By: Emily Stafford, PT, DPT, CAFS, FAFS

The first post-partum bowel movements can be anxiety-inducing and, to add to the emotional hurdle, the movement itself can be literally hard. Let’s break down some factors that go into those first few trips to the bathroom after you give birth.

Hormones: You probably know that your estrogen and progesterone fluctuate during pregnancy and post-partum, but did you know that estrogen and progesterone impact your digestion? As progesterone peaks at the end of pregnancy, you get the infamous slow down of the bowel movements – sometimes leading to constipation, straining with a BM, and hemorrhoids (common late in pregnancy and post-partum). Add to that the sharp drop in estrogen post-partum with the rise in cortisol that makes it harder to get that bowel movement moving. As a fun bonus, that drop in estrogen also dehydrates you.

Hydration: Milk production is another major contributor to post-partum dehydration. You are losing water to produce milk in a way that you haven’t before lactation. When less water makes it through your large intestines, you will have a harder stool. One of the best ways to tell if you’re adequately hydrated is by the color of your urine; it should be clear to clear/yellow.

Often, moms who are experiencing urinary incontinence will avoid water to avoid having an accident. This is a huge mistake! If you’re having issues with hard stool or constipation, you’re actually making the incontinence worse by dehydrating and further constipating yourself.

Physical Injury: With birth, there may be natural tearing in a vaginal delivery, a surgical incision, an episiotomy, or other procedures that impact the tissue of the pelvic floor and core. After a vaginal delivery, you may have a wound that is healing on tissue that naturally experiences stretch in order for you to have a bowel movement. After a Cesarean delivery, the abdominal incisions can make it difficult to manage the pressure associated with a bowel movement. In either case, even getting in and out of the position to use the restroom can be difficult. Let alone finding the time.

Mom Life: A big element that can impact your post-partum bowel movements is just feeling like you don’t have enough time to use the bathroom. Many new moms experience a fight or flight state due to loss of sleep, a massive shift in daily routine, the adrenaline rush of delivery, the post-partum spike in cortisol, etc. All of this stress can make it hard to relax enough to have a bowel movement.

What can you do to make it easier?

Do whatever you can to make it easier on yourself. For example, you will likely be prescribed a stool softener after birth. It may be useful to continue a stool softener for a bit longer or to use intermittently to establish a routine of no-strain, pain free bowel movements. After a vaginal delivery, they also often provide numbing spray for perineal tears and can teach you to prep ice packs at home. You will want to manage any hemorrhoids you have, whether they appeared before or after delivery.

Magnesium or fiber supplements can also aid in your post-partum bowel movements. Magnesium can help with retaining water in your stool, which makes it softer, and may also help to reduce stress and sleeplessness. Fiber, naturally occurring or as a supplement, gives your intestines something to work against to keep your bowels moving.

Taking a closer look at your diet overall and hydration can also help. First, drink a minimum of half your body weight in ounces per day. Second, food is medicine – some can help and some can exacerbate the issue. Peaches, pears, plums, and kiwis are great for maintaining soft but formed stool and good bowel motility. If you are experiencing constipation, you may want to avoid foods like bananas, sweet potatoes, highly processed foods, and sugary treats. These can constipate you more.

Your daily habits and routine can make a huge positive impact. Chew your food thoroughly to let your digestive system know it’s time to get stuff moving. Maybe take the time to have a cup of coffee to encourage a morning BM. As impossible as it sounds, you will want to find a way to relax or rest. Even if it is taking just 10 minutes to yourself, if its good for your brain and your stress, its probably good for your bowel movements. If its good for mom, its good for baby.

Managing Your Pelvic Floor Post-Partum

Pelvic floor physical therapists can work with you to help you and your post-partum pelvic floor. If you have a wound or hypersensitivity, we can treat that. We also can help you figure out the proper position to go to the bathroom successfully and easily. Alongside this, we treat and educate if you are having any abnormal pelvic floor muscle tone or strength.

If you find that you are suffering or struggling when you go to the bathroom, know that it doesn’t have to be that way. There are a lot of factors that can impact your movements, and most, if not all, of them are fixable. We are on your team to help you move and feel your best post-partum.

Are you about to give birth or just gave birth? Schedule an appointment with a pelvic floor physical therapist today!