Postpartum pooping: tips from a pelvic floor physical therapist

Key Takeaways: 

1. Postpartum constipation and discomfort with bowel movements are common and can be caused by physical changes from birth, pain medication, and stress.

2. Gentle movement, hydration, and healthy eating can help keep your bowels moving and support your recovery.

3. Pelvic floor exercises and simple habits can make bowel movements easier and promote healing after childbirth.

Hinge Health offers virtual physical therapy and more to help with pelvic floor health. Learn more.

You carried a growing baby for the better part of 40 weeks (or more). You took the belly-stretching and feet-swelling parts of your pregnancy in stride. And you delivered your watermelon-sized bundle like a champ. But your first postpartum poop? That part might be freaking you out. As absurd as it may sound to the uninitiated, know that you are neither crazy nor alone in your concern.

If you had a vaginal birth, it may be all kinds of sore and tender down there — especially if tearing was part of the process. The thought of pushing yet another something out of your body may, understandably, make you anxious. And if you had a cesarean delivery (C-section), you might worry that any straining during postpartum bowel movements will cause pain or affect your incision.

Postpartum constipation and other pooping problems are, in fact, common during postpartum recovery. In most cases, they resolve as your body heals. 

Knowing what to expect may help ease your fears, including steps you can take to help smooth the way for your first postpartum bowel movement. 

Here, Hinge Health pelvic floor physical therapists explain what’s going on with your body after having a baby and how to make pooping after birth a little less scary and more comfortable.

Your first postpartum poop

The million-dollar question: How long will it take? The answer: It depends. Typically, women have their first postpartum bowel movement about three or so days after giving birth. However, some moms poop the same day of delivery and others may take longer. Your “when” may depend on whether you had a vaginal delivery or cesarean birth, if you are taking postpartum pain medication (which can slow down your digestive system), and many other factors.

Common postpartum poop problems

Bowel issues after pregnancy are common, and may include:

• Postpartum constipation. If you have hard, dry stools that are difficult to pass, or have fewer than three bowel movements in a week, you’re constipated. This is one of the most common postpartum bowel issues — and it can linger: Studies suggest some women can experience constipation for up to three months after they have a baby.

• Hemorrhoids. Enlarged blood vessels in the rectum often start in pregnancy and worsen during childbirth. Hemorrhoids can cause painful pooping, swelling, and sometimes bleeding at the anus.

• Fecal incontinence. Also called bowel incontinence or bowel leakage, this is the inability to control bowel movements, which causes stool to leak from your rectum without warning. It can range from an occasional leak while passing gas or during a bout of diarrhea to the complete loss of bowel control. Research shows fecal incontinence can affect up to 25 percent of postpartum women.

Giving birth and bowel movements

During and after labor and delivery, your body goes through many changes — both physical and emotional — which can impact bowel movements, such as:

• Pelvic floor stretching. Your pelvic floor is a group of muscles and tissues that forms a hammock from your pubic bone in the front to your tailbone in the back. Like the foundation of a house, your pelvic floor supports the structures above (like the bowel and bladder) and helps control continence (or when you poop and pee). When you are pregnant, the muscles work double-duty to help support your growing baby. And when it’s time to deliver, they can stretch up to three times their length. That process can temporarily weaken the muscles, making it harder to control bowel movements.

• Tearing during childbirth. During birth, the area of skin between the vagina and anus (called the perineum) may tear as you push. Or, in some cases, your ob-gyn may need to perform an episiotomy (an incision in the perineum) to make room for the baby to exit. In both cases, you may end up with stitches in that sensitive spot, which may make it painful to poop. If forceps are needed during delivery, or you have a bigger-than-average baby, it can increase the risk of injury to the rings of muscles at the end of the rectum (called the anal sphincter). This can contribute to fecal incontinence.

• Postpartum pain medications or supplements. Opioids, which may be prescribed to help manage after-delivery pain, can slow your digestive system and lead to constipation. Postpartum iron supplements have the same effect.

• Dehydration. Drinking enough water is key for a healthy pregnancy and is just as important postpartum — especially if you are breastfeeding. When you’re not hydrated, stool tends to be harder and more difficult to pass.

• Feeling anxious or stressed. Lack of sleep, fatigue, and new-mom nerves all play a role in postpartum stress. Higher levels of the stress hormone cortisol can contribute to constipation or diarrhea, depending on the person.

