A Common Yet Overlooked Concern

Most of us take for granted the simple routine of emptying our bowels—until it becomes a constant struggle. If you often feel like there’s still something “left” after you use the bathroom, you’re dealing with a common constipation symptom, specifically incomplete bowel evacuation. This issue, though common, is frequently misunderstood or brushed aside. Yet, it can significantly impact not only how you feel physically, but also can limit what you do on a daily basis (i.e. travel, hobbies, hanging out with friends).

Here at our clinic, I serve as a Doctor of Physical Therapy, dual board certified in Pelvic Health (WCS and PRPC), leading one of the most renowned pelvic health teams in the country. Our mission is to offer clear, evidence-based guidance on common concerns like constipation and specifically incomplete bowel evacuation. In this article, we’ll break down the causes, indicators, and effective approaches—including why pelvic physical therapy can make a huge impact on this condition.

Why Does This Happen?

When you feel like you never truly finish your trip to the toilet, it’s more than just an annoyance. It can be caused by various factors, such as:

• Pelvic Floor Dysfunction: Tight or weak pelvic muscles may fail to coordinate properly, making it difficult for the rectum to empty completely.

• Stool Consistency: Hard, infrequent stools can increase straining, ultimately leading to incomplete evacuation. On the other side, very soft stools can also cause you to not feel fully empty as well.

• Poor Toilet Posture: The way you sit and the angle of your hips can affect and even hinderhow stool moves through your rectum and out.

• Stress and Anxiety: Emotional tension can tighten the pelvic floor muscles, making it difficult for the pelvic floor muscles to relax for proper evactuation.

Incomplete evacuation can arise because of different factors in each person, which is why uncovering your root cause is crucial to break free from the vicious cycle of bloating, discomfort, and repeated bathroom trips.

How to Recognize the Signs

Although everyone’s experiences vary, you might suspect incomplete bowel movements if you notice:

1. Lingering Sensation of Fullness: A feeling that the bowel has not fully emptied.

2. Excessive Straining: Needing to push more than usual or feeling the urge to go again shortly after.

3. Frequent Small Trips: Visiting the bathroom multiple times in a short period without real relief.

4. Physical Discomfort: Abdominal pressure, bloating, or even rectal pain.

5. Excessive wiping: Feeling like you have to keep wiping, and continue to see stool on the toilet paper.

Many people are embarrassed to discuss these symptoms, even with healthcare providers. But remember: the sooner you recognize the signs, the faster you can get effective relief.

The Ripple Effect on Daily Life

Ignoring incomplete bowel evacuation can cause more than just bathroom woes. Over time, you may notice:

• Reduced Confidence: Worrying about odors, leaks, or urgent bathroom needs can hinder social outings.

• Stress and Sleep Disruption: Daily anxiety about bowel habits which can affect rest in turn heighten your sympathetic or “fight or flight” nervous system.

• Avoidance in Travel or hobbies: Often times bowel concerns might cause you to not want to leave your house or participate in things you enjoy.

• Potential for Hemorrhoids: Excessive straining can lead to or exacerbate hemorrhoids and/or anal fissures.

• Further Pelvic Floor Dysfunctions: You might develop chronic tension in the pelvic floor from straining which can trigger pelvic pain or built up stool in the rectum could cause urinary issues, like urinary incontinence, urinary urgency or frequency, or nocturia.

Tackling the problem early helps prevent it from spiraling into a more complex condition. Effective non-invasive solutions exist, and one of the most accessible and impactful is pelvic physical therapy.

First Steps Toward Relief

Before we dive into the role of pelvic PT, let’s look at some simple yet impactful strategies you can try on your own:

1. Stay Hydrated: Drinking enough water helps soften stool, making it easier to pass. Aim for six to eight glasses a day, depending on your body’s needs. You might need more dependent on how much you exercise, warm weather climates, or other medical factors.

2. Fiber-Rich Foods: Whole grains, fruits, and vegetables add bulk, allowing for smoother bowel movements. Make sure to add fiber gradually to avoid bloating and abdominal discomfort.

3. Optimize Your Toilet Posture: A footstool (or a squatty potty) can help raise your knees above hip level, straightening the rectal angle and making evacuation easier.

4. Avoid Excessive Straining: Take deep, relaxed breaths while on the toilet. Pushing too hard, especially while holding your breath during bowel movements can worsen pelvic floor tension, and inhibit the pelvic floor from fully relaxing to empty.

5. Stress Management: Techniques like gentle yoga, meditation, or diaphragmatic breathing can reduce muscle tension in the pelvic region, and improve motility in the gut for natural stimulation of your emptying reflex, the gastrocolic reflex.

These steps may offer partial relief, but if you find yourself still struggling, pelvic floor physical therapy often helps to piece your specific puzzle together.

How Pelvic Physical Therapy Makes a Difference

Now, let’s get to the heart of why pelvic physical therapy is often the turning point in tackling incomplete bowel evacuation. As a specialized pelvic health physical therapist with a WCS and PRPC, I focus on evaluating and treating the intricate network of muscles, nerves, and connective tissues in your pelvic region.

