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Chronic constipation can contribute to pelvic floor muscle dysfunction due to repetitive and prolonged straining. Constipation and straining also create more pressure on the bladder and urethra which may contribute to prolapse, urinary incontinence, frequency, or retention.
What is Considered ‘Normal’ For Bowel Movements?
- Three bowel movements a day.
- One bowel movement every three days.
- Stool that is soft and formed, like toothpaste.
- No straining during a bowel movement.
- No pain during or after a bowel movement.
General Recommendations For Bowel Health:
- Never ignore the urge for a bowel movement.
- Listen for the urge about 20-30 minutes after a meal, especially in the morning.
- Fluid intake should be sufficient. A general guideline is monitoring the colour of your urine. It should be a light yellow (not dark yellow or have a strong odour).
- Avoid alcohol, sweetened beverages, and refined sugars.
- Consume sufficient fiber (soluble and insoluble) of approximately 25-40 grams/day (see below).
- Avoid white rice and white flour.
- Walk for at least 30 minutes per day. Regular exercise has many benefits!
- Use the “I Love You” (ILU) massage 1-2 times daily to facilitate the processing speed of your food through your intestines (see below).
- Bringing your knees towards your chest may stimulate bowel motility (movement of food and waste materials). Do these stretches every morning to help stimulate your bowels. Lie on your back, straightening one leg, and drawing the other knee to chest. Hold this position for 30-60 seconds and repeat on the other side. Afterward repeat the stretch by bringing both knees to your chest at the same time for 30-60 seconds. Breathe softly and deeply during these stretches.
Positions and Strategies on the Toilet:
- Use a step stool so your feet are supported, and your knees are above your hips.
- Keep your mouth and pelvic floor soft and relaxed (see Reverse Kegels).
- Breathe softly, slowly, and deeply, in through your nose, and out through pursed lips, as if you are blowing through a straw.
- Never strain during your bowel movement.
- Try twisting and/or reaching over your right shoulder with your left arm, turning your trunk to the right. This will mechanically help to evacuate your stool (like ringing out a towel).
- Try tilting your pelvis forwards and backwards, gently and repetitively.
- Try blowing hard into a closed fist.
- Try leaning forward with a book against your stomach to increase intra-abdominal pressure.
- If you have a rectocele (bulge of the rectum into the vagina) you may need to push on the prolapse with your fingers or thumb inserted into the vagina (directed towards your back) to support the back wall of the vagina, to help empty your bowels (referred to as splinting).
- Don’t stay on the toilet for more than five minutes. If you can’t go, get up and get busy. Try again when the urge returns, or 20 minutes after your next meal.
- The recommended fiber intake is 25–40 grams per day for adults.
- Should come from a combination of soluble and insoluble fiber, since there are different benefits for each type of fiber.
- While it is NOT necessary to track, a 3:1 ratio of insoluble to soluble fiber is typical.
- Increasing fiber intake slowly to minimize gas and/or bloating.
- Drink plenty of water with your fibrous meals.
- Soluble fiber is absorbed in water. When mixed with water it forms a gel-like substance and swells.
- Soluble fiber has many benefits, including moderating blood glucose levels and lowering cholesterol.
- Good sources of soluble fiber include oats and oatmeal, legumes (peas, beans, lentils), barley, fruits and vegetables (especially oranges, apples and carrots).
- Insoluble fiber does not absorb or dissolve in water. It passes through our digestive system in close to its original form.
- Insoluble fiber offers many benefits to intestinal health, including a reduction in the risk and occurrence of colorectal cancer, hemorrhoids, and constipation.
- Most of insoluble fibers come from the bran layers of cereal grains.
Since dietary fiber is found only in plant products (i.e. nuts, whole grains, legumes, fruits and vegetables), these are essential to a healthy diet, and should form the majority of what we eat.
- Choose whole fruits and vegetables (with peels when possible) instead of juices.
- Choose whole grain bread, cereals, and pasta in place of their overly processed, refined counterparts.
- Replace white flour (or at least a portion of it) with whole wheat flour in baked goods.
- Replace white rice with brown rice.
- Replace meat with beans or other legumes in meals. Lentils are perfect for this.
ILU (I Love U) Massage
- This self-massage is used for constipation and generalized pelvic and abdominal pain.
- Always do the massage from right to left, using soap in the shower, or cream on your fingertips.
- Start by forming the letter “I” by stroking with moderate pressure from under the left ribcage down to the front of the left hipbone, 10 times.
- Next, form the letter “L” by stroking with moderate pressure from the right ribcage, underneath the ribcage to the left, and down to the front of the left hipbone, forming the letter “L.”
- Lastly, do 10 strokes from the front of the right hipbone up to the right ribcage, across to the left ribcage, and down to the left hip bone, forming the letter “U.”
- These strokes follow the path of the large intestine.
- Finish with 1-2 minutes of a clockwise circular massage 2-3 inches away from the belly button to stimulate the small intestine.
- Do this massage 1-2 times daily.