Our #1 Pelvic Floor Tip Involves Your #2

Rachel Gelman: Hey, ⁓ welcome back to Not Enough Information podcast. I am Dr. Rachel Gelman. I am joined by my lovely co-host, Dr. Britt Van Hees. We are both pelvic floor physical therapists, and we are here to give you ⁓ the information that you should know, but probably don't, ⁓ about your body. ⁓

Britt (she/her): Yes.

Rachel Gelman: So last time we talked a little bit about the pelvic floor and all the wonders of the pelvic

Britt (she/her): Mm-hmm.

Rachel Gelman: floor. But what do you think today people need more information about Dr. Van Hees?

Britt (she/her): Well, Dr. Gelman. I think that people forget about the backside. People forget about how important pooping is. And it plays a big role in our life. And also something crazy, like it's like one of the highest reasons for going to the hospital, right? For people over 65 or something like that, like constipation. So it is... It is rampant and very taboo in an odd way. People don't talk about it. No one knows. Very rarely people know how to poop correctly. Yeah. And off, and I'm sure you would agree with me, but if we see a patient, the first thing we want them to get better at is pooping.

Rachel Gelman: Yep, I always want to optimize pooping. I'm like, even if it doesn't help the symptoms you're coming in

Britt (she/her): Yep. Yep.

Rachel Gelman: for, it'll probably, like everyone comes back in and says like, my God, I'm pooping so much better and they feel so happy.

Britt (she/her): Yeah. Mm-hmm. Yeah. And I'd say it's a small amount that doesn't feel better after they get better pooping. Yeah. It's like most people do.

Rachel Gelman: I agree.

Britt (she/her): Yeah.

Rachel Gelman: People are always shocked that my first recommendation people want to know like, like what's your best like sex tip? How can I make my orgasms better? How can I

Britt (she/her): Mm-hmm, yeah. Yeah.

Rachel Gelman: like this? And I'm like, we're going to talk about pooping.

Britt (she/her): Yeah, yeah.

Rachel Gelman: And people are like, how like that's like the most unsexy thing. And I'm like, well, let me tell you that is going to help

Britt (she/her): Yeah. Yeah.

Rachel Gelman: you so much more than doing like a thousand Kegel exercises.

Britt (she/her): Yes.

Rachel Gelman: I always like to hear how you explain to people or what your top recommendations are

Britt (she/her): Yeah.

Rachel Gelman: or how you go about explaining why pooping can really impact all these other areas like bladder

Britt (she/her): Yeah,

Rachel Gelman: function, function.

Britt (she/her): yeah. So I usually kind of get to pooping. I talk about diet with people and specifically I'm very specific about their water intake. So water, like just water. What are you drinking? Only water. And depending on their symptoms, I might be like, okay with like an herbal tea or something counting as water, but if they're having some really like urinary issues or something, I might be like, I just want to know the only the water you're drinking because we want people to be drinking about two liters depending on their height. Like if they're a small person, then maybe like one and a half, but if they're a bigger person, maybe two and a half. like, you know, we're looking for that. And that's the first thing I'm like, I need you to start drinking more water for most people.

Rachel Gelman: And can you

Britt (she/her): and

Rachel Gelman: say what about water? Like why are you so focused on the water?

Britt (she/her): Thank you. The reason I am focused on water is because your large intestine, which is like the last pit stop your poop makes before it hits your rectum and comes out your butt, is the large intestine. And in the large intestine, if your body thinks that it needs more water, it's going to suck it from the poop. So it means your poop is going to get hard and dry. It means it's going to be hard to pass, which is going to lead to your overactivity of the pelvic floor because the pelvic floor has to hold onto that poop. Right? And when that happens, it kind of creates this kind of spiral effect with everything else. So the poop is just in the back, the backside, but we have to worry about the two front sides too for. Yeah.

Rachel Gelman: Right. Because it's so interconnected. It's such a small area. Like these muscles are so little and everything is living in this one little muscular house. You have

Britt (she/her): Mm-hmm. Yeah.

Rachel Gelman: the bladder and either the prostate or the uterus right in front of the rectum.

