Updated: Dec 9, 2020
Once you’ve birthed something the size of a large watermelon I can guarantee that one of the top 5 things you worry about is YOUR first poo.
Having a pee is also one of the first things on your mind, but that urge comes pretty soon, you can’t ignore it, and with the help of a jug of water, or gentle bum gun, you get through that, relatively unscathed. But it also serves to remind you that in the next 2-3 days your bowels are going to be fit to burst, like a baked potato on Little House on the Prairie.
Prevention is definitely better than cure when it comes to constipation, so my top tip is to drink water, water and more water, but I’ll get on to more particular tips below.
It goes without saying that following a ‘poo friendly diet’ will help, for most people this involves fresh fruit and vegetables. Just be mindful that anything that is high fibre is not so easily digested (see my post on hemorrhoids) and broken down by the body, therefore it forms larger stools. Some people therefore find that a high protein and carb diet can temporarily suit their digestive system better, and get things moving faster and more smoothly.
So, top two prevention tips:
Drink lots and lots of water
Poo friendly diet
Preparation for pooing:
Calming music on your phone
It can be nice to have cool packs ready in the fridge - what works really well are sanitary pads, with a little aloe vera and or witch hazel, to place in your pants for after your first poo (you may also use these to help pain and itching due of tears and stitches during birth)
Cleansing water available next to the toilet, can be a simple jug, or a gentle bum gun
Cool hairdryer to dry yourself ‘down there’
Basic poo protocol:
Prime pooing times are 15 mins after you wake up (admittedly difficult to track when you have a newborn that wakes you up every few mins), and 15 mins after you have eaten
Apply counter pressure. Hold a cool pad of clean tissue, nappy or sanitary towel, over any stitches and apply gentle pressure upwards to the front areas (opening of urethra, labia etc) when bearing down to poo
Do not strain. Try to relax. Breathe deeply. Try to connect your mind to your muscles in your colon and allow them to instinctively move the poo through your colon and rectum without conscious intervention
Don’t sit on the loo for too long. Spending too long on the loo strains our pelvic floor. So if nothing has happened naturally for 5-8 mins then move around a bit, drink some water or prune juice and wait for the urge again
Raising your feet and leaning forward can help some people as it alters the angle of the poo’s decent
Above all else, breathe deeply and do not strain. Your pelvic floor should relax and open on the inhale and then contract on the exhale - this will help you gently bring the poo down.
What about medication?
If you really can’t poo then a gentle laxative may help. Speak with your Doctor, I will not make specific recommendations for products, but I will guide you briefly through the types on offer.
Bulk Laxatives are particularly useful where stools are small and hard. However there may be a delay of up to 72 hours before they exert their full effect. Bulk laxatives absorb water within the gut and swell to produce a greater volume of soft stool which is easier to pass. Examples of bulk laxatives are Fybogel® and Normacol®.
Osmotic laxatives work by increasing the amount of fluid in the large bowel. These also have a delay in action but it is generally shorter than bulk laxatives. They help to produce softer bowel movements, which are easier to pass. Examples include Milk of Magnesia and Lactulose.
Always check with your Doctor or Pharmacist but generally speaking, absorption of bulk laxatives is minimal, and the passage of osmotic laxatives into breastmilk is low, therefore they can be used during breastfeeding **
Stimulant laxatives should not be used routinely by anyone as they can lead to a reliance on their action. Which can in turn lead to complications of evacuation of all bowel contents, which then require time to re-build before a regular normal bowel action is resumed. They are however, useful for occasional use. They have a more rapid onset of action than bulk or osmotic laxatives, and are usually given at night to help produce a bowel motion the following morning. Examples include senna products. Side effects in breastfeeding infants have not been proven although loose bowel motions have been reported even with undetectable levels of senna in breastmilk**.
If you ever need to know if a medication is suitable for breastfeeding the LactMed® database is simply amazing. “The LactMed® database contains information on drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where appropriate. All data are derived from the scientific literature and fully referenced. A peer review panel reviews the data to assure scientific validity and currency.”
When to see a Doctor?
you're finding it really difficult to pee
you feel very sore
you notice an unpleasant smell
if you really are constipated and home remedies, like prune juice, don’t work
When to see a physio?
If pee or poo is leaking
If you can’t hold your pee or poo
So, that’s a wrap on the poo front for today. I hope you all manage to poo in peace, and please comment below if you have any other sure fire remedies to help new mums out!
** it is worth noting that two previously used drugs with laxative effects are no longer recommended for breastfeeding mothers:
Turawa EB, Musekiwa A, Rohwer AC. Interventions for preventing postpartum constipation. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD011625. DOI: 10.1002/14651858.CD011625.pub3.