Birth and Bowel Movements: Tips for the first BM after delivery

Bowel movements?!?  Really?!?  You want to talk about bowel movements?  

Yes. Yes, I do.  

This is one thing I certainly never expected or cared to research when I was having kids.  I was just focused on gearing up to get the baby out - I didn’t think so much about after the fact!  One would think that a bowel movement would be nothing in comparison to pushing out an 8 pound baby, no?!? Well…

Many women don’t anticipate this being an issue after delivery, especially if you’ve never had issues with constipation before.  However, a multitude of factors can throw things off and leave you feeling all “backed-up”.  Medications, prolonged sedentary positions and/or an altered diet are just a couple of potential culprits. Regardless of the reason(s), it makes for a less than ideal experience when the time comes to void those bowels.  Your healthcare provider will most likely be asking you and keeping track of how this process is going.  However, if you are having trouble in this department after giving birth, don’t be afraid to ask for help so they can set you up with a variety of resources like stool softeners and enemas to help move things along.  

Here are some additional tips that you can do yourself should you find you’re in the situation of dreading bowel movements after giving birth.  (These tips also work great for general constipation too).  

  1. Relax - Way easier said than done especially if you’ve had any type of tearing, an episiotomy, a C-Section or are just dreading having to “push” one more time!  Pelvic floor muscles relax and open much more easily when you are not stressing about it or anticipating pain.  How do you relax the pelvic floor specifically? One way is to use your breathing - inhale and simultaneously visualize opening the anus.  Sometimes it works well for people to visualize widening the SITs bones away from each other as you inhale (the “SITZ bones” are the two boney points you feel in your backside when sitting in a chair).  This relaxing or opening should NOT feel like you are pushing downwards, it’s simply a reflexive response to the breath. If you’re having trouble getting this down, ask for some help from one of our amazing physiotherapists.  
  2. Don’t clench your jaw - Also, if you’re having trouble relaxing the pelvic floor, check and make sure you aren’t clenching your teeth.  Strangely enough, keeping this area relaxed can also help relax the pelvic floor.
  3. Knees higher than hips - Those fancy commodes are handy so you don’t have to squat down so low, but sitting high doesn’t do much for optimizing the position of the rectum when trying to void those bowels.  Grab a stool or improvise with a garbage can (preferably empty!) tipped on its side.  Place feet up on something secure so your knees are higher than your hips and legs are supported and relaxed.  This can help align things more optimally for faecal evacuation.
  4. Position some more - Lean forward and rest elbows on your knees. This allows for further relaxation.  Let the tailbone untuck slightly to allow for easier passage of stool pass this area.  
  5. C-Section? Splint lower abdomen - If you’ve had a C-section, place a towel or your hands between thighs and lower abdomen for added support at the incision site.  Try not to block your belly totally however as forward movement of the abdomen can further help the muscles surrounding the anus to relax.  I know it’s going to feel like things will burst wide open if you strain too hard, but keep in mind that the surgeon stitches you up with the goal of keeping you closed.  If they thought the forces generated by pooping were going to be a hazard, they would tell you not to poop for 6 weeks or something crazy like that until things are all healed up.  Plus, after reading this article, you now have some strategies to minimize that horrible feeling of pain/pressure/pulling at the incision site! Ready for some more awkward suggestions??  I’m just warming up!
  6. “Moo”, “Grr”, “Hiss” or pretend to “Blow through a very small straw” - Ummm, WHAT?!??! If you didn’t already think I was crazy, I realize I just tipped the scale.  Please, bear with me (no pun intended).  Using your breath or vocalizations on the exhale can help modulate intra-abdominal pressure and act as an effective tool for assisting with a less strenuous bowel movement.  It can help you avoid the Valsalva Maneuvre (breath holding) that can increase downward pressure on the pelvic floor and/or the outward pressure on the C-Section incision site (if you have one).  Try all four sounds out - see which one feels like it opens the anus the most.  Generally speaking, half of these vocalizations will feel like they make you tighten at the anus, and the other half will create an opening effect.  However, which one is most effective will vary from person to person.  When you find one that feels like it creates the greatest opening effect (eg. “Moo”), use that as your go-to vocalization when on the toilet.  If you are having trouble finding one that works, make sure you try again using a low-pitched voice versus a high-pitched voice.  In attempts to try and redeem myself, I’m going to throw in here that you don’t actually have to make the sound so they can hear you at the nurses’ station (although that would be entertaining).  Simply causing that air movement with a whispered “Moo” can be just as helpful.  

Strange tips, I know, but these simple things can make a huge difference in keeping that first bowel movement or two after delivery a much less torturous experience.

If you have any questions about pelvic floor physiotherapy or preparing for birth, please call Rebirth Wellness Centre at, 226-663-3243, or email us at info@rebirthwellness.ca.

Jaclyn Seebach, PT ~ Certified Pelvic Health Physiotherapist

A Healthy Period: What You Need to Know

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Fertility, women's health

A thorough history of woman's menstrual cycle is something I always ask my patients in practice: whether they are tracking it for fertility, just getting it back post partum, or slowly losing it during menopause. Understanding our periods can tell us so much about our bodies and yet all too often I get woman who are unaware of the signs of irregular hormone imbalance and claim that everything is... well, fine I guess.  When I start digging deeper, some admit to having such bad cramps they need to take time off work, some bleed between periods or have such a heavy flow they change a pad every hour. A period shouldn't be a time of suffering. Neither should the weeks leading up to it. Now I have to admit, there is no one fits all perfect period. Every woman will have a different cycle length and experience different symptoms. What is consistent for each woman though is important to evaluate because it's a window into what's going on with her hormones and the state of her general body.  

