BPPT Health Tip: Best Positioning Tips for Optimal Bowel Movements

By Sarah Paplanus, DPT, PT

Are you among the 4 million Americans who suffer from constipation? Or the 1 in 5 American adults with Irritable Bowel Syndrome? Do you occasionally experience the pain and itchy feeling associated with hemorrhoids? If so, the Squatty Potty or similar stool may be the perfect addition to your bathroom! Even if you haven’t been diagnosed with any of these conditions, it is important to note that straining or holding your breath to complete a bowel movement is never normal and is usually a sign of dysfunction. Colorectal medical conditions can vary in their cause, in their presentation and in their severity, but your pelvic floor muscles will always be affected.

null( Image via: squattypotty.com )



Your colon carries waste out of your body, and where the colon meets your rectum is called your anorectal angle. This anorectal angle is an important factor in continence.

Your pelvic floor muscles work together to support the rectum, change the anorectal angle and control opening/closing. One of your pelvic floor muscles (the puborectalis) forms a sling around your rectum and works to maintain the anorectal angle. If that muscle is tight, it can essentially “choke” your rectum and contribute to straining.


What does squatting do?

Squatting straightens the anorectal angle and helps to relax the puborectalis muscle, which helps to facilitate emptying. It also decreases the amount of pressure in the abdomen, which has been shown to decrease the time and effort needed for defecation. This all helps to reduce excessive pressure and strain on your pelvic floor muscles. In cultures where squatting is still prevalent for defecation, such as parts of Asia and Africa, it has been found that bowel movements tend to be more complete and that there is a decreased incidence of colorectal dysfunctions such as hemorrhoids, constipation and hernias.

Why is straining bad?

A principle of elementary mechanics states that “any system exposed to excessive pressures ultimately sustains injury”.These injuries can be in the form of a hemorrhoid, a hernia, a muscle strain or a chronic pelvic floor dysfunction. Straining also increases your risk of the Valsalva maneuver, which is exhaling against a closed airway. This causes a sudden increase in intra-abdominal pressure which can cause abrupt changes in blood pressure.

Toilet Posture


Using a squatty potty, stool, or even two yoga blocks can help you assume a “squat” position. Lean forward and rest your elbows on your knees. Take deep breathes in, using your diaphragm. Place your hands on your belly and feel your breathe fill up your abdomen. Keep your mouth open and jaw relaxed!

Other Strategies to Improve Bowel Health

  • Cardiovascular exercise
  • Proper nutrition (see our previous post on fiber!)
  • Make sure you are drinking enough water
  • Relaxation training, diaphragmatic breathing


What to do if you are still suffering?

If the above tips are not helping defecate regularly and comfortably, you may be suffering from pelvic floor dysfunction. Pelvic floor dysfunction can occur when the muscles of the pelvic floor become too tight, weak, or both to do their job properly. Physical Therapy can help! Visit us at Beyond Basics Physical Therapy to help better your BM’s.

What Version is Your Urine?

By Riva Preil

There are many wonderful aspects to being a pelvic floor physical therapist.  One of the many enjoyable parts of my job is that it affords me the opportunity to converse about matters that others would not routinely discuss.  For example, it is completely normal, expected, and professionally appropriate for me to discuss urinary patterns and habits.  Other health care providers, including urologists, are in the same proverbial boat.

One urologist, Dr. Leslie Spry, M.D., FACP, recently wrote a wonderful article that appeared in the Huffington Post on April 10, 2014, entitled “Five Key Health Insights Your Urine Can Offer.”  In this article, Dr. Spry explains the function of the kidneys is to filter “the bad” (i.e. toxins and waste) from “the good” (i.e. the bloodstream).  Of the 200 liters that pass through the kidneys on a daily basis, approximately 2 liters pass through the excretory system (from the kidneys, through the ureters, into the bladder, finally exiting the body through the urethra).

Dr. Spry further describes how valuable information can be gleaned from the appearance of one’s urine.  He encourages readers to investigate their urine prior to flushing.  Several key points of his article include:

  • Urine concentration reflects hydration levels.  The clearer the urine, the better!
  • Color and scent of urine can provide valuable information regarding kidney health.  An occasional pink shade of urine may simply be the result food dyes (ex. beets) or certain medications, but it may reflect something more.  Therefore, if one notices a color or odor in their urine that is atypical for several days, further medical investigation is warranted.
  • Increased bubble production in urine may indicate excessive protein in the urine, which is an early sign of kidney damage.
  • Increased urinary frequency may be associated with diabetes.
  • Increased urinary urgency may be associated with an infection (ex. urinary tract infection).  These three findings deserve further medical attention as well.

Urinary frequency and urgency may also be the result of pelvic floor muscle tightness. Physical therapy has been proven effective at treating muscular related urinary dysfunction.  We here at Beyond Basics Physical Therapy are trained and skilled in the treatment of musculoskeletal related pelvic floor dysfunction.  If you or someone you know can benefit from pelvic floor physical therapy please contact us- we would be happy to help!

P.S. A special thank you to my wonderful blog reader who brought this article to my attention.  I appreciate and warmly welcome interesting articles that you discover.  Please feel free to share them with me at: riva@beyondbasicsphysicaltherapy.com. Thank you!