Hip flexor pain is a common complaint, often associated with overuse, muscle imbalances, or poor posture. While most people are aware of the discomfort and mobility issues it can cause, not many realize that hip flexor pain can also have unexpected consequences, such as constipation. In this blog post, we’ll explore the connection between hip flexor pain and constipation, shedding light on why these seemingly unrelated issues can be linked.
How Your Constipation is Related to Your Hip Flexor Pain
Location
To understand how hip flexion pain causes constipation, we need to look at the anatomy of the hip joint.
The iliopsoas muscles are made up of two muscles: psoas major and iliacus. The muscle runs from T12 to L5 vertebrae. The iliopsoas muscle is the PRIME MOVER of hip flexion. More specifically, it is the psoas muscle portion that contributes to trunk flexion.
When the iliopsoas muscle is tight or inflamed, it can exert pressure on the surrounding structures, including the intestines, which may hinder the natural passage of stool. Studies shows a direct correlation between the psoas muscle and bowel function.
Hip flexor pain can restrict blood flow to the abdominal region. This reduced circulation can affect the function of the digestive system, leading to slower and less efficient bowel movements.
Let’s take a closer look at the pelvic floor muscles. It has three layers.
- 1st layer: urogenital triangle
- 2nd layer: deep urogenital triangle
- 3rd layer: anal triangle
- The 3rd layer is the deepest layer of the muscle. It consists of the levator ani muscle, the coccygeus, the piriformis, and the obturator internus muscle of the hip.
Research shows that when the pelvic floor muscles are in a state of increased tension or prolonged contraction with the inability to relax (hypertonic Dysfunctions), it can lead to disorders such as the Levator ani syndrome.
The Levator ani syndrome is the spasm of the levator ani muscles that can cause pain in the buttocks, posterior thigh, coccyx, hip, or lower back.
In the following passage, I go over how the piriformis plays a role in causing constipation.
Nerve Pathways
One of the key links between constipation and hip flexor pain lies in the intricate network of nerves that run through the hip area. Hip pain, particularly in the lower back and pelvic region, can result from conditions like sciatica.
Sciatica is “a neuromusculoskeletal pain down the leg in the path of the dermatomatic distribution of the sciatic nerve” (Manske). In other words, it is a sharp pain running down your legs. The primary cause of sciatica is due to the compression of the nerve root from a herniated intervertebral disk. Compression of the nerve trunk from the piriformis muscle can also cause sciatica. This condition is called piriformis syndrome.
These nerves that run through the hip area not only play a role in transmitting pain signals but also influence bowel function.
Autonomic Nervous System
The autonomic nervous system regulates various bodily functions, including digestion and bowel movements. When hip pain, particularly in the lower back, disrupts the autonomic nervous system, it can lead to changes in gastrointestinal motility, potentially resulting in constipation.
Correct Terminology
Constipation is defined by the Rome Foundation Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders as having at least two of the following digestive issues for at least 3 months with symptoms onset at least 6 months before diagnosis (Manske).
- Straining during at least 25% of defecations
- Lumpy or hard stools in at least 25% of defecations
- Sensation of incomplete evacuation for at least 25% of defecations
- Sensations of anorectal obstruction/blockage for at least 25% of defecations
- Manual maneuvers to facilitate at least 25% of defecations
- Fewer than three defecations per week
Symptoms of Constipation are:
- Infrequent Bowel Movements
- Straining: You may need to strain or push hard to have a bowel movement.
- Hard or Dry Stools: Constipated stools are typically dry, hard, and difficult to pass.
- Incomplete Evacuation: You may feel like you haven’t emptied your bowels after a bowel movement.
- Abdominal Discomfort: Constipation can cause abdominal pain, cramping, or discomfort. This pain is often relieved after a bowel movement.
- Bloating: A feeling of fullness and abdominal bloating is common in constipation.
- Rectal Discomfort: You may experience discomfort or pain in the rectal area.
- Anal Fissures: Straining during bowel movements can lead to small tears in the skin around the anus, known as anal fissures, which can be painful.
- Hemorrhoids: Chronic constipation can contribute to the development of hemorrhoids, which are swollen blood vessels in the rectal or anal area.
- Nausea: Some individuals may experience nausea or a sensation of feeling unwell due to constipation.
- Reduced Appetite: Constipation can sometimes result in a decreased appetite or a feeling of fullness.
- Low Back Pain
People often confuse constipation with Irritable bowel syndrome (IBS). IBS is a functional gastrointestinal disorder, meaning there is no identifiable structural or anatomical abnormality in the digestive tract.
It is characterized by a cluster of symptoms related to the bowel, such as abdominal pain, bloating, and changes in bowel habits. Still, it doesn’t involve inflammation or damage to the gut lining. With IBS, people commonly complain of pain in the abdominal region. This pain can last for three days to 3 months. The pain will recede once defection occurs.
