Dr. Trisha Pasricha

And we really don't spend that much time optimizing the pelvic floor the way we think about these other two factors.

And that's like trying to push toothpaste out of a toothpaste tube without ever taking the cap off.

And the pelvic floor is this set of over a dozen muscles in our pelvic floor that have to

coordinate so precisely in order to have a bowel movement and if you think about it you know when you have a bowel movement you're bearing down because we're generating this Valsalva maneuver and if I were to like try to make a Valsalva maneuver right now like my fist would clench you know because you're generating this pressure

But paradoxically, your sphincters have to relax.

If you think about it, this is a little bit counterintuitive, and it's very common that over time, people's pelvic floor starts to work against them, and they sort of train their muscles inappropriately.

And a lot of people, when they're younger, in their 20s, they haven't discovered fiber yet.

They haven't discovered a plant-based diet, and that's just how it is.

And so they have to generate a lot more pressure to have a bowel movement because they have harder stools.

And if you do that over several years, you're going to change how those muscles respond.

Those muscles are going to eventually start to paradoxically close, the very muscles you need to open, such that once you hit your 40s, you discover how much you love kale salads, your muscles are not the same anymore.

And so even though you have this excellent, soft, plush stool, it hits up against this wall and...

You know, I don't know if this is at the point of being an epidemic, but it's somewhere between one out of four and one out of three people who struggle with constipation.

They've tried all these different laxatives.

It's not working.

The actual issue is the pelvic floor.

And so this is a hugely underappreciated problem.

And

I do think that in terms of why things have changed now for us, it's this combination of factors.

One, our diets have totally changed in the last 50 years.