Britt (she/her): Mm-hmm.

Rachel Gelman: And so these muscles, if they're working overtime for the bowel, it's going to trickle or like spread to the front.

Britt (she/her): Yeah, definitely.

Rachel Gelman: Yeah.

Britt (she/her): So that's usually why I go with water. Also, a lot of times people who come in with bowel problems or have been seeing other professionals, they might be on other medications for bowel issues or like done all this nutritional stuff too, which is fine. But I'm like, but they haven't drank enough water. I'm just like, just start with water. I was in like a class about the pelvic floor for like pooping and stuff. And they had this whole list of all these things, but there wasn't even water up there. I'm just like, you guys, it's not that hard. Just

Rachel Gelman: Drink some water.

Britt (she/her): drink some water.

Rachel Gelman: I mean, I think the thing that, I see a lot and it kind of, it's kind of akin to what you're saying is, you know, people start eating all this fiber because they get told like, eat more fiber, eat more fiber.

Britt (she/her): Mm-hmm. Yeah.

Rachel Gelman: But if you increase how much fiber you're eating and you're just like eating gallons upon gallons, you know, like large amounts of, you know, they're adding in these fiber gummies and the metamucil and this and this and this, but you don't add water to that. All

Britt (she/her): Mm-hmm.

Rachel Gelman: you're going to kind of end up with is this big ball of fiber in your gut.

Britt (she/her): Yeah.

Rachel Gelman: And it's the water that helps like move that along and propel it. And

Britt (she/her): Mm-hmm.

Rachel Gelman: so I think what I hear is people are like, I tried, I added all this fiber and now it's worse. And so now they

Britt (she/her): Yeah, yeah, yeah.

Rachel Gelman: don't think like any diet type things are going to help or that fiber. They're like, I think fiber is a, like that's fake. Like there's no, because I tried

Britt (she/her): Yeah. Yeah.

Rachel Gelman: it and didn't work. It's like, well, if you don't also up your water, but you up and increase your fiber that amount, then like you're going to, yeah, be more constipated. And it's going to just sort of like add fuel to the fire. So I think that's where also water can make such a big difference

Britt (she/her): Yeah.

Rachel Gelman: because those two have to go hand in hand. Otherwise, you're just not going to get me anywhere.

Britt (she/her): Yeah. Yeah. And honestly, this person has a poop problem, but if they don't have their water up, I'm not going to give them fiber yet. I'm going to say, Nope, you got it. You got to get your water up. And then once your water's up, we'll see. And if you need to, then we'll try some like. Psyllium husk or whatever to see if that helps support, or I mean, nutritional things are also great, but I'm not an nutritionist. So I'm like, let's just get you feeling better. It's easier to play around from feeling better than feeling crappy and then trying to play around

Rachel Gelman: Mm-hmm.

Britt (she/her): from there.

Rachel Gelman: Yeah, yeah, yeah. So, you know, we have people, you know, drinking more water, drinking enough water, maybe they do some dietary stuff. What

Britt (she/her): Yeah.

Rachel Gelman: is next on your kind of list of helping people or what do you talk to people about when it comes to pooping?

Britt (she/her): The pooping. So the next is our favorite, which is the squatty potty. So if someone has problems pooping, and even if they don't have problems pooping, I just offer it as like, try it out and see what happens because it might change your world. And it's basically, if you haven't heard the squatty potty, you should just Google it right now. But it's basically a stool that you put under your feet. and so that your knees are above your hips and you lean forward a little bit. And what it does is you have your rectum and your anus and your pelvic floor wraps around like that. And so when you put your knees above your hips, the pelvic floor muscle relaxes at straightening out this angle. So you get this nice little like poop shoot. So it also depends on the height of your toilet, because here in the Netherlands,

Rachel Gelman: Yeah, exactly.

Britt (she/her): some of the toilets are very high. You need like a really high one. Or if you're super tall and you already have a low toilet, then you probably only need a little one. So it's very interesting

Rachel Gelman: Mm-hmm.

Britt (she/her): talking to people about that. Also bathrooms are really small. So some people are like putting their feet up on like the wall and stuff. And I'm like, no, you need to put your feet down on a stool.

