Photo by Margaret Young on Unsplash
Our first guest blog from Dr. Robin Ellis, DPT, from SET Physical Therapy.
If you’ve ever felt like you need to have a bowel movement but just can’t quite make it happen, you’re not alone—and you’re not imagining it.
One often-overlooked cause of chronic constipation is something called pelvic floor dyssynergia. It sounds complicated, but the concept is actually pretty simple once you break it down.
The pelvic floor is a group of muscles that sit at the bottom of your pelvis, kind of like a hammock. These muscles support your pelvic organs—including the rectum, bladder, and uterus or prostate.
But support is only part of their job.
Your pelvic floor muscles are also responsible for:
Helping you hold in urine and stool
Relaxing when it’s time to empty your bowels or bladder
Coordinating with your abdominal muscles during a bowel movement
You don’t usually have to think about these muscles—they’re designed to work automatically in the background.
Let’s talk about how a bowel movement is supposed to work.
Normally, your body performs a coordinated sequence:
Your abdominal muscles gently push
Your rectum contracts
Your pelvic floor muscles relax to let stool pass
In pelvic floor dyssynergia, that last step doesn’t happen correctly. Instead of relaxing, the pelvic floor muscles may tighten—or just not coordinate well—making it difficult to pass stool.
In plain English: your body is trying to go, but the “exit door” isn’t opening the way it should.
Pelvic floor dyssynergia is more common than many people realize and can play a major role in chronic constipation.
This can show up as:
Ongoing constipation despite fiber, hydration, or medications
Excessive straining
A feeling of incomplete emptying
Needing to shift positions or use manual assistance
Pelvic or rectal discomfort
This is important because not all constipation starts in the gut. Sometimes, the issue is more about coordination at the very end of the process.
There isn’t always a single clear cause. Some people develop it after:
Pregnancy or pelvic injury
Chronic straining over time
Surgery or trauma
Sometimes, no obvious reason at all
At its core, it’s a pattern your body has learned—often without you realizing it.
The encouraging news is that this condition is very treatable.
Pelvic floor physical therapy focuses on helping you relearn how to properly relax and coordinate these muscles during a bowel movement. Treatment may include guided exercises, breathing techniques, and strategies to improve bowel habits and positioning.
With the right approach, many people experience significant improvement in their symptoms.
Constipation isn’t always about what you’re eating or how fast your gut moves. Sometimes, it’s about how your body coordinates the final step.
And when that step improves, everything else can start to fall into place.
Robin Ellis, PT, DPT, OCS is a physical therapist at Set Physical Therapy in Atlanta, Georgia. She specializes in the treatment of pelvic floor dysfunction. She works with patients of all genders, helping individuals overcome issues like constipation, incontinence, pelvic pain, and sexual dysfunction through personalized, evidence-based care.
References
Stanford Health Care. Pelvic Floor Dyssynergia. Accessed March 18, 2026. https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/pelvic-floor-dyssynergia.html
Stanford Health Care. Pelvic Floor Dyssynergia Symptoms. Accessed March 18, 2026. https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/pelvic-floor-dyssynergia/symptoms.html
University of Iowa Health Care. Dyssynergic Defecation. Accessed March 18, 2026. https://uihc.org/health-topics/dyssynergic-defecation
Rao SSC, Seaton K, Miller MJ, et al. Psychological profiles and quality of life differ between patients with dyssynergia and those with slow transit constipation. J Psychosom Res. 2007;63(4):441-449.
World Gastroenterology Organisation. Pelvic Floor Dysfunction and Refractory Constipation. Accessed March 18, 2026. https://www.worldgastroenterology.org/publications/e-wgn/e-wgn-expert-point-of-view-articles-collection/pelvic-floor-dysfunction-and-refractory-constipation