Let’s Talk About Toilet Time
Hey girl!!
Are you like me?
When I was a kid, I had the hardest time pooping in a public restroom or anywhere other than my bathroom at my parent’s house.
I remember being away for a basketball camp and sharing a bathroom with 4 close friends and I would have such terrible stomach pains, because I wouldn’t poop the whole time we were there. I would sneak away to find a one toilet restroom where I could cover my ears and try to focus on me and relieving my pain. But it just wouldn’t work.
Fast forward quite a few years, and now I’m a mom and have 3 kids and RARELY do I get a FREE moment to go poop without someone screaming at me, pulling my hair, wanting to nursing etc. My hunky, husband on the other hand, gets like 20 minutes of peace and quiet a few times a day to let if all out.
Anyways, lots of us are dealing with bowel issues: constipation, IBS, hemorrhoids or diverticulitis etc and they can be all be caused from poor toileting techniques.
Girl we are so lucky to have indoor plumbing in this country and since it has been around, we have been sitting on cold toilet seats to have bowel movements. Before that, we would squat to eliminate our feces . In other countries people still continue to squat to have bowel movements and with that they have lower rates of the above bowel issues.
So how can we improve your time on the toilet?
Putting something under your feet while sitting on a toilet, can help "un-kink" your hose, the pelvic floor muscle that wraps around the rectum. This could be a squatty potty ($25) (click here for 1 squatty potty on amazon: https://amzn.to/2MAcEUn or if you need 2 squatty potties, click here ($40): https://amzn.to/2S5f42z), child’s step stool ($10.50) (https://amzn.to/2SbSbKL), old phone books….the list can go on and on. There is a pelvic floor muscle that kinks your rectum when sitting and standing. When you sit with your knees above your hips (feet resting on something), you unkink the hose and the feces can move more smoothly out of your body. Once your feet are resting on something and your knees are slightly above your hips, you can rest your arms on your thighs/ knees and slightly lean forward to create a little more space for stool to exit your body.
Avoid straining. My mom would ask us to hoover over the public toilet seat like Marty McFly from Back to the Future so we wouldn’t touch all it’s grossness. If you are like me, you can remember how challenging it was to pee in a half squatted position. I would hold my breath and push to pee. Now that I am in my speciality, I know this is a no-no. Straining or bearing down, causes increased pressure on the pelvic floor muscles, which can put you at risk for hemorrhoids, diverticulosis, constipation, pelvic organ prolapse and pelvic floor dysfunction. Just breathe while sitting on the toilet in your new "squat" position and things should move out easily. And, layer up that toilet seat with tons of toilet paper so you can sit down. If you are in a public place, or a hotel room, grab the trash can, turn it on it’s side, and use it as a stool to help you.
Give yourself more than 2 minutes to have a bowel movement. I feel like as mom, I am rushed to take care of my business. I need to get in and out as fast as I can, to save my screaming child. I also find it difficult to relax when this is playing out. When we feel stressed like this, it is hard for our muscles to relax and we are prone to straining with bowel movements. Act more like our male friends (sorry men). They take their sweet time in the bathroom and relax and read etc. More like what we should be doing. If you do not have a bowel movement after 9-10 minutes of sitting on the toilet, than you are not ready. Get up and walk around and try again later.
– Amanda Fisher, PT, DPT
Quick Links on Amazon:
Squatty Potty: 1 (https://amzn.to/2MAcEUn ), 2(https://amzn.to/2S5f42z)
*This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you. If you enjoyed this blog, check out our website at www.empoweryourpelvis.com. Follow us on YouTube @AmandaFisher or Instagram @empoweryourpelvis
Sex After Baby
Sex. This can be a scary thing for women who have had a cesarean birth, who have torn vaginally, or who have had an episiotomy (or some kind of traumatic birth...or even just birthed a baby). For one, some women find it hard to look at their cesarean scar, think their vagina appearance has changed or have a difficult time letting their partner look at them postpartum because they have lost muscle tone, have a stretched out belly, stretch marks etc.
The scar tissue from the cesarean delivery and vaginal delivery (with a 3rd/ 4th degree tear and episiotomy) is still healing at your 6 week check up and will continue to heal for 6-12+ months, even if you are released at your 6 weeks check up and were told your incision was healed.
Remember, sex should not be painful, but if it is, it would be wise to see a pelvic floor physical therapist to assess your scar tissue (vaginal or abdominal) and see if it might be causing some of your pain. Most OBGYNs and Midwives recommend waiting until after your 6 week appointment to start engaging in sex again. If your doctor has cleared you for intercourse, it is fine to start. There are many factors during pregnancy and delivery that can cause pain with sex. Remember, painful sex is common and not normal. Speak with your doctor about your pain and see a pelvic floor physical therapist to help improve your symptoms. A pelvic floor physical therapist can evaluate your pelvic floor muscles for tightness, poor coordination and assess your scar tissue (cesarean or vaginal) to help address your pain.
