Pelvic Floor vs. Slow Transit

There is a trap that keeps people chronically constipated for decades, and most general practitioners never mention it.

It's the difference between Slow Transit Constipation and Pelvic Floor Dysfunction (also called dyssynergic defecation).

If you don't know which one you have, you might be treating the wrong disease. And the treatment for one often makes the other worse.

Camp 1: Slow Transit — the broken conveyor belt

This means your colon simply isn't contracting fast enough. Food enters, and it just sits there.

The symptoms:

• You go days without feeling the urge to go.
• When you finally do go, it's hard, dry, and pebble-like.
• You rarely feel a physical blockage at the exit; the problem is higher up.

The fix: osmotic laxatives (magnesium citrate, MiraLAX), prokinetics (ginger or artichoke extract), and hydration. You need to speed up the conveyor belt.

Camp 2: Pelvic Floor Dysfunction — the locked door

This means your colon is working fine, but the muscles at the exit — your pelvic floor — are malfunctioning. Instead of relaxing when you try to go, they involuntarily clench shut.

The symptoms:

• You feel the urge to go frequently, but nothing comes out.
• You feel a physical blockage right at the exit.
• You have to strain aggressively, or use manual maneuvers.
• Stools are often soft or normal consistency, but they still won't pass.

The fix: This is a mechanical problem, not a chemical one. Laxatives will just give you liquid stool trapped behind a locked door, which is miserable. The fix is pelvic floor physical therapy and biofeedback training to teach the muscles to relax.

The trap

If you have pelvic floor dysfunction and you keep taking laxatives and fiber, you will be in constant pain. Your body is trying to push material through a door that won't open.

If you suspect you are in Camp 2, ask your doctor for an anorectal manometry test. It's the only way to formally diagnose a tight pelvic floor.

Until next Monday,

— The Bowel Brief Team