Poop has been on my mind lately. I feel like I could just write about it for ages. (Except I won’t. I promise I will take a break after this and pontificate on hormones and sex for a while.)
Anyway, let’s get back to poop.
Sometimes, you get a flurry of clients all presenting with the same thing, and lately that has happened with fecal incontinence. Sexy, right?
The thing about fecal incontinence is that so(!) many(!) times(!) it is driven by constipation.
But not just any type of constipation. SECRET CONSTIPATION. Also known as overflow.
Here’s the tl;dr:
Fecal incontinence isn’t just a blatant pooping of your pants. It can include farting without meaning to, skid marks, and endless, infinity wiping after pooping.
Overflow constipation occurs when the bowel is so obstructed that only liquid or softer stool can get around it, leading people to believe they have diarrhea or, in some cases, perfectly fine bowel health.
To quote my pelvic health idol, Susan Clinton, “You must improve the quality of the stool.” And also, you’ve likely gotta improve the quality of that external anal sphincter, bebe. This is [often] the time for kegels.
The deep dive:
Are you into poop diagrams? If not, maybe skip this one.
If you’re all in, let’s talk about what we are actually looking at when we talk about overflow constipation:
Often, a client will come in and tell me that they have constant diarrhea; multiple (up to 10!) bowel movements a day, and some type of leakage. They’re shocked and often in disbelief when I do an abdominal and pelvic exam and report that they are in fact, very blocked up.
I have to sell them on the truth with the facts, which usually include a distended belly that is firm on the lower left hand side (do some poking around if you’re curious!).
And that’s when the magic happens. Or rather, that’s when the shit stops hitting the fan.
I feel like this is a good time to point out that overflow constipation is ridiculously common in children. In one study of kiddos with chronic constipation, 35% of kids assigned female at birth and 65% of kids assigned male at birth experienced overflow. Just like in adults, it’s easy to miss — you think your kid has chronic diarrhea, or some type of food allergy (or both).
This is exactly what happened with my kiddo. I was living my life believing he had a funky belly (which, to be fair, he does), until a minor stomach bug sent us to the ER with a bowel obstruction. Trust me, this is worth avoiding.
Other signs of overflow constipation in folks of all ages:
bloating and the tummy troubles/aches
urinary incontinence (both stress and urge incontinence due to the literal stress on the bladder — see this article for a sick visual)
fecal incontinence of any stripe (as a reminder, this includes any seepage, excessive need to wipe, i.e. “I just can’t get clean”, farting with no control)
“pencil thin” poops
a first poop of the day that starts out pretty constipated, and subsequent poops become more and more loose as the day goes on
Here’s the take-home:
Okay, so you’re secretly constipated. Welcome.
Since my recent post on laxatives covered the food, water, and (duh) laxatives piece of things, I’m going to focus today’s actionables on the mechanical factors that you can influence to reduce overflow.
I should say first that the evidence is, at best, mixed for any intervention. This meta-review showed minimal evidence for abdominal electrical stimulation, cassia fistula emulsion (a laxative), and avoiding cow’s milk.
However, there are individual studies that show that cupping, abdominal massage, and physical movement can be as effective as laxative therapy. My opinion is that these are very much worth trying, since they’re free or low-cost, and far lower risk than literally any laxative or other higher-level intervention. In addition, all of the following strategies are safe to do for all ages! We love that!
Let’s make shit happen: Simple interventions for overflow constipation
cupping: I use this set. I had never done cupping before, but it’s honestly pretty intuitive — just suction them onto your belly and either allow them to hang out or move them around a bit.
abdominal massage: While I use different techniques in my practice, the easiest abdominal massage is the classic “I love you” massage, which is nicely illustrated in this cute baby massage info-graphic:
physical movement: While there are lots of specific twists and squats to get the party started, the reality is that ANY movement will be supportive of healthy bowels. Fan favorites include walking, and simply swinging one leg at a time (hold onto a wall for balance if needed). Paid subscribers can scroll to the end for a whole collection of video recommendations!
If you are leaking stool, it’s definitely time to seek support. Often, this is one of the rare occurrences where kegels (in this case, focusing on the activation of the external anal sphincter) is totally warranted. If you’re not in proximity to a provider, even beginning with simple bridging for a longer durations (think 30-60 seconds) is going to be better than nothing. (This activates the glutes — obvi — and that can create an overflow muscular activation effect in the pelvic floor. Love that!)
Hang in there, friend. While poop problems are not the most joyous, they are solvable beasts. As always, I think you are a rock star of a human, and I am cheering you on.
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