Postpartum bowel challenges: constipation
Nobody likes to be constipated (obviously), and I’ll be frank: that first postpartum bowel movement can be downright scary because tissues feel raw and incisions are healing. The thought of pushing out a hard stool when everything feels so tender is anxiety-inducing.
Postpartum bowel issues are my second most-common postpartum malady I see my patients experiencing when they come in to address their pelvic floor dysfunction.
Tips to rectify postpartum constipation
About 50-60% of postpartum mothers experience constipation, so unfortunately, this is also a common postpartum malady. Do everything in your power to make those first postpartum bowel movements as painless – literally and figuratively – as possible.
Make stools soft:
You don’t have to be newly postpartum to know that having easier-to-pass stool can make a huge difference in how you feel. Fortunately, making stool softer can be as straightforward as drinking fluids like water and consuming fiber-rich nutritious food, such as oatmeal, soups, and vegetables.
Some providers also advise their postpartum patients to continue to take magnesium and stool softeners on a daily basis as well. Having a daily bowel movement that is strain-free, and one in which you feel completely “empty” afterward and not like any stool is stuck, that you can’t push out, is the goal for most patients postpartum.
Use a foot-supportive device like a squatty potty to give your bowels an anatomical advantage:
Sitting at a toilet to pass stool – without supporting our feet – is actually not advantageous to our bowels, due to the angle at which our legs become situated relative to the toilet seat. In fact, it becomes more challenging for our rectum to pass stool when we are sitting at the toilet with our feet on the floor.
Instead, supporting your feet when you’re trying to have a bowel movement by using products like squatty potties or footstools can help better support your legs and open your rectum in a way that simply having your feet on the floor does not, as it allows for your pelvic floor muscles to relax.
Additionally, after having a cesarean section, a shorter stool is helpful to lessen pressure on the abdomen.
ILU Abdominal massage daily for 5-10 minutes
This intervention works best when done daily for 5-10 minutes, and doing so can help you maintain bowel regularity even when you’re not taking stool softeners or magnesium. Start on the right side of your abdomen and sweep up for the “I,” and then for the “L,” start on your lower right side as before and sweet up and across. For the “U,” again start from the right, and sweep up, across, and down your midsection.
These letters trace our bowels’ movement in our bodies. Research has shown that it doesn’t really matter if you rub your stomach, move it all around, or do a skin-lift or skin-pinching technique; it can all help with bowel movements by decreasing the pressure in your abdomen to have a bowel movement.
If you had a Cesarean: Consider using a pillow to support your abdomen while you’re sitting on the toilet. Brace with the pillow while you’re having a bowel movement to lessen the pressure on your abdomen and thus, on your scar.
If you had a perineal tear: Take a piece of tissue and press it up against the scar, then support it with 1-2 fingers and have your bowel movement. This technique can provide a type of support or splint during a bowel movement.
When to see a pelvic floor physical therapist
So often parents with newborns feel like their own health challenges become secondary, and they assume that their experiences postpartum, like urinary leakage, constipation, or painful perineal or Cesarean scars, are “normal” because they know so many postpartum parents who have the same.
I started Optimize Pelvic Health in part because I want the world to know that just because something is “common” does not mean that it is “normal.” Many pelvic floor dysfunctions are rectifiable by pelvic floor physical therapy; you don’t have to live in pain or discomfort.
Consider seeing a pelvic floor physical therapist if you’ve experienced any urinary or fecal leakage, organ prolapse, or pelvic/back/hip pain that has lasted longer than six weeks. If you’re having difficulties or pain managing your cesarean or perineal scar, you may also be a good candidate for pelvic floor physical therapy.
Pelvic floor dysfunction can feel like an “invisible” injury and oftentimes is uncomfortable and stigmatized to talk about, making it hard for patients to get the care they need. I would love to partner with you and help restore your health so that you can fully and comfortably enjoy life with your family.
Written by Dr. Janet Yiu, PT, DPT, OCS, FAFS