How to make bowel movements easier as your pelvic floor changes

Straining. Sitting for ages. The feeling that you're never quite finished. Maybe even needing to press on the area around your vagina or between your legs to get things moving. These aren't things most women bring up with friends, and many don't mention them to their doctors either.

Symptoms like these can mean the muscles involved in a bowel movement aren't coordinating as well as they used to. The good news is that there are practical steps to try at home and effective treatments if those aren't enough. Here's how to work through them.

Why this becomes more common with age

Your pelvic floor is a group of muscles that supports your bladder, uterus and rectum. For stool to pass easily, some of these muscles need to relax at the right moment while you gently push. Pregnancy, childbirth, weight changes and aging all place demands on this system.

A nationally representative US study examined 1,961 women aged 20 and older. Nearly a quarter (23.7%) had at least one pelvic floor disorder, and 9.0% had fecal incontinence, meaning leakage of stool at least once a month. The share of women with at least one disorder rose from 9.7% at ages 20 to 39 to 49.7% at age 80 and older. It also increased with the number of deliveries, and overweight and obese women were more likely to be affected (Nygaard et al., 2008).

That study didn't measure constipation, but it shows how common pelvic floor problems become with age. If you're noticing changes, you're far from alone.

Steps to try at home

Step 1: Notice the pattern for a week

Each time you have a bowel movement, jot down:

• How long you sat and how hard you strained, from 0 to 10
• Whether stools were hard or soft
• Whether you felt fully empty afterward
• Whether you needed to press with your fingers to help stool pass
• Any leakage of stool or gas

Heavy straining or needing manual help, especially when stools aren't hard, can be a sign of a coordination problem rather than simple constipation. These notes help a doctor tell the difference.

Step 2: Change your position

Put your feet on a small stool so your knees are higher than your hips, lean forward slightly and rest your forearms on your thighs. In a study of 52 healthy volunteers, using a toilet footstool for two weeks was linked to more complete emptying, less straining and less time on the toilet compared with the two weeks before (Modi et al., 2019).

The volunteers were young, with an average age of 29, and most weren't women, so this is modest evidence for midlife women. But a footstool is inexpensive and easy to try.

Step 3: Breathe instead of bearing down hard

Rather than holding your breath and pushing as hard as you can, try a gentler approach:

1. Sit in the position above and let your belly relax outward.
2. Breathe in slowly through your nose.
3. Breathe out slowly through pursed lips, as if blowing through a straw, while letting the area around your anus soften.
4. Repeat for several breaths.
5. If nothing happens within about five minutes, get up and try again later rather than straining.

Step 4: Make stools easier to pass

Even well-coordinated muscles have a harder time with small, hard stools. Aim for steady fluids through the day, fiber from sources your gut tolerates and some daily movement. If you add fiber, increase it slowly and choose types that don't ferment too quickly. Here's how to spot a fiber that may cause more bloating.

When home steps aren't enough

Step 5: Ask about pelvic floor testing and biofeedback

If you still strain or feel incompletely emptied after a few weeks of these changes, ask your doctor about an evaluation for a defecation disorder. The American College of Gastroenterology has published clinical guidelines on evaluating and managing these problems, along with hemorrhoids, anal fissures and fecal incontinence (Wald et al., 2021).

One of the best-studied treatments is biofeedback, a form of guided muscle retraining with a trained therapist. In a randomized trial of 77 people (69 of them women) with chronic constipation and poorly coordinated pelvic floor muscles, three months of biofeedback was compared with sham feedback and with standard care of diet, exercise and laxatives. People in the biofeedback group were more likely to correct the coordination problem and had more complete spontaneous bowel movements than the other groups. They also used their fingers to help less often and were more satisfied with their bowel function than the sham group (Rao et al., 2007).

Step 6: Don't stay quiet about leakage

With 9% of US women reporting stool leakage at least monthly in the national study above, you're far from the only one if this happens to you (Nygaard et al., 2008). It's a medical symptom, not a personal failing, and a doctor can look for the cause and talk through treatment options.

When to see a doctor

• Blood in your stool, black stools or unexplained weight loss
• A new, lasting change in your bowel habits
• A bulge you can see or feel in or around the vagina
• Leakage of stool or gas you can't control
• Pain during bowel movements that doesn't settle
• Anemia, or a family history of colon cancer or inflammatory bowel disease

Sources

1. Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311-6. PMID 18799443
2. Modi RM, Hinton A, Pinkhas D, et al. Implementation of a defecation posture modification device: impact on bowel movement patterns in healthy subjects. J Clin Gastroenterol. 2019;53(3):216-219. PMID 30346317
3. Rao SS, Seaton K, Miller M, et al. Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clin Gastroenterol Hepatol. 2007;5(3):331-8. PMID 17368232
4. Wald A, Bharucha AE, Limketkai B, et al. ACG clinical guidelines: management of benign anorectal disorders. Am J Gastroenterol. 2021;116(10):1987-2008. PMID 34618700

This article is for general information and isn't medical advice. Talk to your healthcare provider about ongoing straining, incomplete emptying, leakage or pelvic pressure so the cause can be properly evaluated.