two finger perineal pressure helps relieve constipation

constipation is a common complaint affecting a considerable part of the population in the western world [1]. compared to men, women suffer more from this ailment [2]. usually, more than one factor is involved. lack of fiber in the diet, the presence of hemorrhoids or rectocele have all been incriminated to cause constipation or else exacerbate it. while bearing down causes some degree of perineal descent, reduced descent may indicate an inability of the pelvic floor muscles to relax during defecation. excessive descent on the other hand can injure the sacral nerves and cause incontinence [3]. during defecation, there is some pressure exerted in the perianal region which causes pain, and the pain thus elicited prevents the normal process of defecation. hard stools in itself cause pain and thus a vicious cycle is established preventing defecation and causing inspissation of stools. under such conditions, a pressure exerted by the fore finger and middle finger on the perineum (figure 1) directed towards the rectum not only acts as a support but exerts a pressure on the rectum and the anal canal and thus facilitates defecation. as hard stools and constipation impel and constrain the person to exert a high degree of straining during defecation and an effective straining effort can only be achieved if a high intra-abdominal pressure is built up, it is but natural that such an elevated intra-abdominal pressure can cause hemorrhoids and inguinal or epigastric hernias. it has been said that perineal massage can increase the elasticity of the perineum and thus reduce the risk of third-degree perineal tears during labor [4]. we would emphasize that the two finger perineal pressure is helpful in relieving constipation and thus can prevent the formation of hemorrhoids. in a very small number of patients in a pilot study, we could find that the two finger perineal pressure had been extremely helpful in relieving constipation and helping in the evacuation of the stools. however, a randomized clinical trial is needed to further elucidate the effective role of the two finger perineal pressure in the evacuation of hard and inspissated stools.