Rachel Gelman: Mm-hmm.

Britt (she/her): just rest your feet flat surface so you can relax and lean forward.

Rachel Gelman: Exactly.

Britt (she/her): you get these

Rachel Gelman: Mm-hmm.

Britt (she/her): like magic poops where you don't have to push. You just sit down, it comes out and you don't even have to wipe.

Rachel Gelman: The way I describe it is, you know, as humans, we're not meant to sit on a toilet to poop, we're meant to squat. So you can mimic that squat position with something like a toilet stool. You know, the squatty potty is one like well-known brand, but there's like so many out there that we, you know, someone can use, they can use some books, they can use some yoga blocks, whatever it is to put under their feet so that their, yeah, knees go above their hips because it mimics that squat position, which is like how we're designed to poop. And if, you know, people try to do like, Oh, I'll just pull my feet up or like do something.

Britt (she/her): Yeah.

Rachel Gelman: It's sort of like, it's going to make it hard for someone to relax. And the whole

Britt (she/her): Mm-hmm.

Rachel Gelman: point in order to poop is you need to relax so it can come out easily.

Britt (she/her): Yeah. Yeah.

Rachel Gelman: But usually, you know, we're wanting people to avoid pushing, straining to

Britt (she/her): Mm-hmm.

Rachel Gelman: poop because if you're pushing or straining, you're putting like all this extra pressure down on these little pelvic floor muscles. And that's just going to call, you know, either contribute to more pelvic floor dysfunction or potentially contribute or cause pelvic floor dysfunction. if you're pushing or straining down on these little muscles and they're going to react to that pressure. sometimes what's happening is like, you're trying to push out stool, but your muscles are going to do the opposite and contract and lift up.

Britt (she/her): Yeah. Yeah.

Rachel Gelman: And we want these muscles to relax.

Britt (she/her): Yeah.

Rachel Gelman: So even if like someone can't, can't get access to a step stool or a toilet stool,

Britt (she/her): Mm-hmm.

Rachel Gelman: just trying to do, you know, relax and avoid this kind of intuition or this kind of like desire to push or strain,

Britt (she/her): Yeah.

Rachel Gelman: which can be really hard to do.

Britt (she/her): Yeah. A couple of things that I like help to explain it. It's like your pelvic floor muscles are automatic muscles. So like, yes, there's voluntary, like you have a voluntary ability to contract and relax them, but they also just respond automatically. Otherwise we just be

Rachel Gelman: Mm-hmm. Right.

Britt (she/her): peeing our pants all the time, right? Or poop in our pants all the time. So they automatically are already contracted. So when I'm sitting, There's a certain amount of contraction there. And when I stand up, I don't have to do anything, but the muscles contract a bit more because of the pressure of my organs on the pelvic floor. So

Rachel Gelman: Mm-hmm.

Britt (she/her): if you're straining and pushing when you poop, you're feeding into this loop where the muscles then contract responsively. usually I'm like, okay, a little bit of pushing is okay to get things

Rachel Gelman: Mm-hmm.

Britt (she/her): started. But it shouldn't be like a throughout thing. We're looking for at least like 25 % or less at the time and not at full force, not with like a closed glottis where you're holding your breath.

Rachel Gelman: Right.

Britt (she/her): And because it actually just makes it harder for you to get the poop out when you do that. Yeah.

Rachel Gelman: Yep, exactly. that kind of, think is a good segue to the other thing. I know you just said the third thing is the squatty potty, but I don't think we already did a second thing, which I think is breathing.

Britt (she/her): Well, I thought the second was the... yeah, I thought the second was the... psyllium husk

Rachel Gelman: Oh, yeah. Okay, so hydration, fiber. We don't know what number we're on now, but we'll just say, we don't need to count. But we'll say,

Britt (she/her): I don't know. Yeah, we don't need to count. Yeah, we're at three and a half.

Rachel Gelman: yeah, breathing is a big one. And I think

Britt (she/her): Breathing. Yeah.

Rachel Gelman: breathing, people like are like, oh, just breathing. It sounds so

Britt (she/her): Yeah. Yeah.