Inflammatory Bowel Disease (IBD) is a group of chronic inflammatory conditions primarily affecting the digestive tract. The two main types of IBD are Crohn’s disease and ulcerative colitis. These conditions involve chronic inflammation, ulcerations, and damage to the gastrointestinal lining.
Other Causes of Constipation
Reduced Mobility and Exercise
Hip pain can limit mobility and reduce your willingness to engage in physical activities. Regular exercise and movement are essential for maintaining a healthy digestive system. When hip pain keeps you sedentary, it can contribute to constipation.
Postural Misalignment
Many cases of hip pain are rooted in postural issues and muscle imbalances. Poor posture can affect the alignment of the spine, pelvis, and intestines, making it more challenging for stool to pass through the digestive tract smoothly.
Medication Side Effects
People with hip pain often turn to pain relief medications to manage their discomfort. Some of these medications can have side effects, including constipation. This can create a vicious cycle where pain medication exacerbates constipation, leading to more pain and further medication use.
Stress and Tension
Chronic hip pain can lead to emotional stress and tension, which can, in turn, affect the digestive system. Stress can slow down peristalsis, the rhythmic contractions that move food and waste through the intestines, contributing to constipation.
Altered Dietary Habits
When dealing with hip pain, individuals might modify their dietary habits, opting for foods that are easy on their digestive system. In some cases, this can lead to a diet that’s low in fiber and fluids, both of which are essential for healthy bowel movements.
Abdominal Muscle Engagement
Hip pain can also impact the engagement of your abdominal muscles. These muscles are essential for pushing stool through the intestines. When they are weakened or not functioning optimally due to hip pain, it can lead to constipation.
10 Effective Ways to Fix Constipation and Hip Flexor Pain
Hip flexor pain can be uncomfortable and limit your mobility. Fortunately, there are several steps you can take to alleviate hip flexor pain and promote healing. Here are some strategies to help you fix hip flexor pain:
1. Rest and Avoid Aggravating Activities
Give your hip flexors time to heal by avoiding activities that exacerbate the pain, such as excessive sitting, running, or high-impact exercises.
2. Ice and Heat Therapy
Apply ice to the affected area for 15-20 minutes to reduce inflammation. Use a thin cloth or towel to protect your skin from direct contact with the ice. After the initial inflammation has subsided (usually after a couple of days), you can switch to heat therapy, using a warm compress or heating pad to relax the muscles and promote blood flow.
3. Stretching and Mobility Exercises
Gentle stretching exercises can help relieve tension in the hip flexors. Some effective stretches include the kneeling hip flexor stretch, standing quad stretch, and butterfly stretch. Be sure to perform these stretches slowly and hold them for at least 30 seconds on each side.
4. Strengthening Exercises
Strengthening the hip flexor muscles can help prevent future pain and improve stability. Exercises like leg raise, hip bridges, and leg presses can be beneficial.
5. Foam Rolling
Use a foam roller to massage and release tension in the hip flexor area. Roll back and forth slowly over the affected muscles to help relax them.
6. Anti-Inflammatory Medications
Non-prescription anti-inflammatory medications like ibuprofen can help reduce pain and inflammation. Consult with a healthcare professional before using any medications.
7. Physical Therapy
Consider working with a physical therapist who can provide you with a tailored exercise and rehabilitation plan to address your specific hip flexor issues.
8. RICE Method
Rest, Ice, Compression, and Elevation can help reduce inflammation and relieve pain. Use an elastic bandage for compression and elevate your leg to promote drainage of excess fluids.
9. Modify Activities
If certain activities are causing or exacerbating your hip flexor pain, modify your approach or technique to reduce the strain on the hip flexors.
10. Correct Posture
Maintain good posture to relieve unnecessary stress on the hip flexors. Sit and stand with your back straight and avoid excessive slouching.
Remember that every individual’s situation is unique, so it’s essential to listen to your body and seek professional guidance from a healthcare professional when necessary. The key to fixing hip flexor pain is patience and a comprehensive approach that combines rest, stretching, strengthening, and modifications to your daily activities.
The Takeaway
The connection between constipation and hip flexor pain is complex and multi-faceted. It’s essential to recognize the interplay between these issues to address them effectively. If you’re experiencing hip pain and constipation, it’s essential to seek medical advice to determine the underlying causes and develop a holistic treatment plan. By addressing both concerns, you can improve your overall well-being, mobility, and digestive health, ultimately breaking the cycle of discomfort and achieving a better quality of life.
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References
- Moriarty CM, Baker RJ. A Pain in the Psoas. Sports Health. 2016 Nov/Dec;8(6):568-572. doi: 10.1177/1941738116665112. Epub 2016 Aug 20. PMID: 27542388; PMCID: PMC5089355.
- https://www.fionawaring.com/recent-articles/psoas-syndrome-and-gut-health
- Manske, R.C. (2016) Fundamental Orthopedic management for the physical therapist assistant. St. Louis, MO: Elsevier.
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