Our women’s health Physio, Becca tells us how to get the most out of our bowel health.
Yes you read that right! And you are still on a Physio website… I talk about pee and poo all day so this isn’t strange for me. Don’t panic! You’ll get used to reading about it and might pick up a tip or two! This post is primarily aimed at my women’s health patients, however, I’m sure it will apply to others as constipation is such a widespread problem. At best, it can make you feel sluggish, and who wants that. At worst, it can cause tissue damage or haemorrhoids.
This post will give you tips on managing your bowels, pooping well and reducing pressure on your pelvic floor; but first – how can we prevent constipation? That’s definitely the preferred option!
Normally an adult would open their bowels every day or every second day. If you are going more or less frequently that might indicate that you have an issue.
Early postnatally, or with a prolapse: if you are having to strain to open your bowels, you are putting a huge strain on your pelvic floor. You are likely to be cancelling out all the hard work you are doing with your pelvic floor exercises. Try wrapping your hand in tissue and pushing up on the perineum when opening your bowels.
Prevention starts with hydration, fibre and exercise. Make sure you are drinking enough, around 1.5 to 2 litres per day, it doesn’t need to all be water. Get enough fibre – you need the right balance of bulking fibre (bran, nuts, wholemeal bread etc) and softening fibre (apples, citrus fruits, peas etc). Lots of ideas can be found online. What you need to eat varies from person to person and it might take you some time to work out what is best for you. Usually your poo will indicate how good your diet has been in the day before – keep a diary to work out for yourself.
Getting moving and exercising regularly are vitally important for bowel health, so please address that if you don’t get the recommended amount of exercise (60 minutes on most days of the week).
Speak to your GP if you are struggling to find the right balance. Some gentle laxatives may help get you started.
So how can you help ease a bowel movement? I focus on three things: time/timing, position and relaxation/breathing.
Timing: go when you feel the urge. Prioritise it, so many women think that their bowel can wait. However, once you feel that urge the poo doesn’t go away – it stays in your rectum and the water gets reabsorbed into your system making it more difficult to pass as time goes on. In addition, when you feel the urge, your sphincters are ready to open and you should find it passes more easily at this time.
Make use of the gastro-colic reflex – around 20 minutes after a meal or hot drink your body will push a movement into your bowel.
Take your time – ladies, if your partner disappears for what seems like forever with the newspaper, you are entitled to take the same time yourself! Especially when you are putting in your initial effort to regulate your bowels, it will take a bit of time for the poo to come more naturally. However, sitting for over 10-15 minutes can increase the risk of haemorrhoids.
Position: Sit with your feet up on a small stool so your knees are higher than your hips. Squatty potty do a stool specifically designed for this purpose. It’s pretty pricey, but worth looking at their video for a great explanation of the reasons…
Lean forward with a straight back, support your elbows on your knees.
Image from Elaine Miller with permission
Relaxation/breathing: Some people make the error of pulling in with their tummy muscles to try to push out the poo. However, this tends to tighten the pelvic floor so you’re having to work harder against a tightened sphincter. The correct action is to let the tummy bulge and widen the waist: as you lengthen the muscles it creates a reflex opening of the external anal sphincter. Breathe into your belly, you should anyway be doing this when you are relaxed to help stimulate the gut’s gentle pulsing to push the poo through the bowel.
Then wait… With a bit of practice you will find the poo comes quite soon after you’ve set yourself up. If you need to give a little push, try taking a big inhale and as you blow the breath out, hold the diaphragm down and feel the push coming from the diaphragm.
Take extra care if you are travelling and your bowels are a bit shy of going when you are not in your own toilet. Find as private a toilet as you can.
If you are extra clogged up, some gentle tummy massage in the evening can help move things along for the next day. Start making small clockwise circles above the pelvis on your right and slowly move the circles up, across just above your belly button and down towards the top of the pelvis on your left. It shouldn’t be painful but you might feel a few lumps (lovely!) and set off a gurgling in your guts – the desired effect!
Let me know if you have any questions at all about this, I really hope it helps!
I am as always, indebted to the wonderful world of pelvic health physios whose work has helped me get the greatest understanding of crafting the perfect poop!