If you are experiencing pain with sex, here are some things you can try:
Water-based lubricant
Hormone fluctuations can decrease the amount of lubricant your body produces, especially if you are breastfeeding. Trying a lubricant that is water based is likely to last longer. Here are some options (In no particular order) :
2. Longer foreplay with deep belly breathing
-It may take a little longer to increase your arousal. Adding in some belly breathing with foreplay can help calm down the tissues and get them ready for the fun!
3. Switch it up!
-A position that used to be comfortable, may not be anymore. Try a new position out and see if that does the trick. For example, on your back might be uncomfortable, but on top might cause less discomfort.
If pain continues, please seek the help of a pelvic floor physical therapist and your healthcare provider.
What You Need To Know About Pelvic Health
As women, we live in this one body, yet, we still have a difficult time bringing awareness to the pelvic floor muscles and learning how to contract and relax these muscles. This is a topic that surprisingly, not a lot of women are well educated on. I love addressing the pelvic floor muscles, their roles in our health and how they can change with pregnancy and birth.
The pelvic floor muscles offer many functions to our bodies: they are supportive to our organs, they help pump/ circulate fluid in as we breathe in and out, they aide in sexual function, they control opening and closing of our openings and stabilize our SI joint, pelvis, hip joints and lumbosacral joints. The muscles run from the front of the pelvis at the pubic bone, to the sits bones and attach to the SI/ tailbone area. When functioning properly, the pelvic floor muscles should fire prior to movement of lifting children, laundry, jogging, grabbing a glass of water etc. So it is important to continue to focus on your pelvic floor muscles through all phases of life.
Your "core" is made up of your diaphragm, pelvic floor muscles, transversus abdominus and your mulitidus muscles in your low back. So, as you can see, doing abdominal exercises for your "6-pack" muscles, will not target the true core.
With life, we generally create habits. Even within our bodies, we tend to do things the same way most of the time. For example, we tend to carry our children or purse on the same side of our body. This can create compensations to certain tissues and joints, especially during pregnancy and postpartum. For instance, during pregnancy we may stand with our bum tucked under, our abdominals stretched and tightness in our backs to hold us up with our growing belly/ uterus. After birth, our bodies stay in a similar posture, with weakened tissue and we start moving throughout the day making new compensations with carrying an infant or a toddler. Seeing a pelvic floor physical therapist can help you fire and re-train your core the proper way to improve your core support during pregnancy and postpartum.
One day, I hope it becomes a natural thing for a women to be seen at least once during her pregnancy and then get an automatic referral to a pelvic floor physical therapist postpartum to check on how the pelvic floor is functioning prior to beginning an exercise routine. I believe many women would benefit on a prenatal visit with a pelvic floor physical therapist, to figure out how to make their pelvic floor muscles function properly and then what posture and body mechanics would be beneficial to avoid to promote a healthy pelvic floor. Then postpartum, addressing women's pelvic floor strength, endurance, coordination and any areas related to pelvic floor dysfunction, diastasis recti or scarring from cesarean birth or perineal tearing. I think so many women are doing too much too soon instead of giving their bodies enough time to heal postpartum prior to jumping back on the exercise train. Remember, it took your body 9 months to grow that baby (ies), so give it grace with healing. You will be glad your took your time and were smart with your healing and exercise, instead of rushing back into things.
What Happens During a Cesarean Birth?
This is an area that as women, even those of us who have HAD a cesarean birth, we know little about. Cesarean births can be planned or unplanned. Planned are scheduled ahead of time and unplanned can happen after pushing for long periods, or when needing to deliver baby quickly, like in my first delivery. There are lots of different reasons for an unplanned cesarean.
During the cesarean delivery, the doctor makes an incision into your skin, through your fat cells, connective tissue and into the abdominal cavity.
The abdominal muscles are spread apart and the bladder is moved so the doctor can get to the uterus. An incision is made into the uterus and the baby is guided out. After the placenta is removed, then the uterus is stitched up, the bladder is put back, the connective tissue and abdominals, and then the skin is stitched up. A lot of layers of sutures within the tissues so scar tissue develops as you heal.
Please note, your abdominal muscles are not cut through during a cesarean birth, but your connective tissue is. This is important to understand why we need recovery programs after birth, not just “sit ups” and running as soon as we feel like it.
Should We See A Pelvic Floor Physical Therapist Postpartum?
