Constipation: More than just a pain in the butt
If you've never experienced difficulty with bowel movements before, then good for you and keep doing what you're doing! However, if you are like many of us who have had experienced constipation then you know it can be quite uncomfortable and more than a little annoying.
Constipation can also become hazardous to the pelvic organs and muscles when we begin to strain and hold our breath in an effort to get the stool out. This puts an enormous amount of pressure on the pelvic structures and over time, this repetitive straining can lead to prolapse of the pelvic organs, weakness of the pelvic floor muscles and also hypertonicity (tightness) of the muscles.
Constipation is medically defined as less than 3 bowel movements per week and is usually due to one of two reasons; either the stool itself is very solid and difficult to pass, or there is a problem with the emptying process.
Solid stools can be due to a number of things:
Dehydration - as your food is digested and moves through the intestines, water is absorbed out of it and into the bloodstream. Water in the stool keeps it soft, therefore the less water you intake, the more solid the stool will be.
Limited physical activity - movement of the body helps to stimulate digestion and the peristaltic activity (contractions by the smooth muscles of the intestines) to move the stool toward the exit. The longer amount of time that the stool remains in the intestines, the more opportunity for water to be absorbed and the harder it will become.
Delaying emptying of the bowels - as above. Once you feel the urge to go, the stool is ready to be passed. If you wait for too long, this again allows water to be absorbed out of the stool.
Insufficient insoluble dietary fibre - there are two different types of fibre, soluble and insoluble. Insoluble fibre is the most helpful for constipation as it does not dissolve in water and stays relatively intact during its passage through the gastrointestinal tract, therefore speeding up the journey. Insoluble fibre is mostly found in whole grains and vegetables, particularly leafy greens.
Hormonal changes due to medication, pregnancy or thyroid conditions can also affect the stool. For example, progesterone in pregnancy slows down the peristaltic activity and thus more water is absorbed once again. * Pregnancy is a particularly vulnerable time for the pelvic organs as the ligaments holding them up are a bit stretchier due to relaxin and estrogen hormones. Constipation should absolutely be well managed during this time and early afterwards.
Problems with the emptying process of the bowels can involve the toileting position (which affects the angle of the colon and the pelvic floor), a rectocele (bowel prolapse), and also the ability of the pelvic floor muscles to relax sufficiently. The role of the pelvic floor is to help support the bowel and close the rectum. A hypertonic pelvic floor (tight muscles) will not allow the anus to open easily and therefore will cause trouble with letting the stool out. A Pelvic Health PT can help with this muscle tightness and teach you ways to manage it.
The invention of the modern western-style toilet made going to the bathroom perhaps more convenient, however it also caused more than a few issues along the way. Changing the position that our bodies were designed to empty waste products has negatively impacted our ability to do so. Having the hips at a 90 degree angle when sitting keeps a kink in the bowel that stops the stool from emptying properly. It also doesn't allow for the pelvic floor muscles to lengthen and relax properly (Click here for more on shortened pelvic floor muscles).
The ideal and most natural toileting position is squatting. This also facilitates great hip and knee flexibility and strength of the legs to get down to the ground. See Katy Bowman's You Don't Know Squat for more info and to learn how to prepare your body for squatting!
If you don't happen to have a bathroom that allows that, a good alternative is to get a stool of some kind to put under your feet while sitting on the toilet.
This helps to raise the knees and mimic the squatting position, allowing the colon to become un-kinked. Try to keep the outside edges of your feet straight and making sure that you don't go up onto your toes as this also helps with the pelvic floor muscle relaxation. Allowing your abdomen to relax and breathing low into your ribs also encourages the movement of stool, further relaxes your pelvic floor and ensures that you are not holding your breath. All of this results in easier evacuation of stool and less straining!
In summary, here are some easy ways to avoid constipation and pelvic floor damage:
Drink 1-2L of water per day
Fibre, Fibre, Fibre (of the insoluble variety)
Stay active and move regularly throughout the day
Go when you need to
Squat or use a stool for emptying the bowel (and also bladder for women)
Maintain a good length of your pelvic floor muscles (by avoiding or resolving muscle hypertonicity/tightness)
Never strain or hold your breath!
And if you don't believe me, check out this video of a mystical unicorn using a Squatty Potty for great pooping.