Imagine this. You are in a post-birth euphoric state, engrossed in the miracle of your baby, reflecting on how crazy the birth experience is, and what a whirlwind the last few days have been. You are amazing. You managed to not only grow a human but either push it out of your vagina or have survived having this little human pulled out of your lower abdomen with major surgery.
You are pretty chuffed, you feel like a warrior that could do absolutely anything. That is of course until the very first urge to do a number two.
As someone who has had both vaginal delivery and CS, and has seen thousands of women on the post-natal ward, I can attest to the universal feeling of trepidation. Like it or not, however, pooing or defecation (as we health professionals call it), is an essential bodily function that will need to be tended to at some point.
It is a bodily function that most people know very little about and takes for granted. You walk to the toilet, sit down, push a little, wipe, then flush. What’s so complicated about that?
Well, in fact, IT IS a very complex interaction between the brain, colon, rectal wall, nervous system, sphincters, pelvic floor and of course the poo or ‘stool’ itself.
This whole process should occur without any abdominal straining, however, because many women rush, straining has become a common habit that does detrimental damage to the pelvic floor. It is not only problematic for the recovering perineal stitches, swollen vagina or cs stitches but straining increases the risk of prolapse and incontinence in the longer term.
In the post-natal period there are many changes that have happened which may make the process of opening the bowels a little different:
The defecation process will only occur if in a “rest and digest” relaxed state. Many women on the post-natal are frightened of opening their bowels. This will impact your bodies ability to actually receive the rectal wall messages as the body and the brain is so tight and fearful. This often means once on the toilet the whole body tenses, meaning straining is more likely to occur. This is not ideal for recovering stitches.
The post-natal period has many visitors from friends, family and medical professionals, as well as many new tasks for the baby. This often results in women deferring multiple urges. The more times this occurs, the firmer the stool will become as it sits in the rectal wall having fluid drawn out of it. This will, unfortunately, need some straining to pass.
The presence of perineal or abdominal stitches may increase anxiety for the potential pain and fear of “bursting open the stitches”. (This is highly unlikely, particularly if straining is avoided)
Bowel emptying in birth
In labour, whether early labour or in the pushing phase the contents of the bowel will usually completely empty, so don’t be surprised if it takes 3 days after birth to have a full bowel motion again.
Depending on how the birth unfolded, it is not uncommon to enter to post-natal period dehydrated. The body also often starts to have post-natal sweats and loses a lot of fluid for lactation. The more dehydrated, the firmer the stools.
Depending on the length of labour, many women haven’t eaten much so the gut has slowed down, then on the post-natal ward there is usually pretty poor-quality food, and certainly not food that will help to get the bowels moving.
Due to exhaustion and pain, there is very little movement in the first few days post-birth. Physical movement is an important part of triggering the gut to start peristalsis.
Anal sphincter or pudendal nerve injury
It is not uncommon for the nerve that innervates the anal sphincters or the sphincters themselves to have sustained an injury during childbirth. In this instance, some women may find they don’t get the sensation to open the bowels, and find they are having a few accidents. This can be mortifying, and unexpected. If this is occurring please speak to the midwife, obstetrician or pelvic floor physiotherapist.
I’m sure you can start to now appreciate why opening the bowels in the early post-natal period may be a little challenging, but I promise it really doesn’t need to be. In my clinical experience, I find women who follow these tips to their surprise report the first poo a total anti-climax and non-event.
My top tips for an optimal first poo post-birth
1. Consistency is KING
Ensure you have the optimal poo so it can slide on out with minimal effort. You want it to be” smooth and soft like a sausage’, which if you check out the Bristol stool chart (below) is a Type 4 (Yes, there is a grading system for poo that we use LOL). The elements that you can play with to achieve optimal consistency are food, hydration and bowel supplements
- Food: Try and bring as much good quality food with you to the hospital that you can especially any foods you know work for you. Foods such as dried fruit, chia seeds and fresh fruit are easy to bring in our ask visitors to. Some of the best fruits are kiwis, prunes, apricots, berries and pears, but avoid bananas if you are a little blocked up. Another little tip is to take in with you sachets of porridge and add chia seeds to them, and or ask visitors to pick you up a smoothie on their way through, it can help you to stay hydrated, energised and your bowels soft.
