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POSTPARTUM BOWEL MOVEMENT
It may take several days before the first bowel movement occurs. Abdominal muscles were stretched during delivery and the bowel may have been traumatized and it will take some time to get back to normal. If you had an enema, a long labor without food, or a bowel movement during labor, you may go a day or two without defecating because there simply isn't anything in your intestines. If you have had a hospital delivery with pain medication or a c-section, it can take three or four days for your bowels to start functioning normally again. Systemic narcotics that are given to ease labor discomfort in a hospital birth, or those you may be taking for postpartum pain, may be slowing down your digestive system.
In many women, there is a psychological fear that the bowel movement will be painful and tear stitches (my mother equated the first bowel movement with passing a roll of barbed wire).
Speaking from personal experience, this was my most feared part of my labors and recoveries, especially if I had an episiotomy (usually done in a hospital birth setting) and/or stitches to worry about. In my hospital births, where I had huge episiotomies and many stitches with no control over fluids and elimination choices (I had to go before they would discharge me), I had many more problems with this. However, with my two homebirths, I had very little if any problem with painful first bowel movements. I had more control over my body and nutrition. It was much easier to work through and less fearsome.
Try not to worry about your first bowel movement and if you had stitches, don't be worried about splitting your sutures. Worrying about it will not help your situation and may make things worse. You may have concerns about hemorrhoids and aggravating them, experiencing a great deal of pain or being embarrassed (especially if you delivered in a hospital setting and you are sharing a room).
If you stay calm and focus on your baby instead of your bottom, you will be ahead of the game. As the saying goes - "Poop Happens" - and it's more likely to happen when you are not obsessing about it. If you feel an urge to go, don't hold back and delay it. The longer the feces stay in the bowel, the more likely you will develop constipation problems since the stool will harden and become more compact in the bowel as time passes. While the first few bowel movements may be uncomfortable, you will do better each time. There are several strategies you can use to minimize this monumental movement:
- Remember that fiber is your friend and whether you are at home or in a hospital, try to eat a high fiber diet consisting of as many whole grains, bran, fresh fruits and fresh vegetables as possible. Dried fruits (stewed or dried prunes work great!) and nuts can rough things up for you. Avoid eating certain food items such as that box of chocolates that you may have received from your partner after the birth of your baby since chocolate can be constipating. Avoid processed foods. Eat a salad instead with lots of raw greens and other healthy veggies. If you have problems with cheese making you constipated, avoid it.
- Drink plenty of fluids Prune juice, apricot nectar and other "bulky-fiber-pulpy" type of fruit juices are excellent for assisting with this first time movement. You not only need to replace the fluids you lost during delivery, but staying hydrated will also soften your stool and get things moving inside. Drink plenty of water, at least 6 to 8 glasses a day, more if you are breastfeeding. Some women find drinking any warm liquid first thing in the morning helps to get things moving.
During labor it is important to keep well hydrated with fluids and well nourished. Choose liquids and foods that may assist you with your postpartum recovery as well as keeping your strength up during labor.
It is also natural for laboring mothers to experience a softening of fecal waste as this is nature's way of cleaning out the colon to make room for the baby to be born. As soon as the baby is born, begin downing these types of fruit juices and other fiber liquids and foods. Not only are they nutritious and help with restoring energy reserves, but they are excellent for softening fecal matter up and keeping it soft for easy elimination.
- Start a mild exercise routine. Take a stroll. The more you move, the more likely you are to move your bowels. A leisurely walk (don't over do it) can work wonders, as can practicing your Kegels (keep in mind you may not be able to feel yourself doing the Kegels at first if you delivered vaginally since this area may feel numb, but do them anyway.
- Try to relax when nature calls. Avoid straining during elimination. Not only will relaxing promote results, but straining leads to or aggravates hemorrhoids, plus it can be painful. You may want to try putting your feet on a short stool while sitting on the toilet during your bowel movement (similar to the squatting position) to help lessen any straining. Hemorrhoids will usually shrink on their own, although they may not go away completely. A witch hazel compress or a commercial compress (Tucks Pads) can offer hemorrhoid relief. Over-the-counter creams and ointments, such as Preparation H may help with hemorrhoids problems. Ice packs may help. More serious measures are usually unnecessary.
Try to "breathe" the stool out, very much like you did the baby during "pushing phase" in labor, allowing it to move slowly and stretch tissue gently as it passes through the rectum and anal opening. Try to let your bowel do the pushing and only push when you absolutely have to do it, but gently. Again, do not strain.
Try to avoid laxatives and stool softeners if possible, using these only as a last resort. If you must use something, try using glycerin suppositories or a very mild natural laxative. A mild laxative or stool softener may be taken right away if you have had any tear that extends into or through your anal sphincter or if you are suffering from hemorrhoids or have taken a high dose iron supplement for anemia or narcotics for pain relief, because constipation can be a side effect of these medications.
