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.

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Anatomy!

 

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.

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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

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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.

Squatty Potty

By Riva Preil

Ever wonder how to pass bowel movements with greater ease?  Believe it or not, the optimal position for passing a bowel movement is …SQUATTING!  Don’t get me wrong, I’m not recommending that we ditch standard toilets for good old fashioned floor holes, however I am suggesting that we become more mindful of our bodies and of our biomechanical alignment while toileting. An important factor in defecation is the anorectal angle, the angle formed by the junction of the anus and the rectum, which at rest is approximately 90 degrees. The puborectalis muscle (part of the levator ani pelvic floor muscles) wraps around the junction like a sling. Contraction or tightening of the puborectalis decreases the anorectal angle or makes it more acute, for our geometry-oriented readers.  (For those who are not, please refer to the Squatty Potty video link here which provides an amazing visualization). On the other hand, relaxation of the puborectalis muscle increases the anorectal angle which allows for descent of stool from the rectum towards the anus. Therefore, it is important to be able to relax or release the pelvic floor muscles in order to allow for strain-free, pain-free passage of bowel movement.  Squatting facilitates pelvic floor muscle relaxation and straightening of the large intestine.  Therefore, it is recommended to attempt passing bowel movements with both feet atop a stool, thereby mimicking the squatting position.  The Squatty Potty is a wonderful tool that was invented with this in mind.  The Squatty Potty is a user friendly stool that can be inconspicuously stored at the base of one’s toilet.  However you choose to simulate squatting while toileting, best of luck and may you have a moving experience!