Rachel Gelman: simple. But it can make such a big difference. Because yeah,

Britt (she/her): Yeah.

Rachel Gelman: you know, There's a difference between like a gentle little push, you're talking about, and like holding your breath and

Britt (she/her): Mm-hmm.

Rachel Gelman: like really bearing down until your face is turning red because you're straining so hard. Like accessing your breath is a nice way to one facilitate again, just like relaxation.

Britt (she/her): Yep.

Rachel Gelman: And when everything's relaxing in your body, your pelvic floor is going to follow suit.

Britt (she/her): Mm-hmm.

Rachel Gelman: But when we know the diaphragm, our big like breathing muscle and our pelvic floor move together in tandem.

Britt (she/her): Mm-hmm.

Rachel Gelman: That can be a nice way using your breath to kind of get these muscles to let go a little bit is a really kind of like effective or gentle way to get your pelvic floor to move when you're trying to poop.

Britt (she/her): Yeah. Yeah.

Rachel Gelman: And I even tell people that they can add at the end of their exhale or while they're exhaling, like, obviously it's hard if you're in a public place, but you know, making some sort of a noise

Britt (she/her): Mmm.

Rachel Gelman: at the end, like a deep like. There's this whole idea of saying like mood of poo, which I don't know who came

Britt (she/her): Mm-hmm.

Rachel Gelman: up with that. So I'm sorry, whoever it is, you get all the credit.

Britt (she/her): Yeah.

Rachel Gelman: but you know, doing a deep like, you

Britt (she/her): Yeah.

Rachel Gelman: know, sound on your exhale when you're trying to poop

Britt (she/her): Yeah.

Rachel Gelman: is kind of an effective strategy.

Britt (she/her): Yeah, I also heard from like, did this like hypnobirthing course thing. And

Rachel Gelman: Mm-hmm.

Britt (she/her): they talked about like J breathing, when you're like bearing down for the baby, but they, they said like, oh, you want to practice it while you're pooping. And it can also be really helpful, but it's a similar idea, right? It's like where you inhale and then when you exhale, exhale out of your nose, but you exhale like a J like you imagine. a J and it kind of helps with like this like weird like I don't know if it's nerve or like down bulge pressure or something but it can be it can also be a nice like trick. So I'll try your moo and you can try my J. Yeah.

Rachel Gelman: Interesting. I have not heard that before. I will. We'll trade and then we'll report back to everyone joining us today. I think people should really think about how they're pooping and try to make it, you know, it doesn't need to be this like taboo thing because it's something everyone does. And it really can play such a huge role in how people feel and it really can impact the pelvic floor. And I think something when people come in, they're always, you know, if they're coming in for like bladder problems or pelvic pain or pain with sex, people always ask the question like, why did this happen? Or like what caused this? And I feel like, you know, it's usually multifactorial. It's never just one thing, but so often when I'm talking to people, they have this long history.

Britt (she/her): Mm-hmm. Yeah.

Rachel Gelman: of constipation. And I'm like, well, you know, we can't say for sure, but if you've always had these issues and you're only pooping every like four days and

Britt (she/her): Yeah.

Rachel Gelman: you're pushing and straining is really difficult and you've been doing that for the last 10 years, you

Britt (she/her): Mm-hmm.

Rachel Gelman: know, that probably wasn't helping your pelvic floor and could have

Britt (she/her): Yeah.

Rachel Gelman: been a contributor.

Britt (she/her): I mean, I didn't know how to poop until I became a pelvic floor physio. I was

Rachel Gelman: wow.

Britt (she/her): like a major strainer. Like major. Yeah.

Rachel Gelman: Wow.

Britt (she/her): So like it's still something that I struggle with. but honestly, the best thing I can do is drink water. If I drink water, it's like no problem. I didn't,

Rachel Gelman: Mm-hmm.

Britt (she/her): I didn't even know you could poo without like bleeding basically before I became a pelvic

Rachel Gelman: ow.

Britt (she/her): floor physio. Yeah. So, you know, I'm a convert.

