Chronic constipation can have a direct impact on the symptoms of urinary incontinence.

Link between chronic constipation and urinary incontinence

You suffer from chronic constipation if:

  • You experience any two of the following bowel movement symptoms for at least 12 weeks of the year (the weeks do not have to be consecutive):

    • You need to push hard for at least 1 out of every 4 bowel movements.

    • You have hard or grainy stools for at least 1 out of every 4 bowel movements.

    • You have a sensation of incomplete bowel evacuation for at least 1 out of every 4 bowel movements.

    • You feel like you have blocked stool for at least 1 out of every 4 bowel movements.

    • You need to place a finger in your vagina or anus to dislodge stool for at least 1 out of every 4 bowel movements.

    • You have a bowel movement fewer than 3 times per week.

The figure below shows the link between chronic constipation and urinary incontinence:

 

Lifestyle-related causes of constipation

  • A diet low in fibre

  • Insufficient hydration

  • Sedentary lifestyle, physical inactivity

  • Poor bowel habits, such as ignoring the need to defecate or waiting too long before going to the bathroom

 

Tips to prevent constipation

  • Drink enough water (at least 1-1.5 liters a day)

  • Watch your diet:

    • Increase your intake of dietary fibre (see table below). A total of 21g per day of fibre is recommended. However, you should gradually increase your intake of dietary fibre to prevent flatulence and bloating (increase your intake by about 5g per week, according to your tolerance).

    • You can also eat prunes and drink prune juice, as these foods promote “intestinal peristalsis” and will help you have a bowel movement. Intestinal peristalsis is the term for the movement that propels food along the digestive tract.

 
 

Amount of fiber in different foods

 

  • Exercise regularly. Exercise after a meal to get the most impact out of physical activity on intestinal peristalsis. 

Abdominal massage to promote bowel movements

  • Massage your stomach after each meal (see figure below). Use the palm of your hand to perform three deep and small circles:

  1. On your right side, from your pelvis to your rib cage (A-B).

  2. Repeat step 1 above and, without lifting your hand, continue massaging toward the rib cage on your left side (A-B-C).

  3. Repeat step 2 above but continue massaging downwards on the left side toward your pelvis (A-B-C-D).

 
 

A number of medications (such as anti-inflammatory drugs, and calcium and iron supplements) can cause constipation. Ask your pharmacist or doctor if any of your medications may be contributing to your constipation and whether certain medications need to be stopped or changed.

If your constipation persists despite the non-medication approaches described above, occasionally or briefly taking over-the-counter laxatives [e.g., docusate sodium (Colace®) or senna (Senokot®)] could help you. If your constipation persists despite occasionally taking a laxative or if you need to take them every day for several weeks, you should talk to your doctor or pharmacist to have your treatment changed.

To avoid weakening your pelvic floor muscles, it is important not to hold your breath when you bear down to have a bowel movement.

To make your bowel movements easier, wait until you feel the urge to defecate. When you feel the urge to go, use the correct position (see figure below).

Correct defecation position and technique

  • When sitting on the toilet, rest your feet on an object about 15 cm high, such as a foot stool or dictionary. Put your feet flat on the object so that your knees are higher than your hips. This position mimics squatting, which is the ideal position for bowel movements. 

  • Then, lean slightly forward while keeping your back straight. Make a fist, press your thumb against your mouth and then exhale into your fist. This technique allows you to have a bowel movement without pushing, as it optimizes abdominal pressure. It is important not to hold your breath while pushing, as this places too much pressure on your perineum. If you can't pass the stool right away, don't force it out; wait until later when you feel the urge to go again.