- Hydration: You won’t believe how thirsty you can get in those first few days, and you really can’t drink enough. Aim to be drinking a cup of water every hour or so, or make sure you constantly have your drink bottle filled up (ask visitors to do this).
- Supplements: The hospital will have an array of supplements to help get your bowel going such as Normacol, Lactulose, Movicol. These are essential for anyone with a slightly slower bowel. Don’t wait to get blocked up before taking these, speak to the midwife and get on to them early. I recommend women stay on these for the first few weeks post-birth.
2. Adopt the “squat”
You may have heard that we are meant to poo in a “squat “position. This is because it opens the pelvic outlet, relaxes the puborectalis muscle (part of the pelvic floor that can kink off the bowel) and ensures gravity is able to best assist. The best way to do this is to place your feet on a footstool, tilt forward from your hips keeping your back fairly straight and place your elbows on your knees.
*HINT: If you have had a cesarian you may find it a little uncomfortable to place your feet on a stool, in which case just raise up on your tippy-toes. I personally found it a little difficult getting on and off the toilet seat in the first few days post cs, so just be prepared to move slowly, using the handrail and a folded towel over your lower tummy for wound splinting*
3. Support your stitches
Once you are on the toilet it’s really helpful to support your perineum or you cs wound to splint it. It helps reduce pain at the time and after, and also gives you confidence and reassurance over such a vulnerable area.
- Perineal Support: Fold some toilet paper around your hand, and place a moderately firm pressure upon your perineum and vulva. Maintain this through the duration of defecation. You will be surprised how much this helps.
- CS Support: Roll up a towel and ask the midwives to give you some tape to tape it tightly. This will become your best friend in the first few days post cs. Use it when getting on and off the toilet, as well as during defecation. It will help pain and reduce the chance you will accidentally Push.
4. Breathe. Don’t push
One of the worst habits for your pelvic floor is to push on the toilet, especially in the post-natal period. Once in the squat position, relax your shoulders, your belly, your whole body and breathe slowly in your nose and out of your mouth. Never hold your breath. Try really hard to resist the urge to push, instead to get the motion going you can distend your abdomen out a little like trying to pop the buckle on a belt. Making a “ moooo” or “ ssssss” noise whilst ensuring your tummy expands and not tightens can be really helpful.
5. Respond to the urge. Ask visitors to leave
If you get the urge to open your bowels do your best to respond to it then rather than defer it The longer the stool sits in your rectum the firmer and more dehydrated it becomes, only making it harder and more difficult to pass once you finally do respond.
6. If swollen – make ice your friend
If the birth has been difficult or assistance such as forceps or ventouse was needed, the perineum and anus can be very swollen. Using ice on the perineum can help to reduce this swelling and pain, which will be helpful for opening the bowels. Speak to the midwife on the ward, or take in your own “ perineal ice strips” you can order online.
7. Get moving
Easier said than done, but in the first few days do your best to walk around the ward, especially in the morning as it helps to kick the gut into action.
8. Visualise and practice the process
It may sound crazy but visualising and practising how the process will unfold will help you significantly. Practice what it feels like to relax your tummy, support the stitches, breathe, make the noises and not strain with your feet on a stool. Relax, relax, relax. When it comes to the real deal, your body will go into auto as it already knows what to do, as both your body and mind have been prepared.
I hope this has helped to give you a little more insight into the wonders of the body, and the incredible defection dance! There is so much you can do to ensure it is a smooth process, so go forth, relax, support those stitches and resist the urge to strain. I promise you can have a non-scary and satisfying post-birth poop experience.