Immediately following birth your rectum will be swollen from the pressure exerted during delivery. This swelling may have caused or exacerbated issues in the surrounding tissues such as haemorrhoids, bowel incontinence and constipation. These can be further exacerbated by trauma to the perineal muscles caused by vaginal tears or an episiotomy.
As your tissues heal, any issues should gradually and naturally subside. There is lots that you can do to support your recovery and help your symptoms subside quicker, so that you can have healthy, comfortable bowel movements.
Constipation
Regular bowel habits are a key indicator of good digestive and bowel health and it is important to be mindful of when you poo and whether you have any symptoms that are indicating that there are some issues to address.
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Following birth you can expect to have your first poo within 3-5 days, or you may have had a bowel movement on the day of, or at the time of birthing your baby.
If you haven’t passed a bowel movement within 7 days of giving birth then you may be constipated.
Symptoms of constipation:
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Infrequent bowel movements.
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Uncomfortable or painful bowel movements that cause you to strain.
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Passing small amounts of hard and dry separate poo lumps.
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Taking longer than usual to pass poo.
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Feeling like your bowel is not empty even after you poo.
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Abdominal swelling and bloating.
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Cramps or pain in your stomach or intestines.
Constipation may have affected you before pregnancy and birth, in which case, it was an indicator that your digestive and bowel health were not functioning optimally. The Bowel Health solutions below will help you to improve your overall bowel health.
Postpartum constipation is quite common and can be caused by several different factors relating to birth including:
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Epidural and C-section medications - which slow down digestion.
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Swollen rectum tissues - which slows the passage of poo.
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Progesterone hormone - which relaxes bowel muscle.
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Haemorrhoids - swollen veins in your rectum.
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Iron supplements which can cause constipation & haemorrhoids.
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A vaginal/perineal tear during birth - which may have damaged your anal sphincter muscles.
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A painful episiotomy wound.
Postpartum constipation can be uncomfortable, but it can be alleviated using several common bowel health strategies (see below).
Passing a bowel movement may be uncomfortable as your tissues are healing, but it is always best to poo earlier on, so that you can prevent a build-up of faeces and rid your body of waste materials and toxins before they are reabsorbed back into the body.
You may be prescribed stool softeners by your midwife or medical consultant to soften your faeces and make it easier and more comfortable to have a poo during the first 1-2 weeks following birth.
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Solutions specific to constipation:
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Eat natural laxatives e.g. prunes.
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Consume psyllium husks.
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Perform a colonic abdominal massage.
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Take a postpartum stool softener if they prescribe it to you in the hospital/birthing centre.
Bowel Health & Constipation solutions
The following tips will help to relieve constipation and improve your overall bowel health. They can be applied now and in the future to ensure that you boost your lifelong bowel health.
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Stay hydrated (drink at least 2 litres or non-caffeinated, non-diuretic drinks per day).
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Reduce your consumption of caffeine and alcohol.
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Eat high-fibre foods such as fruits, vegetables, legumes, pulses and wholegrains.
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Eat prebiotic and probiotic foods.
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Place your feet on a footstool and elbows on your knees to improve the passage of poo.
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Exercise regularly (walking is great for bowel health).
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Poo as soon as you feel the urge (don’t hold it in).
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Check your poo and aim for type 4 on the Bristol Stool Chart
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Get plenty of rest.
Optimal bowel health is vital for your general health and especially during postpartum recovery. It can help you prevent more serious or chronic long-tern conditions such as those listed in the red flags section below.
Haemorrhoids (piles)
Haemorrhoids are swollen veins inside and around your rectum and/or anus. They are common during pregnancy and birth due to the increased pressure and trauma caused to pelvic tissues.
Haemorrhoids can be itchy, sore and painful, especially when having a poo, but they usually subside once the pressure and swelling reduces.
Symptoms of piles
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Lumps around your anus.
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Bright red blood after you poo.
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Feeling like you have not completely finished a poo and still need the toilet.