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Cycle Length

The average length between periods should fall between 21-35 days and be consistent each month. A day or two difference isn't much to worry about, but if you're noticing that your cycle was 21 days one month, then 40 days the next, and then possibly one month skipped, this is a sign of irregular hormone balance and can either be caused by stress, dieting, or PCOS.

Length of Bleed

Anywhere from 2-7 days of bleeding is typical for woman. A period will start on the first day of a true bleed, as in the need for a liner or tampon. Some woman may experience bleeding between periods, after intercourse, for only 1 day or for over 1 week. These again are signs of hormone irregularities and possible issues with the endometrial lining.

Quantity and Quality of Blood

The amount of blood can be a large predictor of just how much lining is being shed during a period. Often woman who have very heavy flows and need to change even a super absorbent pad every hour will need to rule out estrogen dominance and conditions like endometriosis or iron deficiency as a possible cause.  Heavy dark clots are also something that should be investigated. If on the other hand there is very little blood, this could be a sign of estrogen deficiency, often caused by menopause, smoking, dieting, and stress.  

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PMS/Pain

This may come as a surprise, but women should not be experiencing irritability before their period and intense pain during it! Excess pain during a period is another hallmark sign of endometriosis, fibroids, or inflammation and should be evaluated by your health care provider. Mild twitching and aches can be felt on the first few days, as blood loss is often that highest, but the pain itself should never be severe or debilitating. Some woman are so used to heavy painful periods that they assume it's the norm. I often ask patients if they require medication, such as Tylenol or Advil, and how many of them. If it's 8 a day to get by, it's too much. It is, however, common to feel a slight cramp in the middle of a cycle during ovulation, this can actually be a good sign that ovulation is occurring.

Cervical Mucous

This isn't specific to a period per se, but to the overall health of a full hormonal cycle. In the first two weeks after day 1 of your period, estrogen is rising. This should be a state of happiness as estrogen is linked with serotonin and rising libido towards ovulation. Often you'll notice cervical mucous will be white and creamy. As ovulation approached, your body prepares to thin out this mucous in order for sperm to enter. Leading up to ovulation, you should notice that your cervical fluid increases and becomes thinner, clear, and more slippery - somewhat like egg whites. After ovulation, it will return to a thicker consistency.

Temperature

This is again an indicator of ovulation. Temperature will fluctuate throughout the cycle, with it being the lowest before ovulation, spiking during ovulation, and then slightly higher after ovulation. If you track your temperature daily (best to be done first thing upon rising before eating or even brushing your teeth) and notice there is no spike or a very erratic fluctuation, this should be evaluated as well. This could indicate an issue with ovulation or even thyroid imbalance.

What if my period isn’t “normal”?

All too often birth control is used to try and "regulate" cycles. Unfortunately, birth control simply stops your body from producing these wonderful hormones and instead causes what is known as a fake bleed. Often times, woman will be on birth control for 10 years or more and then once stopping, their cycles can become irregular and conceiving may even be difficult. If you think your period pain and overall cycle could be improved, talk to your naturopathic doctor about safe, gentle, and effective ways to optimize your period health!

Dr. Natalia Ytsma

From a young age, I knew that a career in health and medicine was in my future. Having spent time in doctor's offices and hospitals to correct a congenital heart defect, the idea of providing care to families in need and educating them on their health was something that I knew I had to do. It motivated me to always be cautious of how I treat my body and I grew to really appreciate what being healthy was all about, a lifestyle that ensures you take care of yourself from the inside out. I focused my education on science and business and gained experience in teaching, which allowed me to help others empower themselves with the knowledge they acquire. Having also traveled throughout the world, I gained work experience in North America, Europe, and Asia, which allowed me to learn from different work ethics and cultures. I grew a passion to learn about natural medicine and how to help others use it to achieve optimal health. I learned to understand that there's almost always a root cause to a health issue and that you can use safe, gentle, and effective treatment to address it. Ultimately, naturopathic medicine was my calling.
 
EDUCATION
•            Bachelor of Science and Business: McMaster University, Hamilton 2009
•            Holistic Health and Skincare: CNM, London UK 2013
•            Doctor of Naturopathic Medicine: CCNM, Toronto 2015

With 8 years of post-secondary school complete, I completed my clinical internship at the Robert Schad Naturopathic Clinic - with a full year rotation on the paediatric focus shift- and the LAMP Community Health Centre both in Toronto, Ontario. 
 
After graduation, I moved to Beijing where my husband was working at the time. While there, I designed pregnancy and fertility workshops for a local spa and ran a health elective for local teens to educate them on proper nutrition, mental health, and fitness. While abroad, we got pregnant with our son and decided to return back to Canada to begin raising our family close to home. Currently we reside in London, Ontario and I am practicing at Rebirth Wellness Centre, a thriving place dedicated to empowering woman into motherhood and providing family based health care at its best.