Chronic constipation can cause difficult bowel movements, abdominal pain, bloating, pelvic pressure, and symptoms that overlap with autonomic or pelvic pain conditions.
Chronic constipation can be a sign of an underlying neurologic, autonomic, or gastrointestinal condition rather than a digestive issue alone. Dr. Siefferman explains the potential causes of chronic constipation and how identifying the underlying problem is key to effective treatment.
Our team organizes conditions and treatments into related zones of expertise to make it easier to explore the care paths most relevant to your symptoms and goals.
Use the zone tags above to browse dedicated pages for each focus area, including services, providers, and what to expect during treatment.
Chronic constipation is a side effect of many medications and something that co-occurs with dysautonomia. Dysautonomia is when the fight-or-flight response and the rest-and-digest—the sympathetic and the parasympathetic nervous systems—are not in balance. When that happens, a number of things occur in the body. One of them is slowed gut motility. Slowed gut motility can happen with chronic pain, with visceral pain, with hernias, with low back pain, with medication side effects, with POTS, with mast cell activation syndrome, and with a number of issues.
Chronic constipation is often not recognized by patients. Most of the time when I’m diagnosing chronic constipation, the patient is not aware that they are constipated. They’ll say, “Well, I just went this morning”. My analogy is the Lincoln Tunnel during rush hour: just because cars are coming out on one end doesn’t mean they’re not backed up on the other end. So, recognizing the role of chronic constipation in abdominal pain, in back pain, and in pelvic pain is essential because that fullness in the belly can contribute to pain.
Chronic constipation is a long-lasting or recurring pattern of difficult stool passage, infrequent bowel movements, hard or lumpy stools, painful bowel movements, straining, or a feeling of incomplete evacuation.
Constipation is not a disease by itself. It may be a symptom of digestive motility changes, pelvic floor dysfunction, medication effects, autonomic dysfunction, connective tissue laxity, chronic pain mechanisms, or another medical condition.
Some patients also experience abdominal pain, bloating, pelvic pressure, low back discomfort, or worsening pain sensitivity. Because constipation can overlap with GI, pelvic, neurologic, autonomic, and chronic pain conditions, careful evaluation is important before building a care plan.
At Manhattan Pain Medicine, evaluation begins by identifying whether constipation-related pain is connected to abdominal pain, pelvic floor dysfunction, autonomic symptoms, nerve-related pain, hypermobility, medication effects, endometriosis, fibroids, hernia pain, or chronic pain sensitization.
For patients looking for chronic constipation treatment in Manhattan, MPM does not replace gastroenterology, primary care, pelvic floor therapy, gynecology, colorectal surgery, or emergency care when those are needed.
Instead, MPM helps evaluate pain drivers that may overlap with constipation and coordinate care when pelvic, abdominal, autonomic, or nerve-related pain is part of the clinical picture.
Constipation can cause abdominal pain, bloating, pelvic pressure, and discomfort from stool retention, straining, bowel distension, and pelvic floor tension.
In some patients, constipation is also connected to broader patterns such as pelvic pain, pelvic floor dysfunction, POTS, autonomic dysfunction, Ehlers-Danlos syndrome, hypermobility spectrum disorder, endometriosis, fibroids, hernia-related pain, fibromyalgia, or complex chronic pain.When standard approaches such as fiber, hydration, laxatives, or diet changes do not fully help, the issue may be more complex. The problem may involve motility, pelvic floor coordination, medication side effects, pain-related guarding, autonomic regulation, connective tissue mechanics, or chronic pain sensitization.
MPM’s diagnosis-first approach helps place constipation-related pain in context while coordinating bowel management with the appropriate GI, pelvic floor, gynecology, colorectal, vascular, or primary care specialists.
Chronic constipation fits across several MPM Zones of Expertise, including Complex Chronic Pain, Autonomic Dysfunction, and Pelvic Pain. This matters because constipation-related symptoms may involve bowel motility, pelvic floor coordination, abdominal pain, pelvic pressure, nerve sensitivity, hypermobility, POTS, EDS, endometriosis, fibroids, hernia-related pain, or chronic pain sensitization.
MPM uses the Zones of Expertise framework to evaluate whether symptoms appear primarily GI-related, pelvic, autonomic, connective tissue-related, nerve-related, or part of a broader chronic pain pattern. For some patients, the priority is coordination with gastroenterology or pelvic floor therapy. For others, pain remains a central issue and requires its own careful evaluation and treatment pathway.
