In order to effectively evacuate stool, the anal sphincter and pelvic floor muscles must relax. Optimal posture can help promote muscle relaxation and, ultimately, ease of passage.
Potty posture
- Sit on toilet (do not hover)
- Feet apart
- Knees higher than hips. Ideally, use a stool or squatty potty underneath feet. Can lift heels off ground if no stool is available. This position helps to relax one of the pelvic floor muscles called the puborectalis, allowing stool to pass more easily.
- Lean forearms on thighs
- Maintain a neutral spine
Toilet Routine
- Whenever you feel the urge to have a bowel movement, use the AIRBAG technique:
- AWARE- be aware of your potty posture as described above.
- IMAGINE- focus on the process of your pelvic floor muscles letting go, your anus opening, and the bowels emptying.
- RELEASE- let the tension in your pelvic floor, hips, back, thighs and feet go.
- BREATHE- breathe in through your nose and out through a relaxed open mouth. Feel your ribs and your diaphragm moving with each deep inhale and slowly exhale. Don’t force the air.
- ALLOW- trust that your body will do what it was designed to do. It knows how to breathe, pee, and poo but sometimes we get in the way and try to take control.
- GRATITUDE- thank your body for doing a very important job that we often take for granted. Think of at least one thing that you are grateful for today.
- If no stool is evacuated, move on to #2.
- Twist your trunk to the right and left to facilitate movement of stool into the rectum. Rock the pelvis forward and backward. If no stool is evacuated, move on to #3.
- Take a deep breath and hold for 5 seconds. Repeat 5 times. If no stool is evacuated, move on to #4.
- Exhale into a semi-closed fist, making sure to keep anal sphincter and pelvic floor muscles relaxed. If no stool is evacuated, move on to #5.
- Press a hard-covered book into the low abdomen between the front pelvic bones, making sure to keep anal sphincter and pelvic floor muscles relaxed.
- When you feel the stool move into the anal canal, twist your trunk to the right, reaching your left arm to the right side of your body to help wring the stool out of the canal.
- If no stool is evacuated within 5 minutes, try again when the next urge comes; don’t force it.
AIRBAG meditation video by Shelly Prosko: https://www.youtube.com/watch?v=w9zsTUvNn-8 AIRBAG meditation blog by Shelly Prosko: http://physioyoga.ca/the-6-stages-of-toilet-meditation
No urge?
If you rarely or never feel the urge to have a bowel movement: after eating, sit on the toilet for 2 minutes while doing your AIRBAG meditation. Do this for at least 1 month to retrain your body’s gastrocolonic reflex, the reflex responsible for producing the urge to defecate after consuming a meal. Once the urge to defecate resumes on its own, you no longer have to do this after-meal routine.
Rectocele
If you have a rectocele, it may be helpful to apply pressure one of two ways while having a bowel movement.
- In order to provide extra support to the pelvic floor muscles and soft tissue, apply counter-pressure externally over the perineum.
- Insert thumb vaginally and push toward the
rectum in order to help propel stool in the correct direction, so as to
evacuate completely and not have stool get stuck in the pocket of the
rectocele.
- There is a handy tool on the market called the Femmeze that is designed to help stool evacuation by inserting it into the vagina during a bowel movement. It works by putting pressure on the back wall of the vagina, thereby supporting the rectocele and encouraging the stool to pass through the properly aligned rectum instead of getting stuck in the prolapsed part of the rectum. You can use this tool instead of inserting your thumb into your vagina.
https://www.amazon.ca/Femmeze-Rectocele-Realigning-Relieving-Constipation/dp/B00EV025P8
The information in this blog is provided as an information resource only and should not be used as a substitute for seeking personalized direction from your overseeing physician. Please consult your healthcare team before making any decisions about your pessary treatment plan, which is unique to you and your overall health. Toronto Pessary Clinic expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this blog.