Pain with Pooping
Pain with Pooping
Common diagnoses that can cause painful bowel movements:
Hemorrhoids
Anal fissures
Coccyx (tailbone) injury or fracture
Any history of grade III/IV perineal tears- this is when your pelvic floor tore to or through your anal sphincter during a vaginal childbirth
Rectal prolapse
Tight/hypertonic pelvic floor
Anismus/pelvic floor dyssynergia
Pooping should NOT be painful. Issues with having bowel movements can occur at many points in a person’s life. Issues can begin anytime from infancy to later adulthood. There are many different reasons why a person may have issues pooping and it is always important to discuss any concerns with your health provider. There are also many safe things you can do for yourself at home to help improve your bowel movements.
How to Poop
When it is required, a light push to poop should originate from your abdominals.
During a push, while your abdominals are contracting and creating a downward pressure, you want to relax your pelvic floor.
Take relaxing the pelvic floor during bowel movements a step further as you think about doing a light but active “bulge” down. This further lengthens and opens your pelvic floor to allow stool to completely exit your body
If you look at your pelvic floor with a mirror (which we do recommend)
the pelvic floor should go up inside you with a contraction
it comes back down to normal resting position after a contraction
With a bulge you would see it come out “at” you, in the direction of external to your body
Tips to help with painful bowel movements:
Give your pelvic floor some manual support during bowel movements (known as splinting). The normal stretching of this muscles that occur with poop exiting your body may be somewhat painful in the early stages. This technique will help to reduce any painful stretching
Wrap toilet paper around your index and middle fingers. We want to keep this area clean and dry
Place your fingers on the area between your vagina and anus (this is your perineum) to add some additional pelvic floor support for bowel movements.
Exhale with bowel movements (when pushing)— remember to “Blow as you go!”
Use a squatty potty (this helps you strain less on the toilet). Other step stools will work as well.
Good nutrition continues to be extremely important! Better diet = better, softer poops. Constipation is not your friend
Pelvic floor PT
In addition to manual techniques to release pelvic floor tightness, biofeedback with a pelvic floor PT is often part of treatment for my patients who have GI complaints. What happens after a severe tear is that your pelvic floor does not relax (or even tightens!!!) during bowel movements. This essentially closes the anal sphincter and you are trying to have a BM against a “closed door”. Learning how to generate some abdominal pressure from above (to evacuate) while keeping your pelvic floor relaxed below is key! Exhaling with a TA contraction while you are attempting relax/lengthen the pelvic floor is the end-goal of rehab. You can work on this on your own, and biofeedback is helpful as it objectively tells you when your muscles are contracted/relaxed
Need more help?
How to relax your pelvic floor