Potty Talk
Potty Talk

Potty Talk

The famous book title says it all: everybody poops! And, a lot of people have problems with their poop. It’s a shame this isn’t talked about more openly, because there are so many simple things that can help if you are constipated in particular!

By, Stephanie Dillon, PT, DPT, WCS

Let's start with the big one: how often should you poop?

Great question! And the answer might surprise you—typical frequency for bowel movements (BMs) is anywhere from 3x/day to 3x/week. So, most of us fall into "normal" on one end or the other. HOWEVER, I will say that I feel best if I poop every day, and I think the same is true for my patients! So I generally prefer myself and my patients to have a daily bowel movement at minimum.

What if you poop less than that?

Technically, then you would meet the guidelines of constipation. However, you can poop daily and still be constipated—it really depends upon how much stool you are actually getting out. Many people with constipation struggle with not getting very much poop out whenever they do sit down to poop, which may happen more often than not. The main rule of thumb is that you should NOT have to strain with your bowel movements. Yes you should have to push gently, or exert some effort, but generally your stool should come out easily. If you are holding your breath or pushing really hard, then most likely you are constipated too.

What if you poop more than that?

There is a chance you may have a different sort of bowel problem, such as irritable bowel syndrome. This is especially true if you are pooping frequently but only getting small amounts out. However, of course you can't diagnose IBS just by bowel frequency! But it can be one component of IBS. Other problems like stress and anxiety can also lead to an increase in bowel frequency, or people that have medical diagnoses like Crohn’s or Celiac disease also can have frequent BMs.

What about poop consistency?

This is the golden ticket! By seeing where you fall on the Bristol Stool Scale, you can learn SO much about your bowel health. The optimal stool type is a type 4, but type 3 is also pretty darn good.You are most likely constipated if you have types 1-2, or have diarrhea and/or fecal incontinence if you have types 5-7.  

And, there is an excellent version of the Bristol scale that is for kids, but also I use it with my adults too sometimes just because it's fun. :)

Type 1 especially is really indicative of an overactive/hypertonic pelvic floor. These "rabbit droppings" mean that your pelvic floor muscles only relax JUST enough to squeeze a tiny bit of poop out, and then tighten back up again. In order to get nice type 3's and 4's, you need to be able to relax/elongate your pelvic floor for about 15-20 seconds.

How do I improve my stool consistency if I'm either a type 1-2 or a type 5-7?

The answers are actually very close to each other! Both types typically benefit from fiber. Insoluble fiber doesn't get absorbed by the body, but essentially helps push stool through your colon faster. So that can help types 1-2. Soluble fiber helps bulk stool and slows digestion, which thus can help types 5-7. Check out more info on soluble and insoluble fiber here.

Here is a great chart of how much fiber is in different types of foods. This way you can make some easy choices (sub peas for green beans, for example) to help boost your fiber intake.

And, especially for stool types 1-2, make sure you are drinking enough water! Water helps keep your stool soft and keep things moving. Aim for half your body weight in ounces, or until your pee is a pale, straw-colored yellow.

Does the squatty potty help?

Absolutely! The squatty potty is the million dollar idea we all wish we would have had, lol.  

If you aren't familiar with it, they have very catchy ads you can watch. But basically the squatty potty is just a stool with a half-circle cut out in it. This way it can slide easily under your toilet when you are done, rather than take up extra space in your bathroom.  

The idea is that by using a stool under your feet, you can elevate your hips higher than your knees while pooping. This helps your pelvic floor relax naturally, so then you have to exert less effort to eliminate your stool. This article also gives an excellent overview of the importance of toileting posture, among other things!

What about breathing?

Breathing is SO important for bowel movements! No matter your bowel issue (and even if you don't have any bowel issues per se), if you work on your breathing and use a stool underneath your feet, then you will poop so much more easily, I promise!

When you "push" to get your poop out, it's really important that you don't hold your breath. Instead, you want to exhale as you push. (Note: this is the OPPOSITE of brace/blink/rocket if you are already doing the MommaStrong program! We need to exhale and contract our PFM with exercise, but with bowel movements it's exactly the opposite. The PFM need to relax/descend to get your poop out, and in order to help them relax, it's important not to hold your breath.)

It's also helpful to keep your belly distended a bit as you push, rather than do a "brace" or draw belly to spine. For kids, I often use the "bubble belly/bubble bottom" imagery. The idea is that if the belly is pushing out slightly, that helps the pelvic floor push down slightly, and then the rectum can open better to get your stool out. Give it a try!

Stay tuned for upcoming posts where we will talk more about specific bowel problems, especially ones that can develop as a result of pregnancy and childbirth. And, we’ll even dive into pediatric constipation, with some recommendations on how you can help your kiddos if they struggle with pooping too!