These guys are the best. I've been going here for over 6 years and their familiarity with my Schwannomatosis (most ppl have never even heard of it - its rather rare) and their ability to diagnose my CRPS quickly and accurately and then treat it like I was merely getting a flu shot is just incredible...
Highly recommended for those who need Pain Management. Everyone at Manhattan Pain Medicine is extremely nice and helpful. I have had very good interactions with both Dr. Siefferman and Dr. Louis. All of the staff is very responsive. 5 stars.
The providers at Manhattan Pain Medicine are exceptional. I wish I had found them 30 years ago!
I genuinely can’t say enough good things about the team at Manhattan Pain Medicine. I have MCAS, EDS, and an inflammatory autoimmune disease, and I’ve basically been searching for answers since I was a kid. I had years of unexplained inflammation markers, chronic pain, and allergic reactions despite...
I have a complex medical history and have seen a lot of doctors over the years. Dr. Mikaberidze and Dr. Siefferman each took the time to really listen and understand everything I had been dealing with. I also appreciated how they work together and communicated about my care. I left with a plan that...
Sharing my gratitude for the pleasant experience last week during my visit, the medical team provided great care and also treated my session as a learning experience, I left my session with a wealth of knowledge. A big thank you to the kind, and professional staff who welcomed me to the office as a...
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
Dr Siefferman is the most thorough, patient doctor I have even been to. Currently I travel from miami to nyc to see him because his bed side manner and desire to help is incomparable.
ZocDoc
This practice is wonderful. I have been a patient of Dr. Siefferman’s since 2019 and he’s extremely helpful and kind. He has brought in a Rheumatologist who is also great. They handle very complex pain issues and always try to find new ways to help me.
Dr. Siefferman is an incredible doctor! He is extremely diligent and knowledgeable. It feels like you are his only patient. He invests a lot of time and effort into your injuries and concerns. I did not find these wonderful qualities with other pain specialists before, who were always rushed and som...
ZocDoc
Dr. Siefferman is a doctor who combines the old world bedside manner of doctors from my childhood (60 years ago) with a sta te of the art embrace of modern technology. It is always a pleasure to have an appointment with him...always has options and solutions to my medical issues. He is truly the doc...
ZocDoc
Dr. Siefferman is a genius. He is very informed and listens attentively.
ZocDoc
Dr. Siefferman and his entire team continue to be efficient, dedicated, and driven by precision and a genuine desire to give fantastic care. Will always recommend.
ZocDoc
Doctor Siefferman is fantastic. Have been seeing him for 5 years. Couldn’t recommend more.
ZocDoc
Dr. Siefferman is the ONLY doctor who has ever been able to diagnose my pain and treat it. He is hands down the best
ZocDoc
Chronic constipation is long-lasting or recurring constipation that may involve fewer than three bowel movements per week, hard or lumpy stools, straining, painful stool passage, or a feeling that stool has not fully passed. Some patients also experience bloating, abdominal pain, pelvic pressure, nausea, or worsening pain with bowel movements. Constipation is not a disease by itself. It may be a symptom of another medical issue, medication effect, motility disorder, pelvic floor dysfunction, autonomic problem, or chronic pain condition. Persistent constipation should be evaluated rather than treated only with repeated self-care.
Chronic constipation can have many causes. These may include low fiber intake, low fluid intake, reduced activity, medication side effects, bowel motility disorders, pelvic floor dysfunction, neurologic or autonomic dysfunction, pain-related muscle guarding, connective tissue conditions, endocrine issues, structural concerns, or overlapping pelvic and abdominal pain conditions. Constipation may also occur with POTS, EDS, hypermobility spectrum disorder, endometriosis, fibroids, chronic pain syndromes, or after changes in medications. Because the causes vary, treatment should be based on the likely driver and coordinated with GI, primary care, pelvic floor therapy, or other specialists when needed.
Yes. Constipation can contribute to abdominal pain, bloating, cramping, pelvic pressure, low back discomfort, and pain with bowel movements. Stool retention can stretch the bowel and increase pressure. Straining can aggravate the abdominal wall, pelvic floor, and surrounding nerves. Some patients develop pelvic floor tension or guarding because bowel movements are painful or difficult. Constipation can also overlap with pelvic pain, endometriosis, fibroids, hernia-related pain, autonomic symptoms, and chronic pain sensitization. MPM evaluates whether pain is mainly bowel-related, pelvic, nerve-related, musculoskeletal, autonomic, or multifactorial.
