Let’s Talk About Poop

November 7, 2017

Pooping…we all do it.  For some of us, we poop at the same time every day, maybe 2-3 times per day.  Others of us may poop 2-3 times per week.  Just as there is great variability in people, there is variability in the frequency of defecation. This can be due to several factors, including the motility of the digestive system, one’s diet and activity level, fluid intake, stress level, etc.  The thing that should not vary too much, however, is the ease in which pooping happens.

Before we get to that, however, let’s discuss what is considered “normal” poop.

One very important factor affecting the passage of stool is its consistency, or how hard or soft it is.  Stool should be neither too hard and small (think “rabbit pellets”) nor too soft.  When you look in the toilet, ideally you should see a sausage shape that is not too thin.  Stool that is too soft or liquid is consistent with diarrhea, in which stool passes too quickly through the intestines.  Stool this soft is most often implicated in fecal incontinence, or the involuntary loss of stool from the anus.  The reason behind this is that the anal sphincters are designed to hold back solid matter versus liquid.  Stool that is harder in consistency is a hallmark of constipation, in which too much water has been absorbed from the fecal matter as it passes through the large intestine.  Stool this hard is typically much more difficult to pass, in which case one may resort to straining.

At some time or another you may have had to strain, or push harder than normal, to pass a bowel movement.  To do this, you probably held your breath and pushed down very hard, a process called bearing down.  This tends to increase pressure inside the abdominal cavity, which can then assist the natural peristaltic movements of the colon to pass poop.  However, this method can be detrimental over time, because it can increase the downward pressure on your pelvic organs as well, leading to a condition called prolapse.  It can also contribute to hemorrhoids.

So how am I supposed to poop, you ask?  Here are some tips to try to make your pooping experience easier:

    1. Improve your stool consistency.  Make sure you are getting enough fiber by eating a healthy diet rich in fruits, vegetables and whole grains.  Also make sure you are drinking enough water.  General water intake guidelines are 1 ounce per pound of body weight, but this may vary according to your particular health needs.  Always follow your doctor’s advice regarding fluid intake if you have any restrictions.
    2. Improve your toileting posture.  Defecating is actually easiest in a squatting position, because the pelvic floor muscles are lengthened in this position.  This is important because some of the pelvic floor muscles encircle the rectum; if they are not relaxed, they can constrict the rectum, making it more difficult to pass stool.  The best way to mimic the squatting position is to raise your feet up on a stool, so that your knees are quite a bit higher than your chest.  The Squatty Potty is a stool that was designed specifically for this purpose; check out their YouTube video for a full explanation.  You don’t need to specifically use the Squatty Potty; any footstool will do.
    3. Relax!  The body remembers very well, so if you have been having difficulty pooping for a while, you may unknowingly be tensing up your muscles in anticipation of another difficult episode.  This tension can very easily carry over to your pelvic floor.  Tense muscles are difficult to relax, so if your pelvic floor muscles are tense, it may be difficult for you to poop.  When you sit on the toilet, take a few deep belly breaths:  inhale deeply through your nose, allowing your belly to expand, then exhale slowly through your mouth.  Repeat this 4-5 times, visualizing your muscles relaxing.
    4. Finally, if you have done all these things and find that you still need to push, try this tip to reduce the downward pressure exerted on your organs:  Do not close your glottis.  This means, do not hold your breath.  Time your push with a forceful exhale.  One successful technique I have taught my patients is to exhale through a closed fist.

In some cases, some may feel the need to strain with bowel movements, but may find that their fecal consistency is soft.  They may also find that their poop resembles the shape of a worm (very thin) rather than a sausage.  This may indicate that the pelvic floor muscles are tight, in which case, the sphincters are not relaxing enough to allow stool to pass through.  If this describes you, a visit to a pelvic physical therapist may be very beneficial to help teach you ways to relax and loosen the tight muscles to improve the ease of pooping.