When we talk about the pelvic floor, often the first thing people think about are Kegel exercises to help strengthen pelvic muscles and reduce urinary leaking. With so much focus on these aspects of the pelvis, it’s easy to forget that colorectal function is also an important part of maintaining healthy pelvic floor function. That’s right. I’m talking about your bowels and the question is how well do you poop?
Constipation is defined as having less than 3 bowel movements a week or difficulty passing stools that can lead to excessive straining, according to The Mayo Clinic. Common causes of constipation can include an unbalanced diet, lack of exercise, and nervous system or musculoskeletal dysfunction.
With constipation getting enough exercise is important. Addressing deficiencies in your diet is essential. Consuming enough fiber—adding flax seed into your diet is a good way to increase your fiber intake—and drinking lots of water can be helpful. If these basic steps are not enough, your doctor can work with you suggesting things such as stool softeners or fiber supplements such as Citrucel or Metamucil.
Performing a daily colon massage is another excellent way to get your colon moving. Ask your physical therapist to show you how to do this. Also, changing the way you sit on the toilet can help get things move along. The squatting position is one of the best positions for pelvic floor relaxation, and it easier to have a bowel movement in a position similar to a squat as compared to sitting upright on the toilet. To simulate the squatting position on the toilet, you can use a small stool. a yoga block, or a phonebook to prop your feet on. Your knees should be higher than your hips. This position helps your pelvic floor muscles that sling around your rectum relax a bit, so the stool can pass easier through the rectum.
While it is evident and proven that squatting or a squatting position helps you poop, there is another piece to consider: What if you are squeezing when you think you are pushing? In other words, when bearing down (or bulging) like you are having a bowel movement, the pelvic muscles tighten and squeeze instead of lengthening. This common muscle dysfunction can be quite counterproductive.
So let’s say you’ve done everything right. You poop when you have the urge. You squat on the toilet. You eat well, take fiber and exercise daily. You’re not on any meds that would cause you to be constipated. And you’re still having trouble pooping. Well, maybe you are squeezing when you should be bulging. You’re not alone in this. But what to do?
A mirror is a great tool! Recline in bed, place a mirror where you can see your perineum and anus. Try squeezing, you should see your perineum and anus lift. Then try bulging or bearing down, you should see your perineum and anus bulge. Just like any other muscle in your body, the muscles in your pelvic floor function most effectively when they have full range of motion.
And don’t forget to breathe! In fact steady, deep and full breaths are one of the most effective ways to teach the pelvic floor muscles to let go enough in order to bulge. If you are still concerned about how to poop, consult with a pelvic floor physical therapist.
~ Meagen Satinsky MPT, PYT
Meg is leading Beyond Kegels: Discovering Pelvic Floor Foundations, a 2.5-hour women’s workshop to locate, relax, stretch, strengthen and exercise the various muscle groups of the pelvic floor, hips and lower abdominal muscles. Saturday April 9, 1-3:30 pm at Evolution. Sign up here.

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