We’ve been pushing hard on pregnancy-related topics, but speaking of pushing hard….constipation and other bowel issues are timely topics at all stages of life. Potty training, moving away from home after high school, pregnancy, postpartum – each of these stages has unique characteristics that can adversely affect our bowel health. Particularly when most of us don’t understand it very well to begin with.
The following guest post from Jenna Sires, physical therapist at Proaxis Therapy in Columbia, SC is a fantastic overview. For more info, check out the Share MayFlowers website for a piece written by physical therapist, Ruth Maloney (click here). For more levity, watch this sock-puppet sing-along, “Everybody Poops!”.
That sing-along cracks me up every time.
We All Do It, But Are We Really Doing It Right? (And yes, I am talking about pooping)
It’s 6:45 AM. You wake up, eat your usual breakfast, enjoy a ‘cup of joe’, and the next thing you know you’re sitting on the commode emptying your bowels with no straining, grunting, or pain. But what happens when this doesn’t go your way? What happens if you haven’t had a bowel movement for 7 days, or when you sit to have a bowel movement and the pain is excruciating? What if every time you passed gas, you actually leaked a little stool? It’s amazing how easily we can take our normal bodily functions for granted when they are working properly; but when things go wrong, they can really go wrong. The good news is… There is help out there for those who are suffering from bowel dysfunction.
Bowel dysfunction (everything from constipation, hemorrhoids, flatulence incontinence, to leaking stool) is more common than one would think. Constipation alone is the most common GI complaint and ~ 4 million Americans report frequent constipation (NIDDK). When I treat patients with chronic constipation, I always hear “I’ve been this way forever”, or “I’ve been constipated since I was a kid”. And this is so true. We are never taught how to poop. Instead, we are plopped on the toilet, with our little legs dangling side to side and our parents yell, “We aren’t leaving until you poop”! So we push, grunt, strain, and pop out a little poop. Our parents rush in and do a little potty dance while putting a star on our “Poopie Chart”. Or, what about the young lady headed off to college. You never had to worry about privacy when it came to pooping. But now, you’re in a dorm and sharing a bath room with 10 other girls. You don’t want anyone to know that you actually poop, so you hold it until 3:00 AM, set your alarm, and poop in private (I’ve heard this on more than one occasion). These poor bowel habits work for a while, but after 25 years of chronic straining or poor stool consistency, things start to catch up with us and all of a sudden something that should be natural and easy, is causing distress in our daily lives and can even be painful or embarrassing.
As a pelvic floor therapist, specializing in bowel and bladder dysfunction, I have treated a myriad of patients who struggle with bowel dysfunction. During our treatment sessions I find it most beneficial to hit on, what I call, The Big 3: Stool Consistency, Proper Toilet Position, Complete Pelvic Floor Muscle Relaxation (and breathing).
We all know that if we have loose stools, our fecal urgency dramatically increases (think food poisoning) and if we have hard, pellet-like stool it is harder to empty. Therefore, stool consistency plays a huge role in normal defecation dynamics. A bowel movement should be soft and easy to pass. It should be formed, have a texture similar to peanut butter. Each person’s stool consistency and shape may vary a little, but remember: bowel movements should never be painful and you shouldn’t have to push like you’re delivering a baby.
Diet and fluid intake are very important!
- Some fiber-rich foods: bran, brown rice, fresh fruit, steamed fresh vegetables, whole-grain cereal and bread, oatmeal, and baked potatoes.
- Drink plenty of fluids! Get 8-10 eight-ounce glasses/cups of fluid per day (preferably water). Dehydration will make you more constipated.
Proper Toilet Position
I’m just going to go ahead and say it. We were made to squat to defecate. Our ancient ancestors didn’t have porcelain thrones to empty their bowels. Instead, they popped a squat with an urge to go and they went. Now, we have toilets (which I personally am grateful for) but we also have a rise in defecatory dysfunction. This is because the rectal canal is “kinked”. In standing and upright sitting the puborectalis muscle chokes the rectum (maintaining continence) and the rectal angle is decreased. With squatting (or getting our knees higher than our hips) the puborectalis muscle is more relaxed and the rectal angle is now increased. Essentially this “unkinks” our rectum and allows a straight shot for stool to empty.
Complete Pelvic Floor Muscle Relaxation
The muscles at the base of the pelvis not only contract to maintain continence, but also have to fully relax to allow complete elimination. When these muscles lack coordination, a person may feel like they are “bearing down” or pushing to have a bowel movement but really they are squeezing the pelvic floor muscles making it extremely difficult to have a bowel movement. It is crucial that when having a BM you don’t forcefully push, strain, or hold your breath. But rather, focus on complete relaxation of the pelvic floor (almost as if you visualize your anus widening) while gently pushing with your breath.
Remember…. Poop smarter, not harder!
-Jenna Sires, PT, DPT
Jenna Sires received her Doctorate in Physical Therapy from the University of South Carolina in Columbia, SC. Upon graduation, Jenna remained in Columbia where she was married and gained a variety of experience in the outpatient setting. She had the opportunity to work with patients of all ages and diagnosis; including neurological, orthopedic, amputation, pediatric, general debility, and pelvic floor dysfunction. She quickly fell in love with ALL things pelvis. Jenna has been practicing at Proaxis since July 2012 and has chosen to specialize in the care of male and females experiencing pelvic floor dysfunction. She is a Share MayFlowers “first timer”, but looks forward to spreading the word for years to come!