Toileting Strategies for Constipation

  1. Use a squatty potty. Having your knees positioned above your hips straightens out your anorectal junction, allowing the poo to slide out easier. If you don’t have a squatty potty, a stool or any other elevated surface you can comfortably rest both feet on will work.

  2. Let your feet be flat and gain a sensory awareness of your bottom cheeks on the toilet seat. “Ground” yourself in a relaxed, but upright seated position to allow the reflexes that govern your BM to work.

  3. Take your time (but not too much time). Yes, ideally a BM takes less than a minute. But you have constipation! So if you like to rush through your BM–slow down and give yourself time to work through your BM completely. 

  4. Avoid screens, and even books, on the toilet. When we read on the toilet, we get distracted and fall into our old bad habits. You’re trying to learn a new way to coordinate your BMs to reduce your constipation–so focus!

  5. Take deep breaths. Before you try any sort of straining, just take deep breaths for a minute or two. On each inhale, feel your pelvic floor relaxing and stretching open and down toward your feet. Picture the circle of your anus, and visualize it widening on each inhale. On the exhale, just continue to relax.

  6. Use a “healthy straining” technique.

    1. The main thing to make straining for BMs healthy is to keep the throat open and avoid holding our breath. When we bear down or hold our breath and push to have a BM, it usually gets the job done but at the cost of stressing the pelvic floor. Holding our breath creates a lot of abdominal pressure that helps push the poop out—but we also induce a reflexive contraction of the pelvic floor that makes it harder to get the poop out! When you have a history of pelvic pain, prolapse, urinary or bowel incontinence, hemmorhoids, or other pelvic floor issues, pushing with a closed glottis/throat is especially not optimal!

    2. Try this instead: Blow out the birthday candle! Take a deep breath (think: “belly big”), then on the exhale, purse your lips and blow forcefully, as if you are trying to blow out a trick birthday candle (think: “belly hard.”) As you are breathing in this way, make sure to keep your pelvic floor relaxed. This technique of blowing out the birthday candle allows us to create increased downward abdominal pressure through deep abdominal muscle activation and controlled diaphragmatic movement (rather than breath holding), which bypasses the reflexive pelvic floor contraction and helps us keep the anus open. We also keep the throat open, which is like a pressure valve that keeps us from exerting too much downward pressure on the pelvic floor while we strain. 

      1. Some ideas: Try “fog up a mirror” breathing on the exhale, instead of using pursed lips. Which is more productive for you?

      2. Other ideas: Some people prefer the “4 part breath” technique to the “belly big, belly hard” technique. For a 4 part breath, we inhale to a count of 4, hold full for a count of 4, exhale for a count of 4, hold empty for a count of 4. Which works better for you?

Pelvic Care Physical Therapy

3770 W. Robinson St. - Ste. 112 - Norman, OK - 73072 

www.pelviccare.org - 405.240.9575 – info@pelviccare.org