Take the strain out of having a poo

pug dog sitting on toilet and reading magazine having a break

Do you know how to poo? It sounds as silly a question as “do you know how to breathe?” Yet both can be troublesome and have potentially far-reaching consequences.

pug dog sitting on toilet and reading magazine having a breakWhen something as natural as bowel movements goes awry, it’s not something ladies usually talk about. As with most issues ‘down there’ we tend to cross our legs as society requires, put up and shut up.

The movement of food along the gut and bowels takes around 24 hours and we’re not conscious of 99% of that journey. It methodically processes everything we eat, and nourishes every cell of our body – literally fuelling us in every moment of our lives.

So why do we feel we need to forcefully help things along at the last moment? Time pressures, distasteful odours, perhaps we even think that pushing is necessary, especially if our digestion tends to be sluggish.

Perhaps it’s time to help our body, not fight it…

Under pressure

Constipation, poor digestion and bloating are a feature of many people’s lives. Straining on the toilet seems a perfectly reasonable way of getting rid of all the bad stuff as fast as possible. But unfortunately it’s one of the worst things you can do.

Bearing down to push out increases the pressure inside your abdomen, compressing your organs, straining against your pelvic floor muscles, aggravating any gaps in your tummy muscles after having kids and possibly making you lightheaded as you hold your breath.

I know that an increase in pressure to move things along is the point – but it really isn’t good for you.

That pressure has to go somewhere and the result is often painful haemorrhoids. These are actually blood vessels designed to gently cushion your stools on their way out, which should be a fairly relaxed process. If they are compressed too much or inflamed, they can bleed, become very sore, and sometimes migrate out of your back passage to be visible on the outside. They can be difficult to get rid of once they are out there, especially if the causes are not addressed.

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Another role of the haemorrhoids is to assist in the complete closure of your back passage after going to the loo – something nobody wants to lose control over.

One in three women suffer from the ‘loo taboo’ of urinary incontinence at some point in their lives. This is usually down to some weakness or dysfunction of the pelvic floor muscles – that hammock of muscle supporting your abdominal organs between your tailbone and your pubic bone. Increased pressure during straining is only going to make the poor pelvic floor’s job harder and exacerbate any other symptoms you are experiencing.

As an inherently natural function, a good poo takes place in a calm, relaxed environment. Holding our breath usually takes place when our environment is challenging – underwater, hefting heavy things (not good to hold your breath here either) or when waiting anxiously for news that could go either way.

By holding our breath to strain, we are firing up the anxious side of our nervous system right when our body would appreciate a little down-time to process things with ease.

The great news is that there are some simple solutions that can make a big difference to you if you strain or suffer the effects. And other related benefits include clearer skin, better sleep and reduced stomach pains and cramps.

Get in the poo position

If you’ve had children you’ll have come face to face with the business end of things all too many times, and we spend a great deal of time and effort getting our kids to use the potty and sit on the toilet ‘properly’, rather than squatting in the flowerbeds (or the middle of the carpet!) as they sometimes seem to prefer.

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The first successful, solo toilet trip is a magic moment, a glimpse of future freedom and nappies past.

Image from http://www.stressnomore.co.ukBut the reality is, we are kidding ourselves. The kids have got it right all along…

The easiest, and possibly most significant, thing we can do is to change our position on the toilet.

Part of our pelvic floor musculature creates a loop around our colon, holding it in an exaggerated kink while we are up and about. In a traditional squat position that children find so easy, that muscle is relaxed, the colon straightened, and the contents easily move forth.

Sadly, the design of our toilets tend to keep everything at right angles, with our knees often below our hips, our backs rigid straight and some of us littler ladies even on our tiptoes. Such a position keeps the kink intact and can even activate the pelvic floor to further restrict our movements. It’s easy to understand how straining, in this position, can sometimes be the only option.

Screenshot of the correct loo position, avoid constipationMost adults can’t squat fully and thankfully we don’t have to in order to make improvements, though I encourage you to try.

Simply adopt a different position – pop your feet on a low stool, with your knees slightly higher than your hips. Lean forward to rest your arms on your knees, and let your belly relax outwards. You may even feel your undercarriage relax outwards a little.

Then wait. If you are starting from a point of regular constipation, your body may take a few days to start appreciating its new freedom, so have patience and you’ll be amazed how you start to feel the body moving things along just fine on its own.

A little push may be all you need, and in this position, with your tummy relaxed rather than bearing down, you won’t be risking damage to other structures.

 Bristol stool chart, constipatedMake it mushy

Consistency varies even with a healthy gut, but the majority of the time easy-to-pass-poo generally has some moistness to it, is reasonably soft, and a bit slimy. Sounds delightful, but they’re all the things that enable a happy onward journey. Check out the Bristol Stool Chart.

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If you are passing hard, dry stools then simple things like drinking more water – around two litres a day, not including tea and coffee – and eating more fibre like good fruit and veg, wholemeal bread and pastas will stimulate the gut and make things easier.

You may also want to talk to your GP if you have had problems for a long time – a short course of Lactulose laxative syrup can start to make things far more pleasant and set you up for longer-term recovery.

Move about more

Though our gut processes can be seen to be mysterious and magical, they also benefit a great deal from simple mechanical stimulation i.e. moving about. Exercise and general activity not only improves our physical health and our mental wellbeing, but it’s a valuable contributor to a healthy gut process. It usually ensures a relaxed post-exercise state, and therefore allows the ‘rest and digest’ nervous system to take over and get the maximum nutrients from your food.

Go on time

You will find that your body has a routine and things work best if you allow yourself to go when the urge strikes you.

Constipation can be aggravated by holding in for hours waiting for ‘the right time’ or ‘the right toilet’. Natural evacuation should only take a couple of minutes – a few more with a good book – so by working on the tips above, and reducing blockages, fitting time into a busy day should get easier as time goes on. Challenge old habits and literally feel a new-found freedom!

So in summary, though straining may seem like your only option, trust your body and give it the tools necessary to resume its natural function. A few tweaks can make big changes.

Kathryn Peden

About Kathryn Peden

I specialise in women's health physiotherapy – meaning pelvic, bladder, and pre and post-natal care – and musculo-skeletal physio – necks, shoulders, backs, knees etc. My goal in life is to help people overcome physical problems while developing a new understanding of and positive relationship with their bodies. I find it hugely rewarding, especially working with people who have been told or believe they 'just have to put up with it' – that's so often not the case! It's important to take the whole person, their mind and body, into account when working on pain, injury or dysfunction, as well as their work or home situations. BSc Hons, HCPC, MCSP, MPOGP