Constipation should be evaluated when it persists despite self-care, keeps recurring, worsens, or is associated with concerning symptoms. Red flags include rectal bleeding, blood in stool, black stool, constant abdominal pain, inability to pass gas, vomiting, fever, severe bloating, lower back pain, unintentional weight loss, anemia, new constipation after age 50, or family history of colon or rectal cancer. These symptoms may require GI, colorectal, emergency, or primary care evaluation. Patients should also seek medical guidance before changing medications, using frequent laxatives, or adding supplements for persistent symptoms.
Yes. Pelvic floor dysfunction can make stool passage difficult when the muscles that control bowel evacuation do not relax or coordinate properly. A person may feel the urge to go but have difficulty passing stool, strain frequently, feel incomplete evacuation, or experience pelvic pain and pressure. Pelvic floor dysfunction may overlap with abdominal pain, urinary symptoms, endometriosis, hypermobility, EDS, pelvic pain, and chronic pain sensitization. Treatment may involve pelvic floor physical therapy, bowel retraining, GI care, and pain-focused support when pain or guarding is part of the pattern.
Yes. Autonomic dysfunction, POTS, Ehlers-Danlos syndrome, and hypermobility spectrum disorder may contribute to constipation in some patients. The autonomic nervous system helps regulate gut motility, while connective tissue laxity and pelvic mechanics may affect bowel movement coordination, pelvic support, and pain sensitivity. Some patients also experience gastroparesis, abdominal pain, bloating, pelvic pain, or chronic fatigue alongside constipation. These connections are complex and should not be assumed without evaluation. MPM considers autonomic, pelvic, connective tissue, nerve-related, and chronic pain contributors when reviewing constipation-related pain.
Treatment depends on the cause of constipation and the source of pain. Constipation management may involve GI-guided medication changes, fiber, fluids, bowel training, laxatives, prescription medications, pelvic floor therapy, and treatment of related medical conditions. MPM focuses on pain contributors that may overlap with constipation, such as pelvic pain, abdominal wall pain, nerve sensitivity, autonomic dysfunction, or chronic pain sensitization. Care may include medication review, pain psychology, autonomic-informed care, and selected interventions for pelvic or sympathetically mediated pain when appropriate. Pain procedures do not directly treat constipation and should not replace GI care.
A pain specialist may be helpful when constipation occurs alongside chronic abdominal pain, pelvic pain, nerve-related symptoms, autonomic dysfunction, hypermobility, endometriosis, fibroids, hernia-related pain, or widespread pain sensitivity. MPM does not replace gastroenterology or pelvic floor care for bowel management. Instead, MPM helps evaluate whether pain drivers are contributing to symptom severity, guarding, pelvic pressure, functional limitation, or chronic pain sensitization. The goal is to coordinate care so bowel function, pain, pelvic mechanics, and autonomic symptoms are considered together.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Chronic constipation is a recurring or persistent pattern of difficult bowel movements, infrequent stools, hard or lumpy stools, straining, painful passage, or a feeling that stool has not fully passed. It can be uncomfortable, frustrating, and sometimes embarrassing to discuss. It can also become painful, especially when constipation overlaps with abdominal pain, pelvic pressure, bloating, autonomic symptoms, hypermobility, or chronic pain.
Constipation is not a disease by itself. It is a symptom pattern that may have many causes. Some are related to diet, hydration, activity level, medications, or bowel habits. Others involve motility disorders, pelvic floor dysfunction, autonomic nervous system regulation, connective tissue conditions, nerve sensitivity, gynecologic conditions, hernia-related pain, or chronic pain mechanisms. This is why persistent constipation deserves careful evaluation rather than repeated trial and error.
Patients with chronic constipation may have fewer than three bowel movements per week, hard stools, painful stool passage, straining, bloating, abdominal pain, pelvic pressure, low back discomfort, or a sense of incomplete evacuation. Some feel full, heavy, or distended. Others have pain that worsens before a bowel movement or during attempts to pass stool.
Constipation may also affect daily life. Patients may avoid eating, travel, social plans, exercise, or sexual activity because of bloating, discomfort, urgency, or fear of pain. Over time, chronic constipation can contribute to pelvic floor guarding, abdominal wall tension, pain sensitivity, and anxiety around bowel movements.
