We're kind of working against ourselves with that. So you want to go lightly, gently come into the area, and then you'll be able to accept more pressure as you go.

And then when you're switching from side to side, you just lighten up your pressure, slide to the other side and then address that. So you're going from this sacrotuberous and spinus – it’s a little above into the belly of your undercarriage essentially. And you can do it seated, you can do it on a wall. On the wall, usually, you can vary the pressure a little bit more. Your hamstrings might be too tight to get into that position, and if they are, you can always do it seated. But that is a great way to address the back side of the pelvic floor where you might have some tension.



If you're having those issues with bowel movements, remember that can be an indicator of something you need to address. If you've got chronic low back pain, hip pain, SI joint pain that isn't getting remedied by classic treatments to the low back, this might be your missing component.

This is not an issue solely for women. I have treated plenty of men who have the same issue that possibly have desk jobs, where they sit a ton or under an extreme amount of stress because we tend to carry a lot of stress there, and we'll clench our glutes, tuck our tailbones under.

Cyclists are very prone to having issues here because of the way bike seats are and not getting that area to relax if you are using it a great amount of time.

So if you have any questions, I highly recommend taking more interest in your stool, making sure that it matches up with the stool chart. Make sure that you're going regularly, and if you're not, you might want some abdominal visceral massage work. We do that in the office, but there are lots of people out there that do it in different professions - PTs, chiropractors, some muscle body-workers like athletic trainers or massage therapists. Sometimes they have studied those techniques.

So if you're interested in it, always interview whoever you're working with to see what kind of techniques they do and if they are well versed in that stuff.

So have a good one! Let me know if you have any questions.

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