Constipation. If your back passage (bowel release and anorectal action) isn't working well, nothing else in your pelvis (bladder, intimacy, pelvic organ support and core strength) will be working well.  So, brace yourself, let's talk constipation!
 
Do you enjoy a consistent, full, complete and satisfying bowel movement every morning?  BMs should be a minimum of every 2 - 3 days and a maximum of twice daily.  You should never need to rush, have skidmarks in your undies or lose stool without you knowing or before you're ready.  Ever.  The stool should be firm but not dry or very cracked, smooth but not sticky and medium sized to pass with comfort.  It should be brownish, of a consistent smell and without mucous or blood.  It shouldn't be painful to release your stool nor should you bear down.  Hemorrhoids can come with pregnancy or stress, but shouldn't be persistent.  You should be able to travel or change your routine without upsetting your BMs.  Your bowels are meant to digest your food and drink, transfer nutrition to your body, then get rid of the waste.  It's a beautiful system!
 
How does it actually work?  When you take that first warm drink in the morning, the sphincter between the esophagus (food tube) and the stomach sends a signal to the rectum that today's food is en route.  Yesterday's waste is nudged along the colon, down the digestive tract and into the rectum.  The sphincter at the end of the rectum opens up.  Counterintuitive?  Stool has just landed and it opens up to take a sample.  It checks if it's gas, liquid or solid. If it's gas, it nudges you. If it's liquid, it slams shut and gives you to signal that you need to move!  If it's solid, it shuts firmly and gives you the message, "Time to go to the toilet".  Don't delay.  It nudges, you calmly go.
 
Toileting habits are important. Sit comfortably and relax.  Your knees should be slightly higher than your hips, supported on a stool or block. Breathe into your belly and sense your pelvic floor softening, descending, and the sphincters opening up to let stool pass.  If you have the urge to push, don't!  Just breathe into your belly and do a bass hum, low growl or pursed lip outbreath to protect your pelvic floor.  Keep allowing your system to release and let go.  Don't stop the stool until your body says you're done.  Then belly breathe again, rock your pelvis and enjoy a few moments of quiet.  When you're sure you're done, do a few gentle pelvic floor squeezes to help clear the anus so that wiping is gentler and more complete.
 
You can support your digestive system.  Keep hydrated, drink mostly water, and enjoy a drink of warm water with tooth-brushing to help your stool stay hydrated overnight.  Be cautious with fibre, adding a little at a time.  Pay attention to the foods that your body finds a problem - what makes your stool too solid and/or what makes it too loose?   What gives you gas?  You're unique, so learn about you.  Support your system with a heated wheat bag and a massage.  Help your system release its waste products after all the work it's done for you.  Depending on your issues, there are specific techniques, stretches, breathing patterns and habit changes that will help you enjoy lovely BMs that support your health.
 
If you have specific problems with your bowel release, a pelvic physiotherapist provide you with with an internal and external assessment and treatment plan just for you.  Your digestion, bladder, pelvic organ support and intimate life will thank you!

The bossiest, most demanding part of our pelvis is our "back passage" (our anorectal function, BMs or pooping).  If your bowels aren't emptying well (full, complete and satisfying daily BMs), then your bladder, your pelvic organ support, your intimate function and your general sense of wellbeing won't be thriving either.  "Back Passage First" is a rule in pelvic physiotherapy.  Once you learn and/or relearn wonderful bowel release, your other pelvic issues may be addressed with ease.
 
What is normal for your BMs?  The rule is that you enjoy a full, complete and satisfying BM at least every 2nd or in rare people, every 3rd day or as frequent as 2 - 3x per day for some people.  There should always be a sense of full evacuation of your stool, not a sense of "there's still some left behind".  There should be ease in release, not pushing, forcing, breath-holding or grunting.  There should be ample time to get to the toilet, not making a mad dash to get there in time.  There should be a clean exit with tidy wiping with ease, no skid marks in your undies or loss of stool without you being aware.  There should be no straining or pushing or pain.  And it should end with a sense of satisfaction of a job well done!
 
What should a normal bowel movement be?  Perhaps surprisingly, we talk about this a lot and the smart folks in Bristol, England developed the Bristol Stool Chart.  It's a handy guide to give both you and your health care providers a simple way to talk the same language about our bowel function.  The scale goes from 1 to 7.  Numbers 1 and 2 describe hard lumps, either separate or together…..think deer droppings and indicate a level of constipation.  3 and 4 are sausage-y like shapes, sometimes dry and cracked or smooth and snake-like.  If your bowel movements look like 3 and 4, that's great as long as they're the width of a sausage, not a pencil.  That indicates other issues. 5 is soft and blobby with clear edges and indicates a lack of fibre in your diet.  6 is the beginning of diarrhea, soft and blobby but with ragged, frayed edges.  7 describes full-on diarrhea….loose, watery, liquid poop with nothing solid visible.  Understanding and getting familiar with the Bristol Stool Chart can help you describe to your health care providers what's going on inside you.
 
