Autonomic Nervous System Series Vol. 016 | Could you be constipated even if you go every day? Chronic constipation from the perspective of the autonomic nervous system, rectal sensation, and the pelvic floor

"I haven't had a bowel movement for several days."

"I go every day, but I don't feel relieved."

"My stool is hard, and I have to strain hard to pass it."

"I feel like it's stuck at the exit."

These conditions may be related to chronic constipation.

When people think of constipation, they might imagine a state of infrequent bowel movements.

However, even if you have a bowel movement every day,

• You have to strain hard to pass it
• Your stool is hard
• It takes a long time to have a bowel movement
• You feel like you haven't finished
• You feel like the exit is blocked

If symptoms like these persist, it may be classified as constipation.

Constipation is not just about "poor bowel movement" or "lack of dietary fiber."

It is complexly related to the sensation of the rectum that feels the urge to defecate, breathing, abdominal pressure, pelvic floor muscles, posture, the autonomic nervous system, and daily rhythm.

"Holding back the urge to defecate," common among busy women

Women in their 30s and 40s are often busy with work, housework, and childcare, and may end up putting off their own bowel movements.

Even if you feel the urge to defecate in the morning,

"I have to get the kids ready."

"I'm going to be late for work."

"I don't feel comfortable using public restrooms."

It is not uncommon to hold back the urge to defecate for reasons like these.

When stool moves to the rectum, the rectal wall stretches, and that stimulus is transmitted to the brain, which is how you feel the urge to defecate.

However, if you repeatedly ignore the urge to defecate, you may gradually become less sensitive to that urge.

Ignoring the urge to defecate
↓
Stool remains in the intestine for a long time
↓
Water is absorbed, making the stool hard
↓
Pain or strong straining occurs during bowel movements
↓
Further avoidance of bowel movements

This leads to a vicious cycle.

For women, factors such as the menstrual cycle, pregnancy and postpartum changes, decreased physical activity, dietary intake, and lack of sleep can also affect bowel movements.

It is important not to just endure it by thinking it is 'just a disruption in the body's rhythm,' but to also pay attention to the hardness of the stool, the feeling of incomplete evacuation, and the strain during bowel movements.

The pelvic floor muscles are not just for strengthening

The pelvic floor muscles are the muscles that support the bladder, uterus, and rectum from below.

While 'pelvic floor muscle exercises' are often introduced for preventing urinary incontinence, it is necessary to properly relax the pelvic floor muscles during bowel movements.

When having a bowel movement,

・The diaphragm moves
・Abdominal pressure increases
・The rectum contracts
・The anus and pelvic floor muscles relax
・The body leans slightly forward

These movements occur in a coordinated manner.

However, if the pelvic floor muscles do not relax when straining, and instead tighten, it becomes difficult to pass stool even if it has reached the exit.

In such cases, simply strengthening the abdominal and pelvic floor muscles may actually make it harder to release tension.

What is needed is not just strength, but the ability to 'relax' at the appropriate time.

For childhood constipation, pay attention to 'signs of holding back'

Constipation in children is also not uncommon.

Once a child has a painful experience with hard stool, they will try to avoid the next bowel movement.

・Crossing their legs
・Clenching their buttocks tightly
・Standing on tiptoes
・Hiding in a corner of the room
・Not wanting to go to the toilet

Such behaviors may look like they are straining, but in reality, they may be holding back to prevent the stool from coming out.

If stool is held back, it becomes even harder, making the next bowel movement painful as well, thus continuing the vicious cycle.

When parents blame their child by saying,

"Why don't you go to the bathroom?"

"It's because you don't eat your vegetables."

the child may feel even more anxious about having a bowel movement.

Behind constipation, there may be hidden factors such as not only pain during bowel movements, but also a dislike of school or daycare toilets, sensitivity to sounds or smells, unstable posture, or changes in the living environment.

First, it is important to understand that the child is not constipated on purpose, and to create an environment where they can have a bowel movement with peace of mind.

The relationship between the autonomic nervous system and constipation

Large intestine movement, secretion, and blood flow are regulated by the enteric nervous system and the autonomic nervous system.

When sleep deprivation, the burden of work or childcare, environmental changes, or intense tension continue, it becomes difficult for the body to switch to a state of rest.

This can lead to:

・Shallow breathing
・Constant tension in the abdomen
・Difficulty noticing the urge to defecate
・Inability to relax even when having a bowel movement

These conditions may occur.

However, not all constipation is caused solely by the autonomic nervous system.

Dietary intake, hydration, the influence of medication, thyroid or neurological diseases, and problems with the large intestine or rectum may also be involved.

How Osteopathy views it

At Morita Therapy Room, we do not just chase after the symptom of constipation.

・Head, neck, and the autonomic nervous system
・Thorax and ribs
・Diaphragm and breathing
・Abdominal wall tension
・Lumbar spine, sacrum, and pelvis
・Coordination of the pelvic floor and abdominal pressure
・Hip joints and defecation posture
・Sleep and lifestyle rhythms

We evaluate these and other factors comprehensively.

Osteopathy evaluates the entire body, aiming to create a physical environment where the nerves, respiration, circulation, joints, and fascia can function easily.

The goal is not to temporarily induce a bowel movement after treatment.

We aim for a "relaxed body" that notices the urge to defecate, avoids straining unnecessarily, and leads to natural bowel movements.

Things to be mindful of in daily life

When you feel the urge to defecate, try not to put it off as much as possible.

Since the intestines are more active after breakfast, creating a habit of sitting on the toilet for a few minutes is one effective method.

If your feet do not reach the floor, using a footstool to keep your knees slightly higher than your hip joints and leaning forward slightly can make it easier to defecate.

While dietary fiber is important, increasing it too suddenly can worsen gas and abdominal bloating.

Please adjust your intake of water, food, and physical activity gradually.

If you are using laxatives, do not stop them on your own due to concerns about "becoming dependent"; consult your doctor or pharmacist.

Symptoms that warrant consultation with a medical institution

If you have the following symptoms, do not assume it is just an issue with your autonomic nervous system or constitution; please consult a gastroenterologist or pediatrician.

・Blood in stool, black stool
・Unintentional weight loss
・Anemia or fever
・Severe abdominal pain or vomiting
・Sudden onset of constipation
・Poor growth or weight gain in children
・Severe constipation persisting since infancy

Constipation should not be judged solely by the frequency of bowel movements.

Natural bowel movements only occur when intestinal motility, the urge to defecate, rectal sensation, breathing, abdominal pressure, the pelvic floor, and posture all work in coordination.

At Morita Treatment Room in Okayama and Kurashiki, we evaluate the entire body, not only for adults but also for children who suffer from recurring constipation.

※This article is for informational purposes only and is not a substitute for medical diagnosis or treatment.

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