Toileting habits aren't usually something we even think about let alone discuss. However, for those experiencing pelvic floor dysfunction, going to the bathroom can sometimes feel stressful and occupy a lot of mental space during the day due to difficulty going or even pain. While it may seem benign, our toileting habits during pregnancy and postpartum can make a big impact on our pelvic floor symptoms such as leaking, prolapse, and constipation. So let's take a deeper dive into some of these habits and why they may be contributing to or making your symptoms worse. I'll also provide some quick tips to help support your pelvic health and make going to the bathroom less stressful. Small changes can make a big difference.
common dysfunctional habits and tips to help
1. Straining and Bearing Down
3. You pee "just in case"
2. You blow your nose while sitting on the toilet
- Wait to go: This can feel daunting due to the fear of leaking, so start off slow and practice when you're in the privacy of your own home. Start by waiting 5 minutes then 10 and work your way up from there.
- Distraction techniques: When you feel the urge, stop and take 5 deep breaths. If that doesn't help, start counting backwards from 100 by 7s or distracting yourself with another task.
- Physical input: Try doing 10 quick flicks (quick pelvic floor contractions) or 2-3 sets of 10 heel raises.
- Bladder frequency diary: Record how often you're going by making note of the times. We should be going every 2-4 hours so this will show you how far off the mark you are. If you consume a lot of fluids (especially bladder irritants like coffee), then this will look closer to the 2-3 hours mark, but otherwise if you're just drinking 8oz every hour, try aiming for every 3-4 hours.
- Bladder diary triggers: Record what you're drinking and what you were doing at the time you felt the sudden urge to pee without a full bladder. Often dietary triggers like caffeinated drinks, alcohol, sugary or carbonated drinks, or habit triggers like peeing immediately when you get home need to be identified to help retrain your bladder.
- Clothing: Avoid tight compressive clothing over the lower abdomen/ bladder.
- Physical Therapy: Addressing soft tissue restrictions such as a hypertonic PF, abdominal scar tissue, or myofascial restrictions and getting help analyzing your bladder diary are just a few things that can be addressed with PT.
4. You ignore the urge to poop or pee
5. You hover over the toilet
6. You spend too long on the toilet
While avoiding "just in case pees" is important, we also don't want to ignore the urge to empty our bladder (when it's actually full) or to have a bowel movement. If our bladder is constantly over distended, this can contribute to things like leaking, pain, hypertonic pelvic floor from clenching, bladder stretching, and even infections. Ignoring the urge to poop, can lead to constipation and the associated pelvic floor dysfunctions.
Tips
- Use a squatty potty: Placing your feet up on a raised surface puts your knees above your hips, effectively simulating a squat position. This works to place your puborectalis (a sling-like muscle that wraps around the rectum to assist with fecal continence) on slack to allow for an easier bowel movement to occur.
- Address your constipation: Exercise, proper hydration, fiber, and magnesium citrate are all great ways to improve constipation. A stool softener may be indicated for more persistent cases, so make sure to discuss options with your healthcare provider.
- Breathing: Take some deep breaths and on your inhale focus on relaxing your pelvic floor and core.
- Don't rush: Take your time and allow it to occur naturally.
- Physical therapy: Learn the correct way to relax and lengthen your pelvic floor without bearing down, address any hypertonicity (increased tone/tightness) in your pelvic floor or scar tissue/fascial restrictions in your abdomen, and techniques like a bowel massage and splinting to assist with going.
The same concepts for straining apply to blowing your nose on the toilet. This will send excess pressure down onto your pelvic floor while it's in a relaxed and vulnerable position, increasing the risk of developing the same types of pelvic floor dysfunctions as above.
- Stop blowing your nose on the toilet!
Tips
The fear of leaking is very common peripartum and can often lead to the habit of peeing "just in case". Our bladder can hold up to 500ml of urine, and our brain tells us we have to urinate around the 250-300ml mark. However, if we start habitually going before this mark, we start training our brain to send signals to empty earlier and earlier which can eventually lead to pelvic floor dysfunctions such as urge incontinence and an overactive bladder. The good news is, we can reverse this cycle and retrain our brain to send signals to empty our bladder when it's actually full.
Tips
Tips
Tips
Tips
- Cover the toilet with a sanitary seat cover or with toilet paper so that you can fully sit down and relax.
- Simply get up after you have finished! You can always close the lid and sit back down afterwards to soak up the quite while protecting your pelvic floor!
I know it's tempting to hover over the toilet in public restrooms, however this prevents your pelvic floor from fully relaxing to allow urine and stool to empty normally. Pelvic floor tension can prevent your bladder from fully emptying leading to leaking, urinary retention, dibbling down your leg due to an uneven stream, and need to strain for a bowel movement.
- Prioritize peeing every 2-4 hours and waiting no more than 5 minutes after the urge to have a bowel movement.
Developing the habit of sitting on the toilet after you've finished is particularly problematic for the peripartum population and those with existing prolapses and hemorrhoids. I totally get that this is often the only time in our day that we can enjoy a moment's peace! But spending too much time here can increase downward pressure on the pelvic floor causing exacerbation of symptoms.
