10 tips to make those first postnatal poos feel more comfortable by specialist physiotherapist

10 Tips to make those first postnatal poos more comfortable

When you are feeling sore after giving birth, the first wees really sting and it is hard to even contemplate how you are going to manage to open your bowels without pain. Postnatal poos need a bit of encouragment.

Here are some tried and tested simple tips to help you have a more comfortable time.

TIP #1   PATTERN

Bowels love a routine and you can train a “bowel habit”.   Try to establish a ritual that your body can get used to and lets you empty your bowel regularly before you become constipated. 

In the near future you will be so much happier if you can relax in the knowledge that you will have had a poo in the privacy of your own home before you have the earliest visitors or want to get out for the day. 

It is very rare to need to open your bowels at night.  But as we get up gravity gets the gut started with some movement (peristalsis) as does movement. Best of all though is the gastro-colic reflex – which means that the sight, smell or taste of food gets the gut going and the bowels moving. 

So have a drink as soon as you can (hot water with lemon used to be served on gynaecology wards) and try to have a small breakfast even if you don’t feel like it.  Clean your teeth and as you clean your teeth start thinking to yourself…next I am going to……….…    

TIP #2  BE PREPARED

Listen out for the alert signal that there is a stool ready to come out.  You absolutely don’t want to miss this.

  The bladder alerts you when it is being stretched so that you can’t overfill it  – but not the bowel – it can get very full and distended without us feeling a thing.  The signal you are looking for is the feeling of pressure and irritation low down on the back passage (the anal sphincter).  This is the stool pushing against the nerve endings at the anal sphincter opening.  You could be a bit numb straight after delivery, and certainly after an epidural, so you may have to really look out for this feeling.

You could be half-way through your breakfast or middle of changing a nappy……if you possibly can, stop what you are doing and get yourself off to the loo.  Even mid-nappy change – just take the baby with  you – they can lie on the changing mat outside the door and get some bottom air!

Don’t put this feeling off.  It is the sign that the body is ready to go and the best poos are the ones the body does naturally.  If you put it off (I’ll just change a nappy…. I’ll just phone my mother……..) you accidentally squeeze it back up inside you where you can’t feel it and then it sits there getting drier and drier making you constipated.

TIP # 3   PRIVACY

Having your bowels open is an intensely private activity.  Make sure that you feel safe and relaxed.  If you are in hospital this might be walking a bit further to find a more tucked away toilet where you don’t feel you will be rushed.  At home, if there are people about ask them to watch the baby (so you can relax about that), excuse yourself,  take yourself off upstairs or as far away as possible, close the door properly.  If you are on your own at home and will worry about the baby – take them with you – leave them on the floor outside with the door ajar.   Ask a toddler to read the baby a story.

TIP # 4   POSITION

They have actually done lots of research about the best way to sit on a toilet.  Yes really.  In Australia.

Nature did not intend us to sit lady like on a ceramic toilet.  We are supposed

the best position to sit to have a poo

picture from POGP booklet Pelvic Organ Prolapse – a Physiotherapy guide for women

to squat down behind a tree.   The key thing is knees higher than your hips.  This un-kinks the bowel and relaxes the pelvic floor muscles.

  • So sit with your feet up on a toddler step or box
  • Bottom well back on the seat
  • Rest your elbows on your knees
  • Untuck your tail bone keeping your back relatively straight
  • Let all your body muscles relax, especially your pelvic floor and abdominals

TIP #5  DON’T THINK ABOUT IT…..AND BE PATIENT.

Emptying the bowel is a natural thing that the body does best on automatic pilot.  It is not something that ‘we’ do.  Like sneezing.  The best ones come from nowhere.  And just like a juicy sneeze that you can feel coming – if you think about it too hard (and especially if you say “I think I am going to sneeze”) – it will disappear!

An age old trick – read a book/magazine/back of a shampoo bottle….anything to distract your corticol (thinking) brain and let your automatic brain do it’s own thing.  Give your body some time.  You are waiting for something solid to move out – it doesn’t just fall out like liquid.  Your body needs to accept that it is a quiet, private moment.

TIP #6  DON’T PUSH……PANT

A traditional ‘push’ involves a big breath, closes your mouth, hooks in your abdominal muscles and then bares down.  This action draws the pelvic floor muscles UP and closes the hole that we want the stool to travel through.  Exactly the opposite to what you want.

Remember ‘panting’ in antenatal classes?  To let the baby’s head birth gently without getting in the way with our own muscles.  Use exactly the same type of breath as you feel the stool coming, soft and gentle, little sighs and slow out breaths.  Nurse it along.

TIP #7  SUPPORT YOUR PERINEUM AND PELVIC FLOOR

The downward pressure of the poo passing through the rectum and bowel opening is going to stretch the perineum which will be tender, sore and healing from your delivery. 

Take a pad of toilet tissue and press it over the whole of your perineum, just leaving the small anal sphincter free.  Press upwards to support your soft bits as the poo is coming down.  This will also direct the poo backwards to come out the anal passage easily,  rather than the pressure coming forward into the vagina area. (Lots of people carry on doing this for ever because it is so helpful).

TIP#8  PAUSE

Now relax, sit back and just wait a good minute before you dash off.  There could be a bit more.  Sometimes there is a pocket of wind which needs to move through and then there can be a ‘second wave’ of stool that could come out.  Again you might not even be able to tell it is there until you have a sudden new urge.  If you don’t wait for this bit and it gets left behind it can act as a ‘bung’ and become windy or uncomfortable later.  Remember to do this for a few weeks and you will get to know your body better and how it is likely to behave.

TIP #9 PROTECT YOUR SKIN

Treat your own bottom just like you do your baby’s.  Wipe gently from front to back.  Don’t scrub at your skin with dry tissue.  Dampen some cotton wool or use a non-alcoholic wet wipe.  Wait for your skin to dry and then apply a baby-bottom cream for you too.  This helps your skin heal and acts as a thin barrier from rubbing against your underwear.

TIP #10   YOU MIGHT NEED TO GO AGAIN…..

You body can be all over the place for several weeks after a delivery.  All the hormones, broken routines for your eating, sleeping and exercise play havoc.  Your pelvic floor muscles are stretched and weakened so you will feel more vulnerable and less certain of your holding powers.

Once you start applying the tips above, and especially once you start really listening out for the signals to go to the toilet, you can be surprised to find that you need more than one poo in a day.  This is perfectly ok.  Often each time  you eat a big meal you then need a poo.  Traditionally most people go after breakfast – but you may need an after lunch one too!   It is that great mechanism the gastro-colic reflex again, triggering  the gut to work after eating.  Make the most of that and keep alert for opportunities.  It is much more comfortable to poo when the poo is just right and wants to come out naturally.

OR YOU MIGHT NOT……

However, guts can also go into shut down after delivery, leaving you feeling constipated. If you suspect at all that you are constipated ask the midwives for a softener or laxative.  The right kind of stool is firm but soft with a beginning and an end.  Too runny and you will feel that you can’t hold it in or will have an accident, but too hard and it is sore and uncomfortable to pass through the soft delicate opening.  Make sure you are are you drinking enough? 

How are you finding coping with your bowels after having your baby?  If you are feeling up to sharing with other mothers, on this very personal topic,  we would love to hear from you.  

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