The First Poo After …
Vaginal Delivery!
Childbirth is a huge event for the pelvic floor. The first poo after vaginal delivery is particularly difficult due to perineal injury during birth. You can prepare some things prior to delivery like putting a stool in the bathroom, some padsicles in the freezer, and getting some stool softeners.
Perineal tearing is the most comon injury postpartum. More than 85% of people who give birth vaginally will experience some degree of tearing and about 10% will experience a grade 3 or 4 tear. Grade 3 and 4 tears effect the anal sphincter muscle and are sometimes referred to as Obstetric Anal Sphincter Injuries (OASIS) which can increase the risk of anal incontinence postpartum.
Constipation can compound the difficulties with the first bowel movement after birth. Hard stool and straining harder puts pressure on the healing perineum. Learn how to manage those first few poos with these pelvic PT redommendations!
Grades of Perineal Tearing
Grade 1: Shallow tear into perineal skin. These are the least severe and may not even need stitches to heal.
Grade 2: Deeper tear that involves perineal skin and perineal muscles. Damage to the muscles can cause weakness and scar tissue can cause pain with sexual activity.
Grade 3: Tearing from the vaginal opening through the skin, perineal muscles, and partially through the anal sphincters. The external sphincter will be involved and the tear may extend into the internal anal sphincter as well.
Grade 4: This is a full thickness tear from the vaginal opening to the rectum. The anal sphincter is torn in this injury. This is why OASIS injuries are more likely to have issues with anal incontinence postpartum.
**As a reminder, Anal Incontinence means the unintentional loss of stool or farts.
Preparation
It is normal to not have a bowel movement for the first few days after giving birth. The first bowel movement after delivery can be intimidating. There is worry about pain or opening the stitches. Making the bowel movement as smooth and easy as possible and learning to support the perineum will help you feel prepared.
The first step is to stay hydrated. This will be essential if you choose to breastfeed and will also help to reduce any constipation. Your OBGYN may recommend stool softeners as well to make things as easy as possible.
Splinting
Supporting your perineum with your hands can help to reduce strain on the healing tissues and reduce pain. Splinting can also help with issues of prolapse or a rectocele. Wrap your hand with some toilet paper and gently press up on your perineum as you gently bear down. Make sure you exhale like you are blowing out a candle as you gently push to prevent straining.
Peri Bottle
Wiping after a bowel movement will be painful and could disrupt the healing scars. A peribottle will help you wash off after pooing, keep the incisions clean, and then you just pat dry with toilet paper after.
Squatty Potty
Support your feet on a stool to raise your knees higher than your hips while sitting on the toilet. This will relax your pelvic floor muscles and make the poo easier. Read more in the blog post below.
Cold Packs
Perineal cold packs are going to be one of your best friends postpartum. You can make homemade “padsicles” or you can buy premade versions. These combine cold for pain relief and absorbing for lochia.
Potty Posture and Constipation
Learn the basics of constipation and how to use your posture and breathing to make bowel movements easier.
Pelvic Floor 101: A Tour of the Vulva
Do you know where the perineum even is? Learn more about the external anatomy with this tour of the vulva.