Personalized Assessment

We start with a thorough evaluation that includes a discussion of your symptoms, lifestyle, and medical history. We look at your posture, muscle coordination, and even breathing patterns. This holistic approach ensures we identify every contributing factor that you may and may not be aware of.

Specific Exercises

Pelvic floor exercises aren’t just about Kegels (which are often misunderstood). We create a program to your body’s specific needs, possibly incorporating:

• Reverse Kegels or Relaxation Exercises: These are exercises that lengthen your pelvic floor for those with tight or overactive muscles.

• Coordination Training: These are exercises that work on the coordination of lengthening your pelvic floor while creating pressure at the abdomen to allow for productive pushing during bowel movements.

• Abdominal Massage and Mobility Work: These are hands on techniques that can help encourage the natural contraction of the colon to promote better bowel movements.

• Rectal Balloon Training: We might use to to help train the sensation in your rectal canal and also help with your pushing mechanics.

Manual Techniques

Manual therapy techniques—ranging from gentle stretches, myofascial release, dry needling, or cupping—can reduce tension in the surrounding pelvic muscles that may be preventing proper evacuation.

Education and Habit Training

One of our main goals is to equip you with knowledge and tools to implement these changes. You’ll learn the healthy toilet habits, the correct posture, and strategies to integrate stress management into daily routines. It’s not just about “fixing” you in a session; it’s about empowering you to maintain a healthier life outside the clinic.

Research and Professional Backing

Scientific studies strongly support the effectiveness of pelvic floor physical therapy (PFPT) in treating incomplete evacuation and bowel dysfunction. Interventions —such as bowel retraining, diaphragmatic breathing, and biofeedback training (which, contrary to common belief, isn’t always electrode EMG biofeedback—check out our blog on this topic!)—have been shown to improve symptoms in 70–80% of patients. (1)

Even more compelling, long-term research indicates that these benefits persist for over two years post-treatment. (1) This reinforces the importance of addressing incomplete evacuation with specialized pelvic PT, rather than relying solely on temporary fixes like laxatives or fiber supplements. By restoring optimal muscle coordination, improving rectal sensation, and retraining proper bowel mechanics, pelvic PT offers a lasting solution for those struggling with chronic constipation and incomplete emptying.

Tailoring the Approach for Every Individual

One of the most valuable aspects of pelvic PT is its adaptability. Every person’s body is unique. Factors like age, sex, activity level, diet, stress, and even relationships all influence your condition. That’s why each therapy plan is designed to align with your specific situation. Even if you have a complicated medical history—like IBS (Irritable Bowel Syndrome), endometriosis, chronic prostatitis, or postpartum recovery—pelvic PT offers an individualized, holistic path to relief long term.

Moving Forward with Confidence

If incomplete bowel evacuation and constipation is affecting your day-to-day life, don’t settle for short solutions like laxatives or cleanses. By recognizing your symptoms and finding specialized help, you’re already taking the first crucial step toward true relief.

Putting It All Together

• Identify the Problem: Recognize and acknowledge the signs of incomplete bowel evacuation.

• Adopt Healthy Habits: Incorporate hydration, fiber, correct posture, and relaxation techniques.

• Consult a Pelvic PT: Get a full assessment and customized plan to address the root causes.

• Stay Committed: Real change often requires consistency and patience, especially with bowel regulation, but the rewards—a comfortable, unrestricted life—are well worth it.

Ready to Feel the Difference?

My entire team and I believe that everyone deserves a worry-free, functional, and empowered life. Pelvic physical therapy is a proven, non-invasive approach that can drastically change how you experience daily activities, including something as essential as bowel movements. If you’re ready to explore a your options and want to learn more about how pelvic PT can help, schedule an appointment with us or reach out for additional resources.

Remember, you don’t have to live with the constant doubt of whether your bowels are truly empty, or have your life run by your bathroom habits. Relief is within reach—pelvic PT can guide you there. Here’s to reclaiming the life you want to live free of bowel issues!

Written By,

Dr. Jana Richardson, PT, DPT, WCS, PRPC, CIDN
Dual Board Certified Pelvic Floor Therapist and Owner of Chicago Pelvic Health

Dr. Jana Richardson is a highly accomplished pelvic floor therapist with dual board certifications and extensive experience in treating complex pelvic floor dysfunctions. As the owner of Chicago Pelvic Health, Dr. Richardson is dedicated to providing personalized and effective care for her patients. With a Doctorate in Physical Therapy, and specialized certifications in Women’s Health and Pelvic Rehabilitation, Dr. Richardson is a leading expert in her field. She is also certified in Integrative Dry Needling, further enhancing her ability to offer comprehensive treatment plans. Dr. Richardson’s commitment to patient-centered care and her passion for helping individuals achieve optimal pelvic health make her an invaluable asset to the community.

Disclaimer: This article is for informational purposes only and does not substitute professional medical advice. Always consult a qualified healthcare provider for a thorough evaluation and personalized treatment plan.

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References:

1. Rao SS, Patcharatrakul T. Diagnosis and Treatment of Dyssynergic Defecation. J Neurogastroenterol Motil. 2016 Jul 30;22(3):423-35. doi: 10.5056/jnm16060. PMID: 27270989; PMCID: PMC4930297.