A wise woman once said that if you can survive your first postpartum poop, you can survive anything.
It’s true that the first poop after birth can be daunting. Unfortunately, postpartum constipation is a common ailment, even among women with no history of bowel issues. Sluggish bowels can result from many factors all occurring at the same time: medications lingering from birth or postpartum pain management, dehydration that might be more significant due to breastfeeding, moving less while you’re recovering, and eating differently (hello, door-dropped casseroles!) might all be contributing factors. At the same time, your still-healing perineum from a vaginal delivery or episiotomy, or cesarean incision may not feel up for the challenge of a difficult poop.
But the body continues to function as it should, and eventually, your body will need to clear things out. It may help to have a few tools and strategies on hand to help keep your stool healthy and optimize your setup.
Keep the stool as soft as possible.
- Drink lots of water. Some sources say that breastfeeding moms need about 3 liters of water per day on average. Most women will remain hydrated if they drink only when they’re thirsty, and most nursing moms will tell you that they feel thirsty quite often. Therefore, there’s generally no need to chug; there is no benefit to drinking more water than you need. You may want to keep track of your water intake if you’re not used to drinking water or if you’re noticing consistently hard stools or dark urine.
- Some birth providers recommend new moms starting an over-the-counter stool softener (like Colace) right away after birth and continuing until you’ve passed your first bowel movement or no longer need to take your pain medications. Everyone’s body reacts differently, so discuss this option with your physician before you start.
- Try a “natural laxative” made up of a combination of soluble and insoluble fiber. The Smooth Move Recipe is a delicious and whole-food way to make sure you’re getting sufficient fiber in those early postpartum days. Just be sure to keep up with your water as much as possible; increasing fiber intake too quickly or without enough water can contribute to bloating and gas, so go slow and stay hydrated along the way. Keep the pre-made recipe in your refrigerator and start with a small dish each day (about 2 tablespoons) followed by a full glass of water. Increase your dose by 1-2 tablespoons every few days as needed.
- Smooth Move Recipe:
- 1 cup Oatmeal (or Oat Bran)
- 1 cup Applesauce
- ½ cup Prune Juice
- Smooth Move Recipe:
Get in position.
- Squat. If you don’t already have a stool to put your feet on while you’re on the toilet, now is the perfect time. A stool under your feet places the knees above the hips in a semi-squat position, which helps the pelvic floor muscles to relax in such a way that will allow you to pass a bowel movement more easily. Once your feet are up, lean forward slightly with a long spine to maximize this squat-like position.
- Hug a pillow pressed against your abdomen to support your belly, protect your incision if you have one, and give your body something to push against. This strategy is especially helpful after a c-section.
- Make noise and exhale as you gently bear down. Holding your breath can actually make the pelvic floor tenser, which might impede your ability to poop. A slow exhale, or even better – a grunt or a groan ensures that your throat remains open and keeps the pelvic floor relaxed. It's important to focus on your breathing and avoid pushing or straining if at all possible as doing so can increase the risk of injuries.
Beyond the basics: What more can you do moving forward?
- Abdominal strength is a known strategy for addressing constipation, as a strong abdominal wall gives the bowel something to press against as it funnels stool down and out of your body. Abdominal strength is a slow, steady process for postpartum women, and it’s important to progress gradually. Look for a program specifically designed for postpartum women to get you started building abdominal strength, and consider abdominal strength to be an investment in your general health for the rest of your life!
- Birth and bowel movements are the only two times in a woman’s life that the pelvic floor relaxes completely. Pelvic floor strength will help with controlled and efficient bowel movements, but pelvic floor relaxation is equally important. Start by trying to complete ten pelvic floor contractions with a full release between each one. Does it take a long time to release? If so, you may benefit from a little focused practice each day for the first few months after birth to establish the coordination you’ll need to release the pelvic floor muscles. Try starting with 10 repetitions in the morning and 10 at night, with your only focus being how quickly and completely you can contract and relax the muscles. Don’t worry about strength for the moment.