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Slimy mucus in your underwear or toilet paper after wiping your bottom.
Solutions for haemorrhoids
Your haemorrhoids can be eased naturally by following the tips below, as well as the general tips for bowel health (at the bottom of this page). You can also ease discomfort and support the healing process via the application of an medicated ointment that you can obtain directly from a pharmacy or via prescription from your medical practitioner.
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Wipe your bottom gently with damp toilet paper.
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Don’t use scented wipes or toilet paper.
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Keep your bottom clean and dry.
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Have a sitz bath or a warm bath to ease itching and pain (don’t use scented bath products).
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Apply an ointment obtained from your pharmacist.
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Apply coconut oil (pure cooking grade) to lubricate and moisten the area.
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Apply pure aloe vera to relieve itching, soreness and swelling.
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Wear loose-fitting, breathable, cotton underwear.
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Spend less time sitting and lie down to relieve pressure on your anus.
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Use an old compress (ice pack wrapped in a towel) to ease discomfort.
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Gently push a pile back inside.
Bowel Incontinence
Bowel incontinence (sometimes called faecal or anal incontinence) is the term used when you are not able to control your bowel movements or gas. This causes you to pass poo involuntarily which soils your garments. It is a common condition following birth and usually improves within a couple of months as the muscles and nerves heal. However, it can be intermittent throughout life or return later in life during perimenopause and post menopause.
Symptoms of bowel incontinence:
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You have sudden urges to poo that you cannot control.
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You soil yourself without realising that you needed the toilet.
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You sometimes leak poo when you pass wind (fart).
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Constipation.
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Diarrhoea.
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Gas and the inability to control the passing of wind (farting).
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Abdominal bloating.
Postpartum bowel incontinence usually occurs because the anal sphincter muscles have become stretched, weakened or damaged following birth. This damage can be exacerbated by an assisted delivery (forceps), other bowel issues or an underlying health conditions such as:
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Long-term or severe constipation.
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Severe Haemorrhoids (piles).
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Diarrhoea (looser stools are easier to pass).
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Perineal tear or episiotomy.
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Damage to the rectal nerves which prevents signals being relayed to your brain.
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Damage to the anal sphincter muscles.
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Conditions: irritable bowel syndrome (IBS) & inflammatory bowel disease, Crohn's disease, diabetes, multiple sclerosis (MS) and stroke.
Though concerning and inconvenient, postpartum induced bowel incontinence is usually a temporary condition that can be improved by applying the solutions listed below.
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Solutions for postpartum bowel incontinence:
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Pelvic floor exercises (kegels) to strengthen the muscles used to control your bowels.
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Functional exercise programme that strengthens the pelvic floor muscles.
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Bowel health and constipation solutions (see list above).
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Incontinence pads.
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Make an appointment to see a ‘Womens health physiotherapist’ (WHP).
Red flags - when to seek help
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It is vital that you take care of yourself and focus some of your attention on your recovery so that you can spot any warning signs and seek medical attention when required. Familiarise yourself with the list below and make sure that you tell your midwife, health visitor or GP immediately if you experience any of these symptoms, as they could indicate a problem that requires further investigation or immediate treatment.
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If you have not had a poo in more than 7 days following birth.
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Chronic constipation - ongoing difficulty passing poos.
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Haemorrhoids: damaged swollen blood vessels in your rectum caused by straining & pressure.
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Rectal prolapse (Rectocele): part of the lining of your rectum falls out of your anus due to too much straining.
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Faecal incontinence: leakage of poo due to the intestinal muscles not functioning correctly.
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Faecal impaction: too much poo packed in your rectum so your muscles cannot push it out.
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How you can support your partner
You can support your partner by ensuring that they have healthy digestive and bowel health.
Below are some ways that you can be supportive:
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Ask them what you can do to help and best support them.
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Prepare them a sitz bath.
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Prepare high fibre foods for them.
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Prepare drinks to help them stay hydrated.
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Remind them to take their stool softeners.
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Set up a footstool in the bathroom in front of the toilet.
