Constipation can feel like one of those problems you are supposed to fix with more water, more fibre, and a longer walk. Sometimes that is exactly the answer. But when bowel movements happen less than three times a week and stools are hard, dry, or painful to pass, there may be a less obvious reason sitting in the background. One surprising culprit that often goes undiscussed is pelvic floor dysfunction.
Bowel habits vary from person to person, but constipation is typically described as fewer than three bowel movements weekly, often paired with bloating, nausea, cramps, or a lingering feeling that you did not fully empty. It is commonly linked to not getting enough fibre or water, stress, too little movement, or certain medications. The tricky part is that even when those basics are addressed, symptoms can stick around. That is where a deeper look can help, especially if constipation has become a regular pattern.
Some experts point out that constipation does not always stay limited to the gut. A backed up colon and rectum can press on the bladder, which may increase urinary urgency or make bladder control feel different than usual. That connection matters because it hints at what is happening in the muscles and pressure systems of the pelvis. When the pelvic floor is not working as it should, bowel and bladder symptoms can overlap in ways that are easy to miss.
Pelvic floor dysfunction happens when the pelvic floor muscles stay tense when they need to relax, including during a bowel movement. If those muscles do not properly release, emptying becomes difficult and stool stays in the colon longer. Over time, more water gets reabsorbed, which can make stool harder and more painful to pass. Straining can then add pressure that makes pelvic floor problems worse, creating a cycle where constipation feeds tension and tension feeds constipation.
The most helpful approach is often to tackle both sides of the issue at once. The basics still matter, hydration, enough fibre, and regular movement, since poor habits can contribute to pelvic floor strain. But if constipation persists despite these changes, it may be worth discussing pelvic floor support with a healthcare professional. Pelvic floor physical therapy can focus on relaxation and coordination, not just strengthening, and that can be the missing piece for people who have tried everything else.
Have you ever dealt with constipation that did not improve with the usual advice, and did anything unexpected help? Share your thoughts in the comments.
