If you’ve been around my office or my blog for any length of time, you know that I love to destigmatize conversations around real things that happen to most women during pregnancy, labor, delivery, and postpartum. These topics should not be taboo — our bodies endure countless changes as we bring life into the world, and there’s no shame in addressing any issues you might be having during this season of life. Today, it’s time for a candid chat about #2. That’s right, we’re talking about postpartum constipation. 

After giving birth, you might have noticed a change in the frequency of your bowel movements. So, when should you be concerned? Technically, constipation is defined by passing fewer than 3 bowel movements per week, or having a difficult time with excessive straining during bowel movements. But again, this is nothing to be embarrassed about! Studies show that almost 40% of women develop constipation during pregnancy, and 1 in 4 women continue to experience these symptoms postpartum. If you’re dealing with this, you’re not alone! 

What is Constipation?

Unless you work in a pelvic floor clinic, you probably are not talking about your bowel habits on a regular basis, so you may not even know what is truly considered as constipation.

So how do you know if you are constipated?

There are two methods to traditionally determine if you are constipated or not.

1. The Rome III Diagnostic Criteria

The Rome III Diagnostic Criteria for functional constipation states that you must exhibit 2 of the 6 following symptoms for at least 25% of your bowel movements over the last 3 months with symptom onset over 6 months ago.

Symptoms:

• straining
• hard or lumpy stool
• sensation of incomplete evacuation
• sensation of anorectal obstruction or blockage
• digital maneuvers
• less than 3 bowel movements per week

2. The Bristol Stool Chart

The Bristol Stool Chart was developed as a visual aid to help classify your bowel movements into seven types of categories. Who knew there was such a thing, right?!

Let’s look at the Types of stool in the chart:

So if you are noticing your bowel movements look more like Type 1 or Type 2 then you are likely suffering from constipation and it is time to take action!

The Problem with Constipation

Aside from being uncomfortable and annoying, constipation and excessive straining can lead to several more serious problems such as:

1. Faecal impaction
2. Rectal prolapse (check out my “What Is Prolapse?” blog post here)
3. Fatigue
4. Abdominal pain and bloating
5. Lower back pain
6. …..and hemorrhoids!

Yup, that’s right, I said it. Hemorrhoids

What are Hemorrhoids?

You may have heard horror stories relating to hemorrhoids or maybe only thought this was something that occurs to older males, but it is actually estimated that 1 in 4 women will experience hemorrhoids during pregnancy (I was one of them) and nearly 1 in 2 women will develop hemorrhoids postpartum (yup, mine lingered postpartum as well).

Hemorrhoids form when extra pressure is applied to your pelvic floor, causing veins to swell and become inflamed. 

These veins live in the anus and lower rectum, and when they become swollen you might experience several symptoms such as:

1. Itching
2. Burning
3. Pain
4. Bleeding

Due to the growing pressure on the pelvic floor that occurs throughout each trimester, pregnant women often develop hemorrhoids. Now, pregnancy is definitely not the only cause of this condition, and many women develop hemorrhoids who have never been pregnant! Whether you’ve dealt with hemorrhoids already or you’re trying to ease general constipation, I recommend 4 simple tips to my clients that will ease constipation and give you symptom relief. 

4 Way to Ease Constipation

1. Take a stool softener.

A stool softener can be your best friend during pregnancy and postpartum to prevent constipation!

I recommend that my pregnant clients start taking a stool softener during the third trimester no later than 2 weeks before their due date as a preventative measure, but many have already been taking a stool softener throughout pregnancy.

Stool softeners help to prevent constipation and hemorrhoids before they start, and it can make your postpartum days a little bit less stressful on your pelvic floor as it heals. 

Most hospitals will automatically provide you with stool softeners after you have delivered your baby and I HIGHLY recommend taking them as scheduled even if you are not experiencing any early signs of constipation because it may show up a little later in your journey.

Colace is a great brand to use! 

2. Buy a squatty potty.

You might know some people who use squatty potties even when they’re not pregnant or postpartum — and it’s with good reason! 

I personally packed a portable squatty potty with me in my hospital bag and was so glad I did! We also have one in every bathroom in our house – no shame here!

Why a squatty potty?

A squatty potty helps to place the rectum in optimal position for bowel movements, and getting your body aligned correctly can help you get or stay “regular” and strain-free. In general, deep squatting relaxes the pelvic floor muscles, which allows the anal sphincter to open. The squatty potty is an easy way to get that deep squat from the comfort of your toilet. If you’re fascinated by this, here’s an article that digs even deeper. 

3. Drink water, water, and more water. 

During pregnancy and postpartum, you should be drinking at least half your body weight in fluid ounces each day – and more if you can! 

This is especially important if you’re breastfeeding. Add one 8oz glass of water per feed to your “half body weight” total. 

Why? 

Because breast milk is over 80% water. 

You’re losing a lot of hydration when you breastfeed, and it’s important to replenish that for many reasons. When it comes to preventing constipation, though, water helps soften stool in your gut and stimulate easier bowel movements. 

4. Try diaphragmatic breathing. 

Breathing is one of the most important exercises I teach all of my patients to perform during pregnancy and postpartum. When you breath like I do in this reel, your diaphragm massages the abdominal muscles and helps to get things moving in the bowels. 

Plus, diaphragmatic breathing helps to release tension in the pelvic floor which also helps to facilitate bowel movements. Check out this reel on movements to relieve pelvic floor tension.

The pelvic floor muscles wrap around the anal sphincter, and if these muscles are tight it can make the passage of stool much more difficult.

I recommend performing diaphragmatic breathing on the toilet while you are trying to have a bowel movement in order to help relax the pelvic floor musculature as well as practicing diaphragmatic breathing throughout your daily life! 

These four tips will help you eliminate constipation – or even prevent it from happening in the first place! If you’re still struggling with regular bowel movements, get in touch with your physician or pelvic floor specialist. They can help you work through what might be causing your individual symptoms and offer you a specific plan for relief. Just remember, constipation during pregnancy and postpartum is completely normal, and this annoying condition is temporary. Keep breathing, keep drinking plenty of water, and you’ll get through it.