Improved Pooping

As promised, here are my tips for better pooping.  For people with chronic constipation, the thought of simply going to the bathroom, sitting down and eliminating waste, seems like a fairytale.  Many of my patients agonize over this simple task, especially when not being able to go leads to belly aches and severe pain.  These tips aren’t a miracle cure, but they can help to get things started in the right direction.

First, timing is important.  The digestive tract is most active shortly after eating or drinking.  This is due to some thing called the gastrocolic reflex.  When food moves from the stomach to the small intestines, this reflex causes the entire colon (large intestine) to increases its activity.  There is some indication that larger meals, warm liquids or meals containing fat may have a greater impact on this reflex.  Making sure you have time to use the potty shortly after a meal (20-40 minutes) can be helpful.  This can be difficult in our hectic life style, where it is common to skip breakfast or “eat on the run”.    Establishing the habit of having  time to use the bathroom after meals is important, especially for young kids, who are often eager to get back to playing and may ignore the urge.


Second, positioning is important.  It is almost impossible to poop standing up.  The body is designed to keep the bowels closed during standing.  Sitting helps some, but squatting is actually the best.  I am a big fan of the squatty potty. 

  Using a step stool or foot rest can greatly improve the opening of the rectum.  Unfortunately, most Americans are not used to squatting and this position may be uncomfortable.  I recommend finding a position somewhere between siting and squatting that works for you.

positioning toilet

Also remember, little bottoms need a little seat.  For small children, a toilet seat insert and a step stool are helpful.


Third,  Take Time and Breathe.   Slow, deep breathing helps to stimulate the colon and relaxes the muscles that keep the colon closed.  Ideally, you should not have to push or strain.  But, if you do have to push to get things started, don’t hold your breath.  Holding your breath triggers the pelvic floor muscles to contract and closes the rectum.  The belly should stay soft and gently blowing out or exhaling can keep the breath moving.  A pelvic physical therapist can help teach proper muscle control and breathing patterns to make sure the pelvic floor muscles stay relaxed to allow for easier bowel movements

Last, gentle massage in a down the left hand side of the belly can help to stimulate a sluggish colon.  For massage, light and slow works best.  Starting at the bottom of the left rib cage slowly stroke downward toward the pelvic bone.  Each stroke should take about 3-5 seconds to complete.

Remember, the colon is a slow learner.  Be patient!  The more consistent you are, the better the colon will be at doing its job.

Love and Peace,



“Everybody Poops” (Taro Gomi) If only it was this simple!

I treat many patients with chronic constipation. Usually, they are referred to physical therapy with the diagnosis of “pelvic floor dysfunction”.  The first thing most patients ask is “What does physical therapy have to do with not being able to poop?”  I probably should come up with a concise, one sentence response, but I have yet to figure out how to do that.   So this is my usual response:

Bowel issues (problems with pooping) can usually be broken down to 2 basic categories.  That is transit problems, when things don’t move smoothly through the length of the digestive system,  or evacuation problems, when things make it to the end of the digestive system, but there is a problem getting them out.  Luckily, physical therapy can (to some extent) help with both of these problems.

First it is important to understand the basics of how the digestive system works.  In 3rd grade, my daughter put together a presentation highlighting the basics that she title Taco Meets Mouth,  that went something like this.  First, food enters the stomach, where acid kills off some harmful bacteria, and the food gets churned up into a watery mush.  A little opening at the bottom of the stomach (pyloric sphincter) controls how much of this mush enters the small intestine at a time.  This mush gets combined with enzymes from the pancreas and bile from the gallbladder (or liver).  These enzymes along with helpful bacteria in the small intestine, break down the food its basic parts.  The walls of the small intestine are designed to be able to absorb the basic parts that the body needs, such as carbohydrates, proteins, fats, vitamins and minerals.



Usually about 6-8 hours later, this food “mush” has completed its journey through the small intestine, and the body has absorbed most of the nutrients that it needs.  At the end of the small intestine is another valve like structure (iliocecal valve) that controls the flow of this waste mush into the large intestine (aka colon).  In the large intestine, a couple of remaining vitamins are removed along with a lot of water.   At the start of the of the start of the large intestine, this waste is quite watery,  and by the end it should be rather solid.  The time that it spends in the large intestine can make a big difference on how soft or hard this waste (poop) is.  When it gets to the end of the large intestine (aka colon),  it triggers the urge to poop (usually 24-72 hours after entering the mouth) .  This is where my daughter’s presentation ended….but not for me.


Under ideal circumstances this urge to poop, should be followed by squatting or sitting in a relaxed position, to allow the colon to do its final job and squeeze out this poop.  But, it may not be convenient, nor socially acceptable to just squat and poop where ever you are when the urge strikes.  Around the age of 2 years old, the nervous system develops a reflex called the rectoanal inhibitory reflex.  This reflex allows us to delay that urge, when it is not convenient, by contracting the pelvic floor muscles.  If we are successful in using this reflex, the end of the colon should relax and the urge should subside or go away.  Great for social situations, not so great for emptying waste from the body.



Problems can arise anywhere along the path from mouth to, as my daughter called it,  “the end of the line”.  Spasm in those small valves can cause difficulty for food to move from the stomach to the small intestine or the small intestine to the large intestine.  Tightness in the tissue that surround the intestines (visceral fascia) can cause slowing of the movement through the intestines, especially in the large intestine, where the waste becomes solid.  Over activity of the pelvic floor muscles can trigger that rectoanal inhibitory reflex and cause the colon to relax and not be able to effectively push the poop out.   Or, as I often say, it “slams the door shut”.



Finally,  the part that we sometimes forget, is that the digestive tract is controlled primarily by the autonomic nervous system.  This part of the nervous system is not under voluntary control.  There are two basic sides to the autonomic nervous system, the fight/flight , and the rest/digest part.  In a very simplified model when the fight/flight part goes up,  energy decreases from the digestive and immune systems and instead goes to the arms, legs, heart and brain.  This is a great response if you find yourself face to face with a bear or tiger.  Problem is everyday stress can also trigger this response, and too much time spent in the fight or flight response can really harm the body’s ability to rest and digest.



So to get back to the question “what does physical therapy have to do with not being able to poop?”  Physical therapists, trained in treating bowel issues, can use exercise or manual therapy to decrease tightness in the visceral fascia around the intestines.  They also have special training in using exercise, manual therapy and biofeedback to help patients be able to decrease over activity of the pelvic floor muscles.  Finally, there are many different types of exercises and breathing techniques that can help to quiet down or control that fight/flight response.

Keep following, for future posts on simple tips and exercises that you can try at home to help manage bowel symptoms and chronic constipation,

Love and Peace,