Push It… Real Good

by Dr. Alyssa Dawson, PT DPT, pelvic health specialist

As a pelvic floor physical therapist, talking all about bladder habits, sexual activity, and bowel regularity is quite literally, my job. We all poop… yet how much do we really know about what is normal and when we should seek help?

In this post, we are going to cover all topics relating to bowel health including; bowel regularity, bowel movement consistency, the pelvic floor connection, and go over some suggestions for what you can do to improve your bowel regularity.

So, what is normal? “Normal” bowel movement frequency is described as someone having a bowel movement up to three times a day or once every 3 days. Yep, you read that right. Obviously, there is a lot of variability here, so let’s dig a bit deeper.

the Bristol Stool Chart

Let’s next consider shape and texture, as this can often give us more information than the regularity of an individual’s bowel movements.

Above is the Bristol Stool Chart, which was created in 1997 as a tool to aid in patient care. We use this daily when working with our clients to help determine the best course of action.

Type 1-3 are in the “constipated” spectrum. This usually means these bowel movements are harder to pass, require straining and may be accompanied with pain.

Type 5-7 are in the “diarrhea” spectrum. These bowel movements can be liquid and free form, leading to bowel leakage and incontinence, fecal smearing and multiple trips to the bathroom throughout the day.

And Type 4 is the perfect bowel movement shape and size. This usually means that it is passed easily, minimal straining is required and should be painless.  

So, now that we know what types of bowel movements typically look like, and what they might indicate, the next thing we need to consider is fiber intake.

According to recent research, only 7-10% of Americans are getting enough fiber in their diets, let’s talk about why this matters. Fiber is found in a lot of our food sources, and can be instrumental in digestion and bowel regularity as it is not absorbed by our GI system, and it stays relatively intact throughout our body.

There are two different sources of fiber: insoluble and soluble. Soluble fiber dissolves in water and creates a gel-like substance, which has a number of benefits including: reducing the body’s ability to absorb fat, lowers cholesterol and blood sugar levels, and increases healthy gut bacteria which can lower inflammation in the body. Insoluble fiber binds to other materials to help the body process waste, improve bowel health including reducing the risk of colorectal conditions like diverticulitis.

Ideally, we should have a combination of both soluble and insoluble fiber in our diet. For sources of soluble fiber that can be found in: apples, barley, beans, carrots, citrus fruit, oats and peas. Insoluble fiber sources can be found in beans, nuts, whole wheat, veggies like cauliflower, green beans, and potatoes, and berries.

So, how much fiber should we get daily? Recommended amounts are: for cis men: 38 grams and cis women: 25 grams

The next thing to consider is water intake. Water makes up 75% of stool, and water is utilized by the rest of the body, and repurposed in bowl bowels for elimination. The guidelines that most people are familiar with is ingesting ½ body weight in ounces, however this can be too drastic for most people. I advise 50-70 ounces normally depending on a client’s activity level. Finding the right balance can help restore normal bladder and bowel function.

Let’s discuss our routines next!  Our gastrointestinal system runs best on a schedule, this means starting the morning with breakfast, then lunch and dinner at normal times for your lifestyle. If you do not typically eat breakfast, I recommend starting with a warm glass of tea, coffee or water to help get the bowels started. Also the act of chewing can help increase peristalsis, involuntary contractions in our digestive system that aid in movement of stool. When considering routines, adding at least 15-20 minutes of walking following meals can also help improve colon motility.

POSITIONING! When we poop, our positioning matters. There is an angle that is created by our rectum and a pelvic floor muscle called the puborectalis. This angle is important because this can determine our ability to effectively empty.

When we are in a “squatted” position, by this I mean hips and knees bent >90 degrees, we can better relax the pelvic floor, improve alignment of the rectum and effectively empty the bowels. Something like a stool or a squatty potty can help put you in a deep squat position, like the one shown to the right.

Lastly, lets cover breathing mechanics so we DON’T have to “Push It Real Good.”  Most people have heard of a kegel before, however the pelvic floor does SO MUCH MORE than contract (which is what a kegel stands for, a contraction or squeeze of the pelvic floor muscles). When we want to successfully empty our bladder or bowel, we want to consider the opposite of this motion: LENGTHENING! The pelvic floor needs to be able to lengthen to reduce tension around our openings (urethra and anal sphincter), but HOW do we accomplish this?

When we hold our breath, our pelvic floor actually tenses, that in turn restricts opening of our orifices which is counter intuitive for having bowel movement. When we exhale, you want to imagine that you are opening through the rectum, spreading through your SITS bones (the bony parts of your bottom), or lengthening to your toes as a cue. When you do have to push, on the exhale, pretend like you are blowing out candles. This will allow for your pelvic floor to lengthen more effectively! 


If you are interested in learning more about bowel health, or have any pelvic floor needs, contact us to schedule a private, individualized evaluation. Follow me at @purelypelvic and @rootsspecialty on instagram for more fun educational tips about pelvic health!

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