Many women have a fear of passing stool (aka pooping) while giving birth. But there can be an equal amount of fear when it comes time to have your first bowel movement after the baby has arrived.
This is a common fear and to counter fear, my belief has always been to educate patients so the unknown isn’t so daunting. Also, this topic is almost always NEVER talked about, certainly not at any pre-natal class or doctor’s visit I attended during my pregnancies. As a pelvic health physiotherapist however, I open up the conversation with my patients – before they give birth.
There’s a lot to be said about giving in to your urges – and having a poop is no exception! If you get the sense you need to have a bowel movement, act on it as soon as you can, especially after giving birth. The fear of passing something else through your perineum is enough to make you want to pucker up for the next 6 weeks but don’t let fear get in the way.
When you get the urge, get your significant other, or nurse/midwife/doula to watch the baby for a while as you get yourself to the bathroom and settle down for some quality toilet time.
I wouldn’t be much of a physiotherapist if I didn’t talk about posture, right? The idea on the toilet is to mimic a squatting position while still sitting on the seat. Grab a 7” or 9” foot stool (depends on how long your legs are) to get your knees up – this will seem quite high at first. But I have a good reason for this: we know that the main pelvic floor muscle around the rectum (called puborectalis) is relaxed the most when the hips and knees are bent as we lean forward (i.e. squatting).
There are lots of products out there to help you dress up the bathroom: The Squatty Potty, Stool Stool, and other such nifty named items! But, a good old fashioned foot stool does the trick as well.
Honey, you are not going to Kegel your way out of this one. I am always talking about ways to find your “relax point” within the pelvic floor. This is especially true after birth – whether vaginal or caesarean section – as the muscles have just had a major stretch session! Even the 9 months that lead up to this miracle of birth have had a huge impact on these muscles.
Think about constant strain on any muscle in the body, such as the jaw with clenching; these muscles get tight and sore. In fact, relaxing your mouth and jaw muscles are a good way to get your pelvic floor muscles to respond to the relaxation cue you are giving it. Other cues include: unpuckering around your anus, and allowing your tailbone to move away from the pubic bone.
Just like you were instructed to do when in labour, breathing is just as important for a bowel movement. The actions are somewhat similar except now you are directing the outlet to your anus. But don’t hold your breath and strain…take a breath in so you can feel your pelvic floor release downward. A few of these breaths should get the stool moving in the right direction.
If you need a bit of help and feel like you want to hold your breath try blowing into an almost closed fist – this will give you some resistance while still moving air in your lungs and avoiding straining.
Now that you are in the sanctity of the bathroom, and your feet are up on a stool, relaxing your pelvic floor muscles, supporting you perineum is a great way to lessen the pressure of the passing stool on your sore bottom.
The best way to splint this area is to gently apply counter pressure to your perineum (the middle zone between your vagina and anus) as the stool is passing out the anus. It may be swollen still but a bit of gentle support with your 2 fingers on the outside part of your bottom is all you need. This can help lessen pressure on your sore bottom which reduces pain and stretch on your pelvic floor.
Over the counter stool softeners are often prescribed by your obstetrician and midwife. Please don’t be afraid to take them even for several weeks post-partum. The supplement magnesium is also a very good option to add to your regime as it can have a dramatic positive effect on your bowel movement ease. The recommended dose is about 300 – 450 mg per day (or 5 mg/kg/day) but speak with your doctor or pharmacist if you feel you need more, which might depend on your other medications and supplements (such as iron), which can cause constipation.
Of course, do not under-estimate the impact of good hydration. Drink plenty of water which might seem like you are already doing that but you are likely dehydrated from the marathon of giving birth. Add on breast feeding and your body is in short water supply!
Getting up and walking around, even little bits as you can tolerate, is really effective in producing a bowel movement.
Timing a small walk 20 minutes after you have eaten is a great way to stimulate the gastro-colic reflex. This is the natural response our bodies have to the intake of food. You will notice your babies are very good at this reflex – often pooping right after a feeding!
Stimulate your bowels to move by adding in a little walk after you eat, whether that is around your bedroom, up and down the halls in the hospital, or a little walk around the block. It all helps getting things moving in the right direction.