Bowel health

Toileting techniques for bowel movements

How to use your belly and pelvic floor muscles to empty efficiently, without straining.

Using your belly (abdomen) and pelvic floor muscles to have a bowel movement is usually instinctive. Sometimes people have problems with these muscles and have to relearn proper emptying techniques. If you have muscle weakness, organs that are falling out of place, decreased sensation in your pelvis, or you ignore your urge to go, you may find yourself straining. You are straining if you are:

• Holding your breath or taking in a huge gulp of air and holding it
• Keeping your lips and jaw tensed and closed tightly
• Turning red in the face from excessive pushing or forcing
• Developing or worsening hemorrhoids
• Getting faint while pushing
• Not emptying completely, and having to go many times a day

If you are straining, you are actually making it harder to have a bowel movement. Many people pull up with the pelvic floor muscles and close off instead of opening the anus. Without pelvic floor relaxation and coordination, the abdominal muscles have to work harder to push stool out. Many people have never been taught how to empty efficiently and effectively.

Notice your body

While you are sitting on the toilet, pay attention to:

• Jaw and mouth position
• Angle of your hips
• Whether your feet touch the ground
• Arm placement
• Spine position
• Waist
• Belly tension
• The anus (opening of the anal canal)

A four-point plan

1. Lean forwardLean forward enough for your elbows to rest on your knees.
2. Support your feetSupport your feet on the floor, or use a low stool if your feet do not touch the floor.
3. Push out your bellyPush your belly out as if you have swallowed a beach ball. You should feel a widening of your waist.
4. RelaxOpen and relax your pelvic floor muscles rather than tightening around the anus.

Your healthcare provider may suggest

1. Sit on the toilet

• Make sure your feet are supported.
• Notice your hip angle and spine position. Most people find it effective to lean forward or raise their knees, which helps the muscles around the anus relax.
• When you lean forward, place your forearms on your thighs for support.

2. Relax

• Breathe deeply in through your nose and out slowly through your mouth, as if smelling flowers and blowing out candles.
• To become aware of how to relax your muscles, contract and release them. Pull your pelvic floor muscles in tightly, as if holding back gas or closing around the anus (visualize making a circle smaller), and lift the anus up and in. Then release the muscles so the anus drops down and feels open. Repeat 5 times, ending with a feeling of relaxation.
• Keep your pelvic floor muscles relaxed and let your belly bulge out.
• The digestive tract starts at the mouth and ends at the anal opening, so relax both ends of the tube. Place your tongue on the roof of your mouth with your teeth separated, which helps relax your mouth and the anus at the same time.

3. Empty

• Keep your pelvic floor and sphincter relaxed, then bulge your anal muscles and make the anal opening wide.
• Stick your belly out as if you have swallowed a beach ball.
• Make your belly wall hard using your belly muscles while continuing to breathe. This makes it easier to open the anus.
• Breathe out and make a sound such as a grunt, ahhh, shhh, ohhh, or grrr.

4. Finish

As you finish, pull the pelvic floor muscles up and in. This leaves the anus in its proper place rather than pushed out and down. If you leave it pushed out and down, that will start to feel normal and give you incorrect signals about needing to have a bowel movement.