“As a pelvic floor physical therapist, I encourage my patients to really, really look at their poop and then tell me all the details,” says Megan Rorabeck, DPT, board-certified women’s health clinical specialist and author. Between the Hips: A Practical Guide for Women.
Rorabeck says that different stool sizes can indicate everything from severe constipation to a lack of fiber and provide great insight into your pelvic floor.
How do you know if your bowel movement is normal or not?
To determine if your anus is saying something about your pelvic floor, you first need to be able to identify it. The best way to do this is with the Bristol Stool Chart. “This gives us the ability to identify what ‘type’ of bowel movement we have, from type 1 (constipation) to type 7 (diarrhea),” explains Rorabek.
While the chart helps illustrate different stool sizes, Rorabeck notes that pencil-thin stools (a popular topic on Instagram) are left out. “Pencil-thin stools can indicate tension in your pelvic floor muscles,” she says. “If your pelvic floor muscles can’t fully relax, there’s a small opening for stool, which can look like a pencil.” According to Rorabeck, pencil-thin stool can range from a hard consistency (type 2) to a soft, normal consistency (type 4), though, it’s usually type 4, she says.
What to do if you notice pencil-thin stool
If you go to the bathroom and see thin stools—ie, much thinner than normal—a weak and/or tight pelvic floor may very well be to blame.
“Here’s what you need to know about tightness (the same goes for almost every part of the body): Often, tightness and weakness go hand in hand,” says Emma Bromley, Pilates teacher, postpartum specialist, and pelvic floor specialist. , and founder of the Bromley method. With that in mind, here are some ways you can release and strengthen your pelvic floor.
Release: Use a therapy ball
A therapy ball (like the Acupoint Physical Massage Therapy Ball, $15) is about the size of a tennis ball, but with a very mild squishiness, Bromley explains. To release a tight pelvic floor, she says locate your tailbone and the largest part of your sit bones on one side, and place your therapy ball between those two points, sitting on it with your full weight.
“Roll the ball in circles and notice if there are any particularly tight spots,” he instructs, making small circles in the tightest spots. “Breathe deeply and completely relax both your pelvic floor and your abs as you do this (think you’re about to pee, but not quite).”
Check in with your shoulders and your glutes—release any muscle tension you may be holding. Spend five minutes a day doing this on each side for five to seven days in a row, says Bromley. “If you notice BM improvement, that gives us a clue that it’s due to pelvic floor tightness. If there is no change, see a doctor to rule out something more serious.”
Stretch: Breathe deeply
How you breathe throughout the day can affect your pelvic floor: Rorabeck says you can stretch it by taking deep belly breaths.
“Instead of adopting a short, upper-chest breathing pattern, you’ll want to try a deep, belly-breathing pattern that’s commonly practiced in yoga,” she says. “The easiest way to learn is to lie on your back with one hand on your stomach and one on your chest. The goal is to move your stomach hand more than your chest hand, indicating that you are breathing deeply into your belly.”
This works because of how closely related the abdominal and pelvic floor muscles are. “When you breathe in, your diaphragm pulls down, your belly pulls up so your abdominal muscles and your pelvic floor muscles lengthen,” Rorabeck explains. “You may not feel anything in your pelvic floor at first, but that’s okay.” Carry on anyway, eventually bringing the breath with you to the toilet. According to Rorabeck, this can help promote a healthy bowel movement.
Strengthen: Use a foam roller
Once your pelvic floor is sufficiently relaxed and stretched, Bromley suggests introducing pelvic floor strengthening. You don’t need weights, just a foam roller and patience.
“Sit on the foam roller with the roller between your feet, bend your knees, and keep your shins flat on the ground (use a pad if it’s a very hard roller),” Bromley instructs, to lengthen your spine, keep your shoulders down, and Look straight ahead. “Notice the sensation of your labia against the roller, and be mindful to maintain that connection at all times so you’re not tempted to do Kegels.” (News flash: Bromley says Kegels can actually overtighten the pelvic floor, which can lead to severe pain and dysfunction.)
Instead of doing Kegels, Bromley says to focus six inches below your belly button. “Try to lift all of your internal organs without changing the position of your spine, squeezing your glutes, and tensing like a Kegel. This is lifting your pelvic floor,” she explains. “Put that lift on and imagine you’re wearing an old Victorian corset, and someone’s tying it tightly around you. That’s your transverse abdominals.”
Once you’ve located your pelvic floor and transverse abdominals, it’s time to breathe while keeping these two connected. For this exercise, you want to avoid abdominal breathing. “Think instead of taking that deep breath behind your ribs,” says Bromley. Without squeezing your glutes or letting your shoulders pull or round, continue breathing deeply, maintaining both a feeling of lifting and wrapping. and without tensing your labia or losing connection with the roller.”
Maintain this pose in 30-second increments for three to five minutes per session, and Bromley says you’ll be well on your way to a stronger pelvic floor.
Adopt good toilet posture
Last but not least, enable a healthy BM by adopting proper bowel movements. Although modern toilets would have you believe otherwise, the best, most efficient way is to elevate your knees above your hips (a stack of books or a squatty potty, $35, can keep you in the right position). Sitting “normally” on the toilet can constrict the rectum, which can lead to diarrhea.
“This comfortable, squat-like position creates relaxation in the puborectalis muscle, the muscle that wraps around the anus,” explains Rorabeck. “There’s more room in your rectum for the anus to pass through, making it easier to pass.”
If you work through all of these techniques and find that your pencil-thin stool shape remains unchanged, Rorabeck recommends seeking pelvic floor physical therapy. To find a pelvic floor therapist near you, visit betweenthehips.com.
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