It's not normal to have blood or mucous.  Blood can appear from a hemorrhoid and enthusiastic wiping or can be an indicator that there are more challenging problems.  Mucous shouldn't be in our digestive tract and suggests that your body is fighting an infection.  You need to see your doc, either way.
 
Your BMs should be brown, with no undigested food visible, not chalky or blackish or have a truly foul or different-from-normal odour.  We're not talking smelling like roses, but healthy BMs don't smell awful!  Stop and have a gander…..this is digested food that's done its job for you, feeding you and giving you nutrition, energy for your life and yumminess….be grateful and pay attention.  Your BMs give you cues about your health.
 
Your toileting habits matter.  Firstly, it's important to understand the gastrocolic reflex.  This is the nudge that you receive (thanks to your lower esophageal sphincter chatting with your lower colon) when you start your day with a warm, caffeinated drink.  As you swallow, your colon gets the message, "Empty out yesterday's food…..today's is coming!"  Paying attention at that moment will help you establish beautiful bowel habits.  Go to the loo.  Spend some relaxed time, not rushing, calmly breathing into your belly, with your knees slightly higher than your hips on support, massaging your tummy and enjoying effortless bowel release.  It takes opening of the pelvic floor to accomplish this, so calm, unrushed presence is really helpful.  Don't wipe right away.  Take a few more breaths to be sure that you're done. 
 
Toileting habits will be in our next "chat".  Bladders and bowels ask different things of us on the toilet, so clarity around the messages you receive and your response is important.
 
Happy BMs!

Written by Joanne Gailius, June 2018
 
Constipation. If your back passage (bowel release and anorectal action) isn't working well, nothing else in your pelvis (bladder, intimacy, pelvic organ support and core strength) will be working well.  So, brace yourself, let's talk constipation!

Do you enjoy a consistent, full, complete and satisfying bowel movement every morning?  BMs should be a minimum of every 2 - 3 days and a maximum of twice daily.  You should never need to rush, have skidmarks in your undies or lose stool without you knowing or before you're ready.  Ever. The stool should be firm but not dry or very cracked, smooth but not sticky and medium sized to pass with comfort. It should be brownish, of a consistent smell and without mucous or blood.  It shouldn't be painful to release your stool nor should you bear down. Hemorrhoids can come with pregnancy or stress, but shouldn't be persistent.  You should be able to travel or change your routine without upsetting your BMs.  Your bowels are meant to digest your food and drink, transfer nutrition to your body, then get rid of the waste.  It's a beautiful system!
 
How does it actually work? When you take that first warm drink in the morning, the sphincter between the esophagus (food tube) and the stomach sends a signal to the rectum that today's food is en route.  Yesterday's waste is nudged along the colon, down the digestive tract and into the rectum.  The sphincter at the end of the rectum opens up.  Counterintuitive?  Stool has just landed and it opens up to take a sample.  It checks if it's gas, liquid or solid. If it's gas, it nudges you. If it's liquid, it slams shut and gives you to signal that you need to move!  If it's solid, it shuts firmly and gives you the message, "Time to go to the toilet".  Don't delay.  It nudges, you calmly go.
 
Toileting habits are important. Sit comfortably and relax.  Your knees should be slightly higher than your hips, supported on a stool or block. Breathe into your belly and sense your pelvic floor softening, descending, and the sphincters opening up to let stool pass.  If you have the urge to push, don't!  Just breathe into your belly and do a bass hum, low growl or pursed lip outbreath to protect your pelvic floor.  Keep allowing your system to release and let go.  Don't stop the stool until your body says you're done. Then belly breathe again, rock your pelvis and enjoy a few moments of quiet.  When you're sure you're done, do a few gentle pelvic floor squeezes to help clear the anus so that wiping is gentler and more complete.
 
You can support your digestive system.  Keep hydrated, drink mostly water, and enjoy a drink of warm water with tooth-brushing to help your stool stay hydrated overnight.  Be cautious with fibre, adding a little at a time.  Pay attention to the foods that your body finds a problem - what makes your stool too solid and/or what makes it too loose?   What gives you gas?  You're unique, so learn about you.  Support your system with a heated wheat bag and a massage.  Help your system release its waste products after all the work it's done for you.  Depending on your issues, there are specific techniques, stretches, breathing patterns and habit changes that will help you enjoy lovely BMs that support your health.

​If you have specific problems with your bowel release, a pelvic physiotherapist provide you with with an internal and external assessment and treatment plan just for you. Your digestion, bladder, pelvic organ support and intimate life will thank you!