One of the most intimidating moments postpartum after experiencing a perineal tear during childbirth, is facing your first bowel movement. The fear of pain, re-injury, or popping stitches is common, but there are strategies you can use to manage discomfort, protect the healing tissues, and make this process smoother. Here are some practical tips to help ease you through your first postpartum bowel movement.

1. Feet on a Stool for Elevation

Elevating your feet by placing them on a stool while sitting on the toilet is a highly effective way to help with bowel movements. This position mimics a squatting posture, which is more natural for passing stools. Squatting opens the anorectal angle and relaxes the muscles and ligaments around the rectum (specifically the puborectalis muscle). Essentially this straightens the rectum and removes any constriction that may hold the stool in. Think of a rectum like a hinged slide that unhinges when you go into a deep squat position. This reduces the need to strain helping to avoid pressure on the perineum, protecting your stitches and healing tissues.

2. Splinting the Perineum

Splinting the perineum is a technique where you use your hand, covered with toilet paper, to apply gentle pressure to the perineal area as you pass a bowel movement. This provides additional support to the perineum which can help reduce pain as the tissues stretch while also reducing fear the area will be reinjured. Splinting can also help you feel how much stretch is being happening allowing you the biofeedback to provide either more or less external pressure to prevent excessive strain on the stitches.

How to do it:

• Take a small wad of toilet paper to cover your hand and press gently against the perineum (the area between the vagina and anus).

• While doing this, focus on keeping the pressure steady as you pass the stool to minimize the feeling of pulling or tension on the healing tissue.

3. Breathe Through the Process: Inhale to Relax, Exhale to “Push”

Using breath control during your bowel movement can reduce strain and prevent trauma to the healing perineum. It’s important not to hold your breath and bear down, as this increases intra-abdominal pressure. Breathing techniques are a powerful tool you can use to manage the pain associated with your first bowel movement as well as a way to facilitate natural relaxation of the pelvic floor.

The technique:

- Begin by inhaling downward into your pelvis focusing on the sensation of your pelvic floor, especially around the anus relaxing and opening. You will also feel your belly and ribs move which is part of breathing, but if you notice your shoulders lifting and neck tension you may be actually sucking the pelvic floor in. To minimize this try to soften your upper body through the process as well as practice diaphragmatic breathing before pooping.

- On the exhale, gently bear down, but keep the effort minimal. Picture a wave of muscle contraction starting in the upper belly moving down to the pelvis, as if your intestines were a tube of toothpaste and you are squeezing from the “bottom.” The focus should be on breathing out and letting your body work naturally, rather than forcefully pushing.

4. Choose Easy To Digest Foods

One of the many changes that occur in postpartum is a decrease in your ability to digest foods. That is why it’s so important to focus on foods that are easy to digest, including how these foods are prepared. Yes, fiber is important to soften stools and ensures they pass more easily, but how the fiber is prepared will also impact how you poop. Focus on warm or hot cooked foods with low ingredients. This very important for your gut health, that has lost some of the enzymes it needs to digest foods. Low ingredients or simple ingredient meals means the gut can relearn how to break down more easily digested foods before working on the more complex. Cooking foods begins the process of breaking down the foods for you and can actually make certain most nutrients and enzymes more readily available to you.

High-fiber foods to include:

• Oats, rice

• Leafy greens, carrots, and sweet potatoes

• Fruits like apples, pears, and berries

• Beans, lentils, and peas

Tips:

• Pair your fiber intake with plenty of water to avoid hardening the stool, which can make bowel movements more difficult.

• When choosing rice and beans soak them overnight prior to cooking for ease in digestion.

• Smoothies are not simple, low ingredient or warm and can actually slow digestion

5. Stay Hydrated

Water is essential for regular bowel movements. Dehydration can make stools hard and difficult to pass, increasing the likelihood of straining. Aim for at least 8-10 cups of water per day to keep your bowels hydrated and to ensure your body has the fluids it needs for healthy digestion.

Bonus Tip:

• Drinking warm liquids in the morning, such as herbal tea or warm water with lemon, can help stimulate bowel movement activity.

6. Get Up and Move

Movement is a natural stimulant for your digestive system. After birth, it can be challenging to get movement in, in a way that feels like it’s enough to actually help. But the simple [but not always easy] act of getting up out of bed and walking around the room or gentle bed exercises can help get things moving. Head to my Youtube channel to watch a a routine of exercises you can do in the hospital or in the comfort of your own bed after birth.

7. Magnesium for Constipation Control

Magnesium is a natural muscle relaxant and can be highly effective in preventing constipation, common with the use of pain medications. If you choose to use pain medications, discuss adding magnesium supplements with your doctor. As well as increasing cooked magnesium-rich foods in your diet postpartum. Magnesium can help form softer stools which reduce the need for straining, helping to protect your stitches and ease the discomfort of passing your first bowel movement.

8. Use a Peri Bottle for Cleansing

Once you’ve had your first bowel movement, you want to continue protecting the healing perineum while wiping. Using a peri bottle with warm water instead of wiping with toilet paper allows you to gently clean the area; reducing the risk of infection and irritation while minimizing unnecessary friction on the healing tear.

How to use a peri-bottle:

• Prior to sitting on the toilet fill the peri bottle with warm water and set next to the toilet (ideally vanity or bathtub)

• Squirt it over the perineal area from front to back.

• Pat dry with a clean, soft towel or toilet paper instead of wiping.

• You can end with a perispray or vulva cream for additional healing support. I like the Earth Mama Organics perineal spray and Medicine Mama’s Vmagic cream.

  [I am affiliated with Medicine Mama but only after years of using their products with patients. If you’d like an extra discount use ExpectingPelvicHealth in checkout]

And since you want to continue supporting your bowel movements to reduce the strain on your healing perineum and pelvic floor continue using these strategies throughout postpartum. Gradually eliminating ones like splinting and the peri-wash once your stitches have dissolved and the scar has formed.

As always, if you experience severe pain or signs of infection, such as fever or foul-smelling discharge, reach out to your healthcare provider for guidance. Patience, gentle care, and the right techniques will help you get through this milestone on your road to recovery.