How to deal with constipation before it becomes a bladder problem
Constipation can be a real drag during pregnancy and immediately after birth.
When it becomes a chronic issue it can really make you feel awful.
But did you know that constipation doesn't only effect your gut health but can cause bladder symptoms?
The definition of constipation for adults varies but generally it refers to going 3 or more days without having a bowel movement.
The longer the stool stays in the colon the dryer and harder it becomes. This makes it even harder to pass and it begins to interfere with the surrounding pelvic organ and tissue function, one of which is bladder function.
Here are a few ways constipation can disrupt or cause bladder problems and what you can do to prevent or reverse these problems.
Constipation causes urinary frequency
The poop in your colon takes up space in the pelvis. This space is occupied by the other pelvic organs (reproductive organs and bladder). They organs all need space to function. In normal circumstances there enough room to go around. But there are times, like pregnancy where the pelvic space is at a premium as baby grows.
Picture a bowl of fruit with one banana, one avocado and one apple. You just went grocery shopping and are putting away the fruit your purchased. You like to keep similar fruit together so you begin to add the avocado next the original in the center of the bowl. This displaces the banana and apple a smidge but not terribly [just like a growing uterus]. Then you add the bananas but you have to slide the avocados and apple out of the way to make room. [just like when your colon fills with poop]. Then you try to add the apple but notice there is only space to add two of the four without overflowing [ just like your bladder fills with pee].
To be able to add the two extra apples you need to make space. You can do this by eating some of the fruit, but the avocado isn't ripe yet. So your choice is bananas or apples.
This is exactly how your body has to make space, but what happens is it signals you need to pee to empty your bladder to allow it to keep filling.
The longer you're unable to poop the more it fills and the more space it takes away from the bladder, which is also constantly filling. Increasing your urinary frequency.
2. Straining to poop stretches the pelvic floor tissue.
Constipation tends to make it even harder to poop. And what generally occurs is you sit on the toilet, hold your breath and push with all your might, straining to get the poop out.
Every time you do this it stretches the anal sphincter [which keeps the poop and gas in without your needing to think about] and the other pelvic floor muscles. Over time the more stretched out these muscles the less they will be able to contract and support the pelvic organ function like keeping pee and poop in.
So not only are you peeing more frequently now you may not be able to hold the pee in because the muscles that stop your from peeing [when you’re not ready to] are stretched out.
Imagine that bowl of fruit in now a hanging string basket. The more fruit you add to it the more the string underneath bulges. This is exactly what happens naturally with pregnancy due to the weight of baby, already compromising the integrity of the pelvic floor muscles.
Beyond peeing your pants, the ligaments that hold your bladder up start to weaken with every strained push you take to poop. Now your string basket pulls and stretches the loops that attach to the ceiling, as you reach up to grab a piece of fruit. The ligaments work with the pelvic floor muscles [and other deep core muscles] to support the bladder [and other pelvic organs] in the ideal position for functioning. When the tissues loose the structural integrity needed to do this the organs droop, also known as a pelvic organ prolapse (POP).
When a bladder droops it can fall straight down compressing the urethra or more commonly back against the front wall of the vagina. This is called a cystocele. You may have a cystocele without knowing it because it doesn’t cause symptoms or it may cause the following:
urinary frequency and urgency
urinary incontinence (peeing when you don’t want to)
urinary retention
vaginal pressure and heaviness [sometimes even pain]
uncomfortable sex
constipation [round and round it goes]
In addition to constipation, pregnancy [up to 5 full term] and births [vaginal delivery more risky than cesarean] can cause a POP.
So what can you do about prevent constipation and these bladder issues?
Eat Breakfast.
Usually the best time of day for a bowel movement will be a half hour to an hour after eating. These times are best because the body uses the gastrocolic reflex, a stimulation of bowel motion that occurs with eating, to help produce a bowel movement. For some people even a simple hot drink in the morning can help the reflex action begin.
I know eating in the morning may be a challenge, especially during the first trimester. But remember that morning sickness can also be caused by hunger. So eating a nourishing breakfast [or at least a piece of toast with a nut butter] with whole grains and gut loving root veggies can make a difference.
Eat all your meals at a predictable time each day.
The bowel functions best when food is introduced at the same regular intervals.
The amount of food eaten at a given time of day should be about the same size form day to day. The bowel functions best when food is introduced in similar quantities from day to day. It is fine to have a small breakfast and a large lunch, or vice versa, just be consistent.
Eat two servings of fruit or vegetables and at least one serving of a complex carbohydrates (whole grains such as brown rice, bran, whole wheat bread, or oatmeal) at each meal.
Drink plenty of water
Use the following calculation to figure out how much you need to drink every day.
1/2 body weight converted into ounces
For example: 100/2 = 50 ounces
During pregnancy this will increase, plus every day will be slightly different based on your activity level and the weather. So start with your base and change from there. Keep in mind that too much fiber without enough water can constipate you as well, so be sure to increase your water intake if you are adding fiber into your diet.
Do the I Love You Massage
Did you know your gut has it’s own nervous system. Massaging along your large intenstines can help the peristaltic action by tuning into this system. Always start from your right hip moving up to the right ribs, then across your upper Abs and then down to your left hip. You can do this in stages staying at one portion for several passes before moving on or doing the whole [upside down] U. The best time to do this is before bed, so you body can digest and be ready for a poop in the morning.
Learn how to poop without straining
The cool thing about the pelvic floor is it can lengthen and stretch A LOT and is meant to. It’s when the stretching become repetitive and combined with other habits that can lead to problems.
Tapping into this ability can make a world of difference when you are pooping.
The pelvic floor lengthens the most during inhale. Practicing by breathing downward into your pelvis in various positions will help your body understand and sense what this feels like. This isn’t quite enough though. Since your pelvic floor wants to contract on exhale, you have to make an effort to remain lengthened and relaxed while you exhale. Combining this voluntary bulge and an abdominal contraction assists your peristaltic action to move the poop through the colon and out.
Use a stool or Squatty Potty
The pelvic floor also relaxes the most in a squat position [going poop in a country that doesn’t use toilets may change your life forever…in a good way].
To compensate for using toilets we add stools, like a Squatty Potty, (watch this hilarous video) to bring the legs into a squat position. This not only relaxes the pelvic floor but it also “unlocks” the colon by changing the angle of the puborectalis muscle that shuts it “off”
Go for a walk or at least move your body!
Your gut likes your body to move. It craves it. Going for a walk after you eat. Doing stretches that gently twist your spine and pelvis to massage your gut supports pooping.
Lastly, see a pelvic floor Physical Therapist (PFPT)
A PFPT can guide you through all the above and more. They can teach you how to tune into your pelvic floor, work on releasing any tension around the gut that may be a part of the problem and teaching you strategies to mitigate this from happening in the future.
To recap, constipation [especially while combined with pregnancy or postpartum] can cause bladder problems like urinary urgency, frequency, incontinence, and prolapse.
But you can prevent this from happening by being proactive about your diet, exercise and how you poop.