Pelvic Wellness Program
Toileting Techniques for Bowel Movements (Defecation)
Using your belly (abdomen) and pelvic floor muscles to have a bowel movement is usually instinctive. Sometimes people can have problems with these muscles and have to relearn proper defecation (emptying) techniques. If you have weakness in your muscles, organs that are falling out, decreased sensation in your pelvis, or ignore your urge to go, you may find yourself straining to have a bowel movement. You are straining if you are:
- Holding your breath or taking in a huge gulp of air and holding it
- Keeping your lips and jaw tensed and closed tightly
- Turning red in the face because of excessive pushing or forcing
- Developing or worsening your hemorrhoids
- Getting faint while pushing
- Not emptying completely and having to defecate many times a day
If you are straining, you are actually making it harder for yourself to have a bowel movement. Many people find they are pulling up with the pelvic floor muscles and closing off instead of opening the anus. Due to lack of pelvic floor relaxation and coordination of the abdominal muscles, one has to work harder to push the feces out.
Many people have never been taught how to defecate efficiently and effectively. Notice what happens to your body when you are having a bowel movement. While you are sitting on the toilet pay attention to the following areas:
- Jaw and mouth position
- Angle of your hips
- Whether your feet touch the ground or not
- Arm placement
- Spine position
- Belly tension
- Anus (opening of the anal canal)
An Evacuation/Defecation Plan
Here are the 4 basic points:
- Lean forward enough for your elbows to rest on your knees
- Support your feet on the floor or use a low stool if your feet don’t touch the floor
- Push out your belly as if you have swallowed a beach ball—you should feel a widening of your waist
- Open and relax your pelvic floor muscles, rather than tightening around the anus
The following conditions may require modifications to your toileting posture:
- If you have had surgery in the past that limits your back, hip, pelvic, knee or ankle flexibility
Your healthcare practitioner may make the following additional suggestions and adjustments:
Sit on the toilet
a) Make sure your feet are supported.
b) Notice your hip angle and spine position—most people find it effective to lean forward or raise their knees, which can help the muscles around the anus to relax
c) When you lean forward, place your forearms on your thighs for support
a) Breath deeply in through your nose and out slowly through your mouth as if you are smelling the flowers and blowing out the candles.
b) To become aware of how to relax your muscles, contracting and releasing muscles can be helpful. Pull your pelvic floor muscles in tightly by using the image of holding back gas, or closing around the anus (visualize making a circle smaller) and lifting the anus up and in. Then release the muscles and your anus should drop down and feel open. Repeat 5 times, ending with the feeling of relaxation.
c) Keep your pelvic floor muscles relaxed; let your belly bulge out.
d) The digestive tract starts at the mouth and ends at the anal opening, so be sure to relax both ends of the tube. Place your tongue on the roof of your mouth with your teeth separated. This helps relax your mouth and will help to relax the anus at the same time.
a) Keep your pelvic floor and sphincter relaxed, then bulge your anal muscles. Make the anal opening wide.
b) Stick your belly out as if you have swallowed a beach ball.
c) Make your belly wall hard using your belly muscles while continuing to breathe. Doing this makes it easier to open your anus.
d) Breath out and give a grunt (or try using other sounds such as ahhhh, shhhhh, ohhhh or grrrrrrr).
a) As you finish your bowel movement, pull the pelvic floor muscles up and in. This will leave your anus in the proper place rather than remaining pushed out and down. If you leave your anus pushed out and down, it will start to feel as though that is normal and give you incorrect signals about needing to have a bowel movement.