Just a little food for thought. Delivering a baby, vaginally or cesarean, is a difficult job for our body. I hate to say it, but birth is traumatic to our tissues. The muscles are stretched during childbirth, some are torn or even cut through, in order to do what is best to get baby out safely. As a pelvic floor physical therapist, I have often wondered, why are these women missing out on opportunities to improve the function of their pelvic floor and abdominal muscles after delivering a child? In all other areas of muscle injury (strain) or rupture/ tearing, patients are usually advised to seek the help of a physical therapist for regaining muscle control, range of motion, strength, flexibility, stability and overall function. For instance, someone might have a whiplash injury (similar to a childbirth with minimal or no tearing), they would see a physical therapist to stretch tight muscles and strengthen weak muscles. If someone tore their Rotator Cuff, they may have surgery to fix the muscles (similar to repairing pelvic floor muscles or abdominal muscles after delivering a baby(ies)), then they would seek the help of a physical therapist to stretch the tight muscles, regain coordination of the muscles, teach the brain how to connect with the muscles again, and go through a program of improving range of motion and strength/ endurance of the muscles.
I think we are missing this with our new moms. Think about it. Women are pregnant for approximately 9 months (posture changes, back muscles tighten, abdominal muscles weaken etc) and then they go thru delivery (with tearing or not) and their body's are expected to bounce right back while taking care of a rapidly growing new born.
What I see with my patients are poor postural stances of weakened and stretched abdominal muscles, tight and short low back muscles, sometimes tucked bums or ribs thrusts with carrying and lifting baby/ children/ car seat etc. I think it would benefit so many new moms to be referred to a pelvic floor physical therapist postpartum. Every new mom could come in for a screen to see if they are having any issues and if there are any things a new mom should be working on in the first couple of months. I personally think, it would be beneficial to see a pelvic floor physical therapist for a screen PRIOR to getting back into an exercise program. A pelvic floor physical therapist can evaluate women for diastasis recti, pelvic pain, pelvic organ prolapse, urinary incontinence and proper postural and body mechanics. Hopefully with seeing pelvic floor physical therapist, this would prevent more pelvic floor risks and issues in the future.
So...see a pelvic floor physical therapist today, even for a screen, to see if you would benefit from starting a pelvic floor home exercise program. Why not support your tissues for a stronger future?
Running Postpartum
Your 4th Trimester is your recovery phase. A time to restore your strength and endurance. Think of your postpartum recovery more like a marathon vs a sprint. If it were a sprint, you would see your OB at your 6th week check up and get released to resume exercise AND you would head home to go for a jog. If this sounds like you, you will likely increase your risk for pelvic floor dysfunction (leaking urine, pelvic organ prolapse, low back pain, hip pain, pelvic pain...I could go on and on and on...).
Retraining your pelvic floor and core muscles how to work for you is very important and should take time to get them back functioning properly. I mean, the pelvic floor and abdominal muscles have been stretched for 9+ months and forgot how to work properly. It is our job, as smart moms, to make sure they are functioning before running/ jumping with 10-12 times our body weight thru those muscles. That's a lot of stress on those muscles. Think about your life down the road with your pelvic floor, abdominal muscles and your organs...you want them working in the correct way when you are in your 60s, 70s and so on, right?! I do!
For my friends and patients who love running, I advise waiting 4-6 months postpartum to begin running. I really think closer to the 6 months would be best for our lovely pelvic floors. 4 months seems to be early when you think about life as a mom of 1, 2 or more children. It is a challenge to train your muscles prior to that time consistently. AND then we throw in breastfeeding (hormones), lack of sleep (increased cortisol-stress hormone-effects how our body heals and recovers) and then 6 months sounds a little early. Especially with the hormones that are still heightened in our bodies. If my patients are breastfeeding, we may push back running past 6 months, depending on how the body is functioning with movement and what the pelvic floor strength, endurance and tone is looking like.
Before my patients are advised to begin running, they have completed certain pelvic floor/ core strengthening exercises and home exercise programs for a period of 8-12 weeks to set them up for good outcome when they go out for their run for the first time.
Things to think about prior to going out for a run at 4-6 months postpartum:
1. Have you had an evaluation with a pelvic floor physical therapist to assess your pelvic floor function? core strength? function with posture and alignment? You should! All of us should postpartum!
2. If you pee your pants with coughing, sneezing, laughing, lifting, bending over etc you are not ready to run yet.
3. Feeling of pressure or heaviness in the vagina? Worse after lifting? Or while on your cycle? If you answered "yes", you are not ready to run yet.
4. Do you have an abdominal separation in your midline that is weak (Diastasis Recti)? If so, I would wait to go out and run.
"So...what can I do instead?"
I love having patients find hills in their neighborhoods to walk up and down. Prior to doing this, patients have been walking on a flat surface (for a long time) with no increased symptoms from above. Patients are to practice proper alignment while walking to promote proper core recruitment. I cue patients to rotate their upper body arm swing while ascending and descending hills.