Rachel Gelman: I mean, I think that's a good thing for people to know that, if you're, if you're bleeding when you poop, that, you know, that's common, but not normal. I

Britt (she/her): Yeah, yeah, no, not a good idea. Yeah, yeah, exactly.

Rachel Gelman: think, I think the other thing that maybe people don't know about is, you know, there's a, there's a big range in terms of like how often people should be pooping.

Britt (she/her): Mm-hmm.

Rachel Gelman: And I know for us, we both always say like clinically, we kind of want people to say they're going every day,

Britt (she/her): Mm-hmm.

Rachel Gelman: but Technically the guidelines say like it could be anywhere from three times a day to once every three days is

Britt (she/her): Mm-hmm.

Rachel Gelman: considered like still in the quote-unquote normal range

Britt (she/her): Yeah.

Rachel Gelman: and And I don't know about you, but the way I always base it is like what's been someone's kind of like lifelong? Who being situation

Britt (she/her): Yeah.

Rachel Gelman: If they've always been every like four days, that's probably something I still want to try to adjust

Britt (she/her): Yeah.

Rachel Gelman: But if someone tells me their whole life, they've always pooped every other day, then I'm probably not going to get them pooping daily. But

Britt (she/her): Yeah, yeah, yeah.

Rachel Gelman: if someone's telling me, oh yeah, like I'm pooping once a week, I'm like, oh yeah, we should probably try to get you pooping

Britt (she/her): Yeah.

Rachel Gelman: once every other day or once a day.

Britt (she/her): Yeah. The other thing that I think is like a number five or wherever we are with the numbers

Rachel Gelman: Yeah.

Britt (she/her): is looking at your phone when you're pooping.

Rachel Gelman: yeah.

Britt (she/her): because that's a problem. Hashtag.

Rachel Gelman: Yeah, is that hashtag. That's a problem.

Britt (she/her): That's a problem because I feel like, cause in my own anecdotal experience, I feel like there's something about the screen and the focusing on that, that turns off your awareness to your pelvic floor and your pooping. And so it can make

Rachel Gelman: yeah. Mm-hmm.

Britt (she/her): an urge just go silent. And if someone has a problem with constipation, right. Then that's just going to

Rachel Gelman: Mm-hmm.

Britt (she/her): lead to more hemorrhoids. was that research that came out like, I don't know, a couple months ago that They did like a retrospective based on people who came in to a clinic for pelvic floor dysfunction or something. was like

Rachel Gelman: Mm-hmm.

Britt (she/her): people who helped you with pooping, doctors that helped you with pooping. And the likelihood of having hemorrhoids was like, I don't know, significantly higher if you used a device while you were pooping.

Rachel Gelman: Wow, I mean, I believe it.

Britt (she/her): I should like, yeah.

Rachel Gelman: If you're sitting there and we already know like you shouldn't be spending time like just sitting on the toilet for long periods of time.

Britt (she/her): Yeah, yeah, they said like it has to be like less than five minutes.

Rachel Gelman: Mm hmm. Yeah. So yeah, I definitely agree. Like not spending time just sitting on the toilet, looking at your phone or I don't know if anyone does like the you it used to be back in the day, be like someone would bring in a newspaper or book. But I

Britt (she/her): Yeah, yeah.

Rachel Gelman: feel like that's like, I don't know, maybe maybe there are people who still do that. But I'm like, I don't know what I think everyone's just on their phone, maybe looking at a newspaper or book.

Britt (she/her): Yeah. Yeah. Yeah.

Rachel Gelman: But the screens definitely think are

Britt (she/her): I think that's like additive, maybe not like

Rachel Gelman: not helping.

Britt (she/her): exponentially, but like linearly or something.

Rachel Gelman: I think we have covered or given people plenty of information about pooping, but I'm sure we'll have more to add at a later date. There's

Britt (she/her): The poops. Yes. Hopefully. There's always more.

Rachel Gelman: always more. We always have more to share. But we are grateful for you joining us and we look forward

Britt (she/her): Mm-hmm.

Rachel Gelman: to chatting more and giving you more information. because our bodies are not TMI.

Britt (she/her): Exactly.