- Walking is one of the best ways to stimulate your bowels. When we walk or exercise, it triggers the smooth muscles around our intestine to start working a little harder, called peristalsis. Although consistent exercise might seem like a far-off goal for your postpartum body, getting your steps in with baby in tow once you are through the initial stages of recovery can be an excellent way to keep your body (and your bowels) moving.
- Abdominal massage is a quick and simple way to stimulate your bowel function and keep things moving. Start with gentle circular movements down near the right side of your lower abdomen, then work those circles up to the right upper abdomen, over to the left upper abdomen, and down to the left lower abdomen to create a larger path that follows the direction of the bowel itself. Each full path should take about one minute. Repeat 3-5 times, at least once per day.
What else might come up?
- Hemorrhoids are veins in the anus or lower rectum that have become swollen and irritated, and are extremely common in pregnant and postpartum women. Hemorrhoids can be internal or external, may sometimes bleed, and commonly feel painful or uncomfortable. Increased pressure on the pelvic region during pregnancy can contribute to hemorrhoids, and the massive amounts of pressure on the pelvic floor during birth can also cause them to develop. Some women find hemorrhoids to be more significant or bothersome during pregnancy, and others say they’re worse during postpartum recovery.
- It may be helpful to know that among the general population, constipation is a major factor in developing hemorrhoids. Though you may not be able to control the pressure on your perineum from pregnancy, birth, or postpartum recovery, there are elements you can control about your bowel movements such as fiber, water, movement, and positioning on the toilet.
- You can keep the area comfortable with an over-the-counter cream or a daily hydrating balm to limit friction and keep the tissues healthy as they heal. If you’re really uncomfortable, don’t hesitate to speak to your care provider about other options for relief.
- A small amount of bright red blood may be seen with hemorrhoids that burst. It is always recommended to let your provider know if you’re noticing blood of any kind in your stool, as you may be a candidate for further screening to rule out other conditions.
- Pelvic physical therapists commonly have training in reducing the severity and symptoms associated with hemorrhoids. Depending on where your discomfort is located, there may be simple manual therapy strategies that can help to mobilize the veins involved and allow for quick recovery and symptom relief.
- Pelvic organ prolapse is another common concern among postpartum moms. Even a mild prolapse of the posterior wall of the vaginal canal (also known as a rectocele) can make pooping difficult.
- Pelvic floor strengthening is the first line of defense, and that’s because it works. Building up your postpartum pelvic floor strength will provide more structure and support in the pelvic bowl, which will help reduce symptoms associated with a mild to moderate prolapse.
- If you have a known or suspected pelvic organ prolapse, it’s always a good idea to see a pelvic physical therapist for individualized recommendations and support.
Still having trouble?
- Keep in mind that “normal” frequency of bowel movements can range from three times per day to three times per week, so consider what your body truly needs and speak with your healthcare provider if you are noticing patterns that are unusual for you.
- We all know it’s hard for parents to find “alone time” to use the bathroom, but we also know it’s best not to rush. When you do make the attempt (even if it’s with a small audience), try to remain seated on the toilet for at least five minutes, focusing on relaxing your body and breathing down into your pelvic floor. If you’re not ready to pass a bowel movement at that time, get up and try again later when you feel ready.
- Try setting up a morning routine around using the toilet so your body gets into the rhythm and is ready to make a move.
- Wake up with a glass of room temperature or warm water.
- Get things moving with some gentle bowel massage or a quick stretching routine to wake your body up and stimulate peristalsis.
- Try adding another small glass of warm water with lemon before breakfast. Warm fluids stimulate the bowel and also provide some much-needed hydration.
- Eat your breakfast, and include some sort of fiber. Oats, fresh fruit, greens, berries, avocados, and whole grains are all great sources of fiber.
- Go ahead and have your coffee or tea if you usually partake. Caffeine is a bowel irritant, which can help get things going if you’re stuck.
- Try a few more stretches, and this time be sure to include deep squats and trunk rotation to keep your system on track to void.
- Sit on the toilet with your stool underfoot, and bring your pillow if you need it.
- Practice deep breathing and pelvic floor release exercises while you relax your body.