Bowel movements?!? Really?!? You want to talk about bowel movements?
Yes. Yes, I do.
This was one thing I certainly never expected to be an issue postpartum and it definitely was NOT something I cared to research when I was having kids. I was so focused on getting the baby out, I didn’t think much about after the fact! One would expect that a bowel movement would be nothing in comparison to pushing an 8 pound baby out of your body, right?!? Well…
Many women don’t anticipate constipation being an issue after delivery, especially if you’ve never had issues before. However, a multitude of factors can throw things off and leave you feeling all “backed-up”. Medications, prolonged sedentary positions and/or an altered diet are just a couple of potential culprits. Regardless of the reason(s), it makes for a less than ideal experience when the time comes to void those bowels. Your healthcare provider will most likely be asking you and keeping track of how this process is going during your hospital stay. However, if you continue to have trouble in this department after giving birth, don’t be afraid to ask for help so they can set you up with a variety of resources like stool softeners and enemas to help move things along.
In addition to the nutritional factors that we all know we should do (i.e. drink lots of water, eat lots of high fibre foods), there are some additional tips you can do should you find yourself in the situation of dreading postpartum bowel movements.
Knees higher than hips - Those fancy hospital commodes are handy so you don’t have to lower yourself down so far, but sitting high doesn’t do much for optimizing the position of the rectum when trying to void those bowels. Grab a stool or improvise with a garbage can (preferably empty!) tipped on its side. Place your feet up on something secure so your knees are higher than your hips and legs are supported and relaxed. This can help align things more optimally for faecal evacuation and it gives the pelvic floor opportunity to relax in a slightly more “open” position.
Position some more - Lean forward and rest elbows on knees. This allows for further relaxation. Let the tailbone untuck slightly to allow for easier passage of stool through this area.
C-Section? Splint your lower abdomen - If you’ve had a C-section, place a towel or your hands gently but with firm pressure over the incision site. Try not to block your belly from expanding forward completely however, as this movement can further help the muscles surrounding the anus to relax. I know feels like things will burst wide open if you strain too hard, but keep in mind that the surgeon stitches you up with the goal of keeping you closed. If they thought the forces generated by pooping were going to be a hazard to healing, they would tell you not to poop for 6 weeks until things were all healed up. Plus, after reading this blog, you now have some strategies to minimize that horrible feeling of pain/pressure/pulling at the incision site!
Relax - Way easier said than done especially if you’ve had any type of tearing, an episiotomy, a C-Section or are just dreading having to “push” one more time! Pelvic floor muscles relax and open more easily when you are not stressing about it or anticipating pain. How do you relax the pelvic floor specifically? One way is to use your breathing - inhale and simultaneously visualize opening the anus. Sometimes it works well for people to visualize widening the SITs bones away from each other as you inhale (the “SITs bones” are the two boney points you feel in your backside when sitting in a chair). This relaxing, opening or gentle drop sensation in the pelvic floor muscles should NOT feel like you are pushing downwards or forcing things open. It’s simply a response to the breath. If you’re having trouble getting this down, get help from a pelvic physiotherapist who can walk you through this more completely.
Don’t clench your jaw - Also, if you’re having trouble relaxing the pelvic floor, check and make sure you aren’t clenching your teeth. Strangely enough, keeping your jaw relaxed can help the pelvic floor relax to. Ready for some more weird and wonderful suggestions?? I’m just warming up!
“Moo”, “Grr”, “Hiss” or pretend to “Blow through a very small straw” - Ummm, WHAT?!??! If you didn’t already think I was crazy, I realize I just tipped the scale. Please, bear with me (no pun intended!). Using your breath or vocalizations on the exhale can help modulate intra-abdominal pressure and act as an effective tool for assisting with a less strenuous bowel movement. It can help you avoid the Valsalva Maneuvre (breath holding) that can increase downward pressure on the pelvic floor and/or the outward pressure on the C-Section incision site (if you have one). Try all four sounds out - see which one feels like it opens the anus the most. Generally speaking, half of these vocalizations will feel like they make you tighten at the anus, and the other half will create an opening effect. However, which one is most effective will vary from person to person. When you find one that feels like it creates the greatest opening effect (eg. “Moo”), use that as your go-to vocalization when on the toilet. If you are having trouble finding one that works, make sure you try again using a low-pitched voice versus a high-pitched voice. In attempts to try and redeem myself, I’m going to throw in here that you don’t actually have to make the sound so they can hear you at the nurses’ station (although that would be entertaining!). Simply causing that air movement with a whispered “Moo” can be just as helpful.
Strange tips, I know, but these simple things can make a HUGE difference in keeping that first bowel movement or two after delivery a much less torturous experience.
You’re welcome.
Until next time,
Jaclyn Seebach, PT ~ Certified Pelvic Health Physiotherapist
*If you have ongoing struggles with constipation, please connect with a Pelvic Health Physiotherapist (like me!) who can help you navigate these issues more completely. Being backed up is no fun for anyone. In addition, you can also connect with a healthcare provider such as a registered dietician, physician or naturopath who can more appropriately address any medical or nutritional factors - this will also be helpful and Jaclyn can’t help you with those.