Pooping

Let’s face it people. A bowel movement (BM) has the ability to make or break your day. Am I right, or am I right? Everyone has experienced a bad time on the toilet. You might have had to strain for 30 minutes after a night of fast food and booze. Or you might have had diarrhea after a food bug from travel.

However, this rare “off” day on the toilet happens to some, while others have a consistent issue with their bowels, an issue that ends up having a sizable impact on their everyday lives.

In this blog post, you are going to read about constipation, a problem that affects 20% of the population. You’re going to learn what it is, the few main reasons for it, and one thing you can definitely do about it.

So let’s get down to business.

What is constipation?

Many think they are constipated if they don’t have a BM every day. However, having three BMs a week is actually considered normal!

So what are the facts?

According to a well-referenced criteria, you are clinically constipated if two or more of the following occur at least 25% of the time, for at least 3 months:

• Fewer than 3 BM a week
• Straining
• Hard/lumpy stool consistency
• Sensation that you haven’t fully evacuated
• Sensation of feeling blocked
• Having to manually remove stool

To check the consistency of your stool, here is a useful chart I show my patients. Types 1 and 2 are considered on the constipation side of things while types 5-7 are considered on the diarrhea side of things. Types 3 and 4 are normal.

If you fit into the above criteria, your next question is probably…. Why is this happening to me?

Why am I constipated?

Here’s a general breakdown of some reasons you might be constipated.

1. Toileting posture: The amount you strain is correlated to how much you bend your hips while having a BM. More on this below. ​
2. Abnormal pelvic floor muscle activity during a BM: Contracting your pelvic floor muscles instead of relaxing them can increase constipation.
3. Hard stool consistency: Slower digestive tract → stool stays in the body longer → harder stool → difficult BM *Medications, nutrition, water intake, age, and your level of exercise can all affect stool consistency. 
4. Sensory changes: Nerves can send mixed signals. You may have an urge to go when you don’t have to or vice versa.
5. Psychosocial issues: Dependency on someone else to take you to the bathroom, poor cognition, dementia, depression, fear of BM pain, and pressure to have a fast BM can all worsen constipation.
6. Diseases: Constipation can be a symptom of many diseases and disorders including irritable bowel syndrome, Celiac’s disease, and more.

What can I do about it?

While I could write a book to address solutions for the full list above, I can address the easiest preventable cause for straining - toileting posture.

Cavemen used to squat on the floor. Watch your dog next time he’s going. You’ll see that pup tuck his pelvis right under him, the normal way to go. But with the advent of Western toilet seats, we end up sitting with our hips barely flexed, which changes the positioning of our pelvic floor muscles.

Now, for an analogy. When your hips are not bent enough, your stool passes through like a kid sliding down a twisty turny water slide. When you squat all the way down, your stool passes like a drop tower at a theme park… straight down, quick and easy!

Tips:

• When you can, sit with your knees above your hips. You might need a stool under your feet (pun intended!).
• Don’t hold your breath on the toilet. Ever.
• Take a deep breath in and out, relaxing your hips, thighs, and muscles around your pelvic floor.
• Do not bring your phone in the toilet, as hard as that may be for some. This activates a nervous system response than can inhibit your ability to have an easy BM.

Last Thoughts.

Pooping problems can ultimately interfere with the quality of your life. It takes a bit of investigation to determine the root causes.

Seeing a pelvic floor physical therapist can address many of the reasons listed above. For example, a pelvic floor physical therapist can teach you proper toileting posture, how to relax your pelvic floor to have a bowel movement, self-massage that can help increase the speed of things moving in your GI tract, how to receive appropriate sensory signals from your pelvic floor nerves, bowel schedules and behavioral changes to improve your BM, and more.

If you suffer from chronic constipation, please get help!

So there it is folks - our first post in our 3-Part Pelvic Series on Pooping! Next up, I’ll be discussing a common issue with… Peeing!

References:

1. Rao, S. Biofeedback therapy for constipation in adults. Best Pract Res Clin Gastroenterol. 2011; 25(1):159-166.
2. Roque MV, Bouras EP. Epidemiology and management of chronic constipation in elderly patients. Clin Interv Aging. 2015; 10:919–930.
3. Sakakibara R, Tsunoyama K, Hosoi H, Takahashi O, Sugiyama M, Kishi M, Ogawa E, Terada H, Uchiyama T, Yamanishi T. Influence of body position on defecation in humans. LUTS. 2010; 2(1):16-21.
4. Shih DQ, Kwan LY. All roads lead to Rome: Update on Rome III criteria and new treatment options. Gastroenterol Rep. 2007; 1(2):56-65.
5. Tanjung FA, Supriatmo, Sinuhaji AB, Hakimi. Functional constipation and posture in defecation. Paediatr Indones. 2013; 53(2):104-107.

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