A sitz bath may be recommended after every bowel movement. This involves sitting in shallow water, only a deep enough to cover the hips and buttocks. Cold sitz baths help reduce swelling and discomfort after delivery. Sit in a lukewarm or room temperature bath, and then gradually add ice cubes to the water. This prevents the uncomfortable, sudden sensation of ice water on the skin. Soak for 20 minutes at a time, up to 3 or 4 times a day. After the first two or three days, warm sitz baths will improve blood flow to the perineum. Check with your midwife or health care provider before adding medications such as Epsom salts to the bath.
Be sure to check with your midwife or health care provider before using any medications. This is important if you are breastfeeding your baby. Most stool softeners and mild laxatives are relatively safe, but you need to make sure the one you are planning to use is safe for breastfeeding. Many health care providers recommend these medications for constipation issues:Use a stool softener such as Colace, Surfak, Dialose or Modance for 2-3 weeks, or until the tenderness in the episiotomy and hemorrhoids has resolved and your bowel movements are normal. If you go 2 days without a bowel movement, use a stool softener-laxative combination such as: Dialose Plus, Senekot, Doxidan, Modane Plus, Pericolace, or use Milk of Magnesia. The drugs listed above are available without a prescription.
DO NOT use an enema without first consulting your midwife or health care provider. Additionally, you should consult your health care provider before using any stool softener or laxative not listed above.
If you don't have a bowel movement within a week or if you become uncomfortable, contact your midwife or health care provider.
MoonDragon's Obgyn Disorders: Constipation
POSTPARTUM URINATION
Urination may be painful, there may be no urge, or an urge with no urination. This may be due to some trauma and bruising from the delivery. Swelling and pain in your perineal area can also compromise your body's urination abilities. There may be psychological (fear) factors that could be keeping you away from the bathroom.
It is important to urinate within 8 hours, less if you have been drinking fluids during your labor, to avoid infection. Infection can occur if your bladder gets overly full and the urine is not eliminated when it should be eliminated. If you are still having trouble urinating after a few days, you might have a urinary tract infection (UTI). If you feel pain when you are urinating even after your incisions and tears have begun to heal, if you feel the urge to urinate but only manage to evacuate small amounts, or you are running a fever, call your midwife or health care provider. Here are some helpful suggestions:
- Squirting warm water over the perineum during urination may ease the discomfort. The warm water will soothe your perineal area and will dilute the urine so you don't feel the sting when you go. When finished urinating, gently pat the perineum dry. Be sure to pat from front to back.
- Getting up and moving around can help. As soon as you can, take a walk (don't over do it). Gravity and movement help get your systems back to work.
- Drink plenty of fluids. Fluids can kick in the urge to "go" and also prevents constipation.
- Ask for privacy if you feel you have a "shy bladder" and you don't feel like the company when you are trying to perform. Ask your partner, doula, midwife or nurse to wait outside the bathroom.
- Using a bed pan isn't any fun, but postdelivery weakness could leave you needing one. Try sitting on the bedpan instead of lying on it. Don't be shy about asking your midwife or nurse to warm it up for you before you use it.
- Run the tap water while you are trying. Listening to the sound of running water can really help you to let the bladder go with the flow.
- Smelling peppermint aromatherapy oil may help. (I learned this one when recovering from gallbladder surgery and the nurse brought it to me to use since I had postsurgical urine retention.)
- Counter urinary incontinence and/or to gain control over your perineal muscles: You can get your vaginal canal back in shape and regain control over urination by doing Kegel exercises. Kegels work the muscles that you use to stop and start the flow of urine. While sitting, squeeze those muscles and count to ten. Release and repeat 20 times. Do five sets a day. A good time to do it is while feeding the baby.
- Acupuncture for urinary retention may be considered.
Mrs. Lin, a 29-year-old teacher, vaginally delivered a normal baby on August 18, 2005. Five hours after delivery she was unable to urinate voluntarily, accompanied by the distension and dullness of the lower abdomen, which lasted for 18 hours. A day later she suffered from anuria, which may have been caused by the prolonged birthing process. The physical examination did not show any organic lesion. The top of the distended urinary bladder reached the level of one finger below the umbilicus. The intolerable sufferings could not be relieved by the administration of drugs. The patient did not want to be treated with urethral catheterization. As the patient was a little familiar to traditional Chinese medicine, she was willing to accept an acupuncture treatment.
