Can Your Pelvic Floor Be the Reason You’re Constipated?
If you’ve been struggling with constipation and haven’t found a clear answer, your pelvic floor might be the missing piece of the puzzle. It sounds surprising at first — but once you understand the anatomy, it makes complete sense.
The Pelvic Floor Is More Than You Think
Most people think of the pelvic floor as one muscle, but it’s actually a group of skeletal muscles that form the base of your pelvis. These muscles don’t just support your organs — they’re directly connected to the structures that control how and when you have a bowel movement. When those muscles are too tight, too weak, or not coordinating properly, the effects ripple outward in ways most people never expect.
Three Key Connections Between Your Pelvic Floor and Your Bowel
1. The External Anal Sphincter and the Perineal Body
The external anal sphincter — the muscle ring that keeps things closed until you’re ready to go — has three distinct layers. The outermost layer attaches directly to the perineal body, a central junction point of the pelvic floor. If the surrounding pelvic floor muscles are holding too much tension at that point, the outer layer of the sphincter becomes too tight as well. That means even when you want to release, the sphincter can’t fully relax — and constipation follows.
2. The Sacrum and Sphincter Mobility
The middle layer of the external anal sphincter attaches to the sacrum — the large triangular bone at the base of your spine. This matters more than most people realize. If your sacrum isn’t moving freely, your sphincter isn’t moving freely either. And if the sphincter can’t fully relax, fecal matter can’t pass through the way it needs to. Sacral mobility is a key — and commonly overlooked — factor in healthy bowel function.
3. The Puborectalis Muscle and the Anorectal Angle
The deepest layer of the sphincter connects to a muscle called the puborectalis (sometimes called the pubrectal muscle). This muscle wraps around the rectum and plays a major role in the anorectal angle — essentially, the angle at which your rectum meets your anal canal. For a complete bowel movement, the pelvis needs to tilt forward (an anterior tilt) so that angle opens up and stool can exit freely. If the puborectalis is too tight or rigid, it prevents that forward tilt, and the angle stays closed. The result? Incomplete emptying, straining, and chronic constipation.
What This Means for You
If you’re experiencing constipation alongside any of the following, pelvic floor dysfunction may be a contributing factor:
- Straining despite feeling the urge to go
- A sense of incomplete emptying after a bowel movement
- Pelvic tension, tightness, or discomfort
- Difficulty with anterior or posterior pelvic tilts
- Lower back or sacral stiffness
The Good News
Pelvic floor dysfunction-related constipation is treatable. A pelvic floor physical therapist can assess whether your pelvic muscles, sacrum, and sphincter complex are contributing to your symptoms and develop a personalized treatment plan — which may include manual therapy, movement re-education, and breath and coordination work.
You don’t have to just live with it. Understanding the connection is the first step toward real relief.
Content based on clinical education from Sheree DiBiase, PT, PRPC, founder of Lake City Physical Therapy.