Constipation can cause pain through several pathways. Stool retention can stretch the bowel and create pressure. Straining can irritate the pelvic floor, abdominal wall, hips, and low back. Painful bowel movements can cause protective muscle guarding, which may make evacuation even harder. Pelvic floor muscles may become overactive or poorly coordinated, creating a cycle of constipation and pelvic pain.
In some patients, constipation overlaps with autonomic dysfunction. The autonomic nervous system helps regulate gut motility. Patients with POTS or related autonomic symptoms may experience constipation, bloating, nausea, or variable motility patterns. Patients with EDS or hypermobility spectrum disorder may also experience changes in pelvic support, connective tissue mechanics, and pain sensitivity that contribute to bowel symptoms.
Chronic constipation may overlap with abdominal pain, stomach pain, pelvic pain, pelvic floor dysfunction, gastroparesis, POTS, EDS, hypermobility spectrum disorder, endometriosis, fibroids, hernia pain, sports hernia, femoral hernia, obturator hernia, umbilical hernia, fibromyalgia, CRPS-like sensitization, May Thurner Syndrome, Nutcracker Syndrome, MCAS, and complex chronic pain.
These overlaps do not mean constipation is caused by one condition automatically. They mean that the symptom pattern should be evaluated carefully. A patient with constipation and pelvic pain may need pelvic floor assessment. A patient with constipation and bloating may need GI evaluation. A patient with constipation, dizziness, and tachycardia may need autonomic evaluation. A patient with constipation and severe focal hernia-like pain may need surgical evaluation.
Evaluation may include medical history, medication review, family history, bowel pattern review, diet and hydration review, physical examination, abdominal exam, rectal exam, blood tests, imaging, colonoscopy, motility testing, pelvic floor evaluation, or other testing depending on symptoms. GI and primary care clinicians often lead constipation evaluation and bowel management.
MPM’s role is different but complementary. MPM evaluates constipation-related pain. This may include reviewing pain location, pelvic pressure, abdominal wall sensitivity, nerve symptoms, autonomic symptoms, prior imaging, prior GI workup, pelvic floor history, gynecologic history, hernia evaluation, and chronic pain factors. The goal is to determine whether pain is bowel-related, pelvic, nerve-related, sympathetically mediated, abdominal wall-related, musculoskeletal, or part of a broader chronic pain pattern.
Constipation treatment often begins with diet, fiber, fluid intake, physical activity, bowel training, and medication review. Some patients need laxatives, prescription constipation medications, pelvic floor physical therapy, motility evaluation, or treatment of another medical condition. Patients should not stop medications or overuse laxatives or supplements without clinician guidance.
Pain-focused care depends on the pain driver. MPM may support medication review, pain psychology, autonomic-informed care, and coordination with pelvic floor therapy, GI, gynecology, colorectal surgery, vascular specialists, or primary care. Pain psychology can help when constipation-related pain causes fear, guarding, stress, sleep disruption, or chronic symptom vigilance. This does not mean the pain is psychological. It means chronic symptoms can affect the nervous system and coping patterns.
Sympathetic blocks, lumbar sympathetic blocks, and superior hypogastric plexus block may be discussed only for selected pelvic or sympathetically mediated pain patterns. They are not standard treatments for constipation and should not be presented as direct bowel motility treatments. Their role depends on anatomy, diagnosis, prior workup, and the presence of specific pain drivers.
Patients should seek medical evaluation when constipation persists despite self-care, worsens, or occurs with rectal bleeding, blood in stool, black stool, constant abdominal pain, inability to pass gas, vomiting, fever, lower back pain, unintentional weight loss, severe bloating, anemia, new constipation after age 50, or family history of colon or rectal cancer. These symptoms may require GI, colorectal, emergency, or primary care evaluation.
MPM approaches chronic constipation-related pain through a diagnosis-first, coordinated model. The evaluation considers abdominal pain, pelvic pain, pelvic floor dysfunction, autonomic symptoms, nerve-related pain, hypermobility, medication effects, endometriosis, fibroids, hernia-related pain, and chronic pain sensitization.
For patients looking for chronic constipation treatment in Manhattan, MPM offers a careful, patient-centered approach to the pain patterns that may overlap with constipation. The goal is to support clearer evaluation, safer coordination, and a treatment plan that reflects the patient’s bowel symptoms, pain drivers, prior workup, function, and long-term goals.
