Just as the Donguibogam paid close attention to cases where straining does not bring relief, modern medicine identifies this as a form of pelvic floor dysfunction. The pelvic floor is a complex of muscles and ligaments forming the base of the pelvis. Like a hammock, it supports pelvic organs such as the urinary bladder, uterus (in women), and rectum, while regulating essential bodily functions including defecation, urination, and sexual function. When we sit on the toilet and bear down, these pelvic floor muscles must relax to allow the rectum to open and stool to pass smoothly.
However, in pelvic floor dysfunction, these muscles fail to relax properly or paradoxically contract, blocking the passage of stool. This resembles pushing against a tightly shut door; no matter how hard one strains, smooth defecation cannot occur. Neurologically, this reflects a disruption in harmony between the autonomic nervous system and somatic nervous system governing defecation. Habitual excessive stress or anxiety elevates sympathetic nerve activity, tensing the pelvic floor muscles and triggering paradoxical contractions during defecation. This aligns closely with the Donguibogam's view that liver qi stagnation stiffens the muscles around the large intestine.
Furthermore, muscle weakness from aging, childbirth, obesity, and frequent straining from chronic constipation are major causes that damage pelvic floor muscles or impair their function. If you often feel the urge to defecate but struggle once on the toilet, need to strain excessively, or must apply pressure to the perianal region with your fingers to pass stool, pelvic floor dysfunction should be considered. These symptoms extend beyond mere discomfort; left unaddressed, they may lead to hemorrhoids, a perianal abscess, or rectal prolapse over the long term, and must not be taken lightly.
From a neurological standpoint, the brain and gut interact through a close link known as the gut-brain axis. Mental factors such as stress directly influence intestinal motility, while gut health can conversely affect brain function and emotion. Difficulties with defecation caused by pelvic floor dysfunction can amplify stress and anxiety, creating a vicious cycle. In endocrinology, elevated levels of the stress hormone cortisol can affect intestinal motility, worsening constipation symptoms. Therefore, pelvic floor dysfunction is not merely a localized complaint; it is a condition requiring a comprehensive approach that encompasses the entire nervous system, endocrine system, and mental well-being. Rather than believing that straining harder will resolve the issue, it is time to listen closely to these subtle signals from your body.
