Pooping in pregnancy: The guide you never knew you needed!

As we know, pregnancy is a massive time of change. The size of your breasts, abdomen, the rate at which you breathe, the amount you pee (never-ending), and your bowels are all affected when creating a new life. 

Let’s face it, talking about the bowel isn’t really a top priority of most during pregnancy, as it’s far more exciting to discuss topics such as baby names and pram choices. However, the one thing I always discuss with all my pregnant patients is the changes to the bowel and how to “poop like a Pro”. 

Bowel changes in pregnancy

For many pregnant women the speed of the bowel changes, and for the majority, it slows right down becoming more difficult and harder to empty. There are a number of reasons for this:

1. Hormones: they affect the smooth muscle in the bowel wall making them a little floppier and not as efficient. 
   
2. Compression: the placenta, foetus and amniotic fluid add pressure, making it even harder to propel down
   
3. Reduced movement: exercise helps move along your bowel movements. During pregnancy, you typically move around less, which also means less bowel stimulation.
   
4. Drinking less water in the 1st trimester due to nausea and vomiting: This creates less hydrated stools, making them dryer and harder to pass through the gut.
   
5. Supplements containing iron: These can have a constipating effect. All pregnancy multivitamins contain some iron, so if your iron levels are normal, and you are suffering severe bowel issues, it may be worth changing to take only the supplements you need. There are also iron supplements that are gentler on the gut so this is worth speaking to your health care providers about.
   
6. Dietary changes of pregnancy mean there is often fewer fibrous foods and more starchy comfort foods, contributing to a more sluggish bowel.

Now all of these changes mean that straining to go to the bathroom often becomes a part of the process, and many women think it’s no big deal.

However, one of the biggest risk factors for long term pelvic floor issues such as incontinence, prolapse and haemorrhoids is straining to open the bowels, and straining through pregnancy will start to develop habits of straining – which should be avoided after birth. 

While you’re pregnant your pelvic floor is already weakened because of the impact of hormones on the tissues preparing it for birth. There is also the increased pressure from the weight of the baby that is going through the pelvic floor all day, so extra straining associated with constipation or poor bowel habits really is the last thing a pelvic floor needs. 

How to start pooping normally

To help your bowels function a little better there a few main things we start with:

1. Diet modifications
2. Increased fluid
3. Movement
4. Supplements ( only when needed)
5. Learning how to “ Poop like a pro” 

Many people don’t know that this is actually a right and a wrong way to open the bowels and our modern-day popping style isn’t actually great on the pelvic floor in the long term. 

The problem with modern day pooping

The goal of pooping like a pro is to allow the stool to pass through easily, with no strain, or breath-holding AT ALL. The problem with modern-day women is that we are often so busy, or don’t like to poop outside of our home, so we have become habitual ignorers of our own ‘defecation reflex’.

Think about it, when you get that urge to poop, how often do you ignore it and make it go away?

By the time you do decide to poo,  the stool has been sitting in the rectum, and the longer it sits the the drier it gets, making it more difficult and hence more likely to strain 

The other issue with our modern-day life is that we became all fancy and decided to sit on toilets rather than how we were designed to poop, which is to squat on the ground. When we sit on a toilet seat it is much harder for the process to happen, requiring excessive straining due to the biomechanics of the bowel.

The way I see it we have two options.

1. Go back to caveman days of squatting…
OR 
2. Embrace our current toilet seat, but alter the set up to bring us as close to the deep squat as possible.

Let’s go with option 2.

So here is the ultimate guide to pooping you never knew you needed: 

Step 1: When you feel like you gotta go – GO!

Step 2: Get a small stool to put your feet on, so that your knees come up as high as they can. If you have to, modify by raising up on your toes, or putting feet on toilet paper rolls or a backpack. Some nifty tricks! 

Step 3: Keeping your back straight, bring your upper body forward so that your pelvis tips forward. Rest your elbows on your knees.

Step 4: Relax your belly, keep breathing and resist the urge to hold your breath. Breathing and not breath holding is essential

Step 5: If you need a little assistance you can generate a little abdominal assistance by pushing your belly out (not straining in and down). Imagine you have a belt on and you are trying to pop the belt buckle. 

Sometimes making a noise such as a ‘sssssssss’ or a “moooo” can generate just enough pressure through your diaphragm and abdominal canister to kick the bowel along.

Your partner will undoubtedly love hearing this!

Step 6: Wipe and off you go! 

Now, this all might seem a little too much, but trust me, perfect pooping takes practice.

This really is how we are meant to open our bowels and learning to open them the right way will help save your pelvic floor in the long term.

Now get to it… listen to that urge, it’s time to poop like a pregnant pro!

*If you are making all of these changes and still having issues with your bowels then it is worth discussing with your health provider (GP, Dietician, Pharmacists or Women’s health Physiotherapist) about considering supplements to help soften the stool or further investigations. 

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