Big Girl Potty Talk.

I’m going to say this super loud for those in the back:

GIRLS POOP

Or at least we should. And it is not unfeminine. However, it is a very feminine issue to have pooping struggles. High stress, hormonal fluctuations, medications including GLP1’s… constipation can be a real bitch. Or perhaps you trend the opposite direction. Or maybe you’re a swinger and everyday is a new toileting adventure!

Getting vulnerable here - I suffer from urinary incontinence. More often than not, if I have a urine leak eek out - I have to poop too. The combination is just overwhelms my pelvic floor sometimes. I know that if I have better control over my poop, I also have better control over my pee.

Stress:

The central nervous system (CNS) has two modes. Sympathetic, otherwise known as “fight or flight”, and Parasympathetic, “rest and digest”. Many of us live in a constant state of high stress. This can really mess with our digestive system. For most people stress slows everything down, leading to bloating and constipation. Stress management techniques including breath work, meditation, yoga, or walking can all help with bowel health.

Hormones:

Hormonal fluctuations during the menstrual cycle, hormonal fluctuations during pregnancy and postpartum - hello breastfeeding! - and during the perimenopausal and menopausal transitions can all interplay with the digestive system. And all are normal, by the way. Reduced estrogen generally causes worsened constipation due to slowed bowel movement. Conversely, decreased progesterone can stimulate increased bowel movement leading to painful abdominal cramping and diarrhea.

During a normal menstrual cycle, this can lead to toileting adventures depending on the day of the month. Tracking your cycle can help you better understand what is happening given the phase of your cycle.

Pregnancy and postpartum have their own challenges - especially in the postpartum phase when a giant drop off in both estrogen and progesterone follows baby’s arrival. Estrogen is further blocked for women who chose to breastfeed. Baby-safe stool softeners such as Colace or Miralax can be very helpful and use of a bidet for easier washing of healing tissues can be a real life-saver. Staying hydrated and gentle movement are key for mobilizing slow bowels.

Perimenopause can be much of an adventure as hormones can fluctuate wildly day to day. And following menopause, the absence of all hormones can really slow your roll. HRT can help. For everyone - regardless of your HRT choice - movement, hydration, a fiber-rich diet and stress reduction techniques are all a must.

Medications:

If you see medication commercials on TV or read the list of your medication side effects more often than not, possible diarrhea or constipation are listed. For anyone taking GLP1’s, this is a prime issue. Same for those taking an iron supplement. You guessed it, your management options should include fiber-rich foods, staying hydrated, movement, and stress reduction. While I hate to chase medications with medications, you may also need to add Miralax or Colace - both gentle stool softeners without an accelerant - to your daily routine. Magnesium Citrate can be another great option.

Slowed digestion can lead to super uncomfortable bloating and constipation. Beyond the discomfort, the resulting increase of pressure inside the abdomen can worsen pelvic floor issues including incontinence and pelvic organ prolapse. Hard poops or excessive wiping due to diarrhea can lead to hemorrhoids, anal fissures or cause damage to fragile vulvar and anal tissues.

Your toileting management list:

🧻 Hydrate

🧻 Move

🧻 Manage Stress

🧻 Fiber-Rich Diet

🧻 Prebiotics, probiotics, digestive enzymes

🧻 Stool softeners such as Colace or Miralax

🧻 Magnesium Citrate

🧻 Cycle tracking

🧻 Know your medication side-effects

🧻 HRT

🧻 Try a Bidet

🧻 And… 👇

One last tip.

Very few ladies have heard of the “I Love You” or “ILU” abdominal massage technique. This is something that I teach patient’s who either complain of constipation in clinic, most especially my pelvic floor patient’s with incontinence or pelvic organ prolapse diagnoses. Postpartum mama’s too - as nearly every one of them reports constipation as an issue, especially my breastfeeding patients. Check out this video on YouTube for instructions on how to try this technique for yourself!

As always, with pelvic love.

xx,

Dr. Heidi