Constipation is complex. There are so many factors that play a role and it can be complicated to figure out what’s going on.

Constipation during pregnancy is pretty straightforward. When you’re pregnant, you have an increase in progesterone, which slows down smooth muscle. This is the type of muscle that we don’t have volitional control over and it includes the muscle of our heart, colon, and uterus. This is important to allow the uterus to expand as the baby grows. After birth, progesterone drops, and the contractability of the colon returns to normal.

Immediately after birth, 47% of vaginal birth moms and 57% of cesarean section moms report being constipated, but within a month this significantly drops to 9% and 15%, respectively.  So what’s going on in those with lingering issues? 

Here are 10 considerations that can’t be ignored:

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Dehydration

If you're nursing, you need to hydrate for yourself and your little one.  Breast milk is about 90% water, so if you’re not drinking enough throughout the day (the recommendation is 128 oz) you can quickly become dehydrated. 

Water is absorbed out of the food we eat in our colon. The more you start with, the more there’s left to keep the consistency of the stool soft. A deficit in fluid intake will lead to harder stools that are more difficult to come out. 

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Inactivity

Immediately postpartum, moms are not moving around much. This helps with the healing process, but can also be hard on the colon. The colon sits on top of the hip flexors and walking creates a natural pump to push the stool forward. If you find yourself lying on the couch all day, take a walk around the block to help move things along. If you need some help, join the Foundations Challenge to start building a habit of movement.

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Ignoring the Urge

Moms are busy and sometimes the urge to poo comes at the most inconvenient time. But if you’re struggling with success on the toilet, it’s time to stop ignoring the urges. When we ignore it, the stool is pushed back up into the rectum. As it sits there, more stool is added, making it a larger and harder stool to come out. It’s best to just listen when nature calls. 

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Low Fiber Intake

There are two types of fiber - soluble and insoluble- and they have the opposite effect on bowel movements.  Soluble fiber tends to slow digestion and help with nutrient absorption. Insoluble fiber draws water into the colon and adds bulk to your stool, helping the stool pass more quickly through the intestines. Most high-fiber foods have a mix of soluble and insoluble, but if you’re struggling with constipation, check out this chart to figure out how to add more insoluble fiber into your diet. 

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Slouched Posture

If you’re constantly slouched or tucking your pelvis (hello mommy butt!), your posture is making it harder for stool to move through the colon. Your colon needs room to contract and push the stool forward. Lifting up through your ribcage gives your colon more room.  It also helps you breathe, which adds a rhythmical pumping to the intestines. A tucked pelvis can also lead to gripping and tightness around the anal sphincter.

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Perineal Tear

Perineal tears, especially 3rd or 4th-degree tears, can interfere with normal bowel function. If it’s painful for the anal sphincter to open, the pelvic floor muscles can tighten to guard the tissue, making it harder to defecate. This should improve with time as the scar heals. Scar tissue also doesn’t stretch as easily and can restrict a full opening of the sphincter. Here’s a video on how to release perineal scar tissue restrictions. 

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Rectocele

A rectocele is a type of prolapse where the rectum pushes forward into the vagina. When you have stool sitting in the rectum, it can feel like heaviness and fullness in the vagina. This creates a bottle-neck situation where the stool is sitting in a larger cavity with a small door. The key in this situation is to keep your stool soft and make sure the anal sphincter can fully open. 

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Pelvic Floor Tightness

If the pelvic floor muscles become too tight, it’ll be hard for them to open to allow for complete emptying. This can happen from prolonged guarding if there is pain present. It can also occur following a c-section as the muscles naturally tighten throughout pregnancy to support the weight of the baby, but don’t get the natural stretch from a vaginal birth. If you have pelvic floor tightness, you should make an appointment with a pelvic floor physical therapist. You can find one in your area here. 

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Core Weakness

For a successful bowel movement, you need to generate healthy abdominal pressure. This is different from straining in that it doesn’t hurt your core or pelvic floor. A weak core can make it harder to generate healthy pressure.  If you had a c-section, generating pressure in your core may be extra difficult. Adding counter pressure to your abs on the toilet will feel really good. You can take a pillow and gently press it against your stomach while breathing to generate pressure.

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Poor Toilet Strategy

The rectum is more vertically aligned to allow stool to more easily come out when you are in a squatting position. Placing a stool under your feet can mimic a squatting position while staying seated on the toilet. 

When pushing, make sure to not slouch or pull in your abdomen - this almost guarantees that you’re closing off the exit. Instead, take a deep breath in so that the belly (and pelvic floor) expand, and then keep that expansion while transferring the pressure down to push.