Pelvic floor physical therapy for postpartum recovery

During pregnancy and birth, your pelvic floor muscles experience additional strain, which can affect bowel movements. Pelvic floor physical therapists (PTs) can recommend exercises to help address pelvic floor changes and improve bowel control. Pelvic floor exercises are not just Kegels. Rather, they include a variety of moves to strengthen or relax the muscles of your pelvic floor, which support your pelvic organs. Many women can safely start pelvic floor exercises within a few weeks of having a baby, but it’s a good idea to check with your doctor before you begin. Pelvic floor physical therapists can also improve postpartum recovery by teaching you strategies for lifting and carrying your baby, good toileting habits, and more.

You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

Tips for easier postpartum pooping

Chances are your first post-baby poop won’t be the ordeal you are anticipating. And with time, postpartum bowel issues should resolve. Still, there are things you can do to help your bowels move more smoothly. Some tips to try:

1. Worry less. Granted, it’s easier said than done. But fear and anxiety can cause pelvic floor muscles to become tense, making it harder for stool to pass.

2. Avoid straining. Pushing with force could aggravate a tear or make hemorrhoids worse. If you don’t have a bowel movement within 10 minutes, leave and return when you feel the urge again.

3. Drink plenty of water. Aim to drink half your body weight in ounces of water a day. That means a person who weighs 150 pounds should aim for 75 ounces a day. You may need more if you are breastfeeding. 

4. Eat more high-fiber foods. Fruits, vegetables, beans and whole grains are all high in fiber, which helps make your stool softer.

5. Practice proper pooping posture. Sit up straight and rest your feet on a small box or toilet stool to bring your knees higher than your hips. This helps relax your pelvic floor and makes it easier to pass stool. If you had a C-section, you can brace your incision with a pillow when you push during a bowel movement for extra support.

6. Focus on breathing. Instead of holding your breath and bearing down when you push through bowel movement, breathe in and then start a gentle push as you continually exhale. This helps you use your abdominal muscles to evacuate stool and allows your pelvic floor to relax. Off the toilet, deep belly breathing can help reduce stress and reconnect your core with your pelvic floor.

7. Consider a stool softener. While the evidence is still unclear, stool softeners are generally considered safe to use while breastfeeding. Some women find them helpful in the early postpartum period to lessen discomfort during bowel movements. Check with your doctor if you’re considering an over-the-counter stool softener to make sure it’s right for you.

PT tip: Stay on top of constipation

“I would not hesitate to use a stool softener, even if you don’t think you will need it,” says Amanda Welter, PT, DPT, a Hinge Health physical therapist. “As long as your doctor gives the okay, staying on top of constipation with a stool softener can lower your risk of common but pesky postpartum conditions like hemorrhoids, fissures, and prolapse,” she adds. “Using a step stool under your feet while on the toilet can also be a game changer. Elevating your feet lets your pelvic floor relax, allowing stool to pass through more easily. Bottom line, you want to use whatever tools are available to avoid straining, which puts excessive pressure on your pelvic floor and can lead to pelvic issues.”

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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2. Chang, Y.-M., El-Zaatari, M., & Kao, J. Y. (2014). Does stress induce bowel dysfunction? Expert Review of Gastroenterology & Hepatology, 8(6), 583–585. /doi.org/10.1586/17474124.2014.911659

3. Chin, K. (2014). Obstetrics and Fecal Incontinence. Clinics in Colon and Rectal Surgery, 27(3), 110–112. doi.org/10.1055/s-0034-1383903

4. Shin, G. H., Toto, E. L., & Schey, R. (2015). Pregnancy and Postpartum Bowel Changes: Constipation and Fecal Incontinence. American Journal of Gastroenterology, 110(4), 521–529. doi.org/10.1038/ajg.2015.76

5. Spinelli, A., Laurenti, V., Carrano, F. M., Gonzalez-Díaz, E., & Borycka-Kiciak, K. (2021). Diagnosis and Treatment of Obstetric Anal Sphincter Injuries: New Evidence and Perspectives. Journal of Clinical Medicine, 10(15), 3261. doi.org/10.3390/jcm10153261

6. Turawa, E. B., Musekiwa, A., & Rohwer, A. C. (2020). Interventions for preventing postpartum constipation. Cochrane Database of Systematic Reviews. doi.org/10.1002/14651858.cd011625.pub3

7. Walker, L. O., & Murry, N. (2022). Maternal Stressors and Coping Strategies During the Extended Postpartum Period: A Retrospective Analysis with Contemporary Implications. Women’s Health Reports, 3(1), 104–114. doi.org/10.1089/whr.2021.0134