Method: The patient took a lateral recumbent position. Zi Wu Dao Jiu needling was applied to the Huiyang (BL 35) acupoint. After the needling sensation was obtained, the reinforcing technique was performed by quickly and forcibly thrusting, as well as slowly and gently lifting the needle when it was thrusted downward by three steps to a deeper level together with a counter-clockwise twisting manipulation of the needle. As for the reducing maneuver, the needle was lifted upward by quickly and forcibly raising it, as well as slowly and gently thrusting, together with clockwise twisting manipulation of the needle to induce a needling sensation toward the perineal region. The needle should not be inserted too deep or it may influence the inferior gluteal artery and vein. The needle was then retained in the acupoint. Twenty minutes later, she felt a sense of urination and 800 ml of urine was spontaneously discharged. Forty-five minutes later, her pain was relieved. A follow-up visit after six months showed no sign of a relapse.
For full article by Acupuncture Today see: Treating Urinary Retention with Acupuncture: A Case Report
- Catherization with a Foley catheter is a last resort but may be necessary in some instances.
A full bladder can interfere with the midwife checking your postpartum uterine tone and can become quite painful. You should have urinated by the time she is ready to leave after the birth.
After 24 hours, there is an increase in urination as the excess body fluids from the pregnancy are excreted. If this doesn't occur, there may be a bladder infection. If so, antibiotic treatment will need to be started.
HELPFUL CONSTIPATION PRODUCTS
Easy Move & Colon Cleanse, TCM Formula, 100% Natural, 60 Caps - Easy Move & Colon Clean is made of hemp seed, bitter apricot seed, medicinal rhubarb, costus root, tangerine peel and common peony root, colon cleanse herbs. Chinese medicine uses this famous formula to moisten the intestines, increase peristalsis, facilitate bowel movement, clean internal heat and eliminate congestion and bloating. Direction for Use: As a dietary supplement, take 3~5 capsules 3 times daily. Not recommended for use by pregnant woman. Store in a cool and dry place out of the reach of children. Balanceuticals formulas are formulated and manufactured according to the most stringent quality standards and the most up-to-date achievements in traditional Chinese medicine. They are screened for quality and safety by a specialist group at the China Academy of Traditional Chinese Medicine, the highest research institution for traditional Chinese medicine.
AloeMaxLax (Aloe Laxative), All Natural Remedy for Constipation, Nature's Way, 445 mg, 100 Vcaps - AloeMaxLax is a powerful, all-natural stimulant laxative. AloeMaxLax is specially formulated for those with tough constipation. It delivers relief of occasional constipation and irregularity. It is an excellent all natural constipation remedy. This product generally produces bowel movement in 6 to 12 hours. Recommended Daily Dosage: 445mg per capsule. Adults and children over 15 years of age: Take one capsule at bedtime or when needed, with a full eight ounce glass of water, juice or other liquid. Do not take more than one capsule in 24 hours. As with any medicine, if pregnant or nursing a baby, seek advice of a health professional before using this product. This package is not child resistant. Not suitable for homes with small children.
Bekunis Nature's Gentle Senna Laxative Tea, NatureWorks, 2.83 oz. - Bekunis Herb Tea works with the body to gently promote regularity and the excretion of toxic substances which contribute to fatigue. Bekunis Nature's Gentle Laxative. 100% Natural Senna Tea Gentle overnight relief of constipation. Relief of constipation as natural as Nature itself. Bekunis works with your body's natural processes to relieve simple constipation whenever it occurs. Gently stimulates the large during the night to naturally induct smooth, comfortable elimination in the morning. Bekunis Herbal Tea contains only the fruit and the leaves of the Senna plant - regarded the world over as the ultimate natural laxative. After years of research, it has been standardized for more natural and dependable relief. Directions: Adults, use one rounded teaspoon per cup. Add boiling water, let steep for about 20 minutes then pour off. Add honey or lemon to taste. Children over 6, consult a health care provider. Start with one cup daily, preferably in the evening. If desired, drink one cup before breakfast and one at night just before retiring. Warnings: Do not use when abdominal pain, nausea or vomiting are present. Frequent or prolonged use of laxatives may result in dependence on laxatives. If constipation persists consult a health care provider. As with any drug, if you are pregnant or nursing a baby, seek the advice of your midwife or health care provider before using this product. Keep out of reach of children. Ingredients: Senna fruit - 75%, Senna Leaves - 25%.
Heather's Tummy Fiber, Organic Acacia Powder, 1 lb. - Heather's Tummy Fiber Supplement Acacia is a natural, pure, certified organic, soluble dietary fiber produced from the gum of the Acacia tree (also known as gum arabic). Acacia is a natural plant water-soluble fiber that has been harvested for millennia in Africa; its recorded dietary use dates back to the Egyptian pharaohs. Pure soluble fiber supplements are helpful not just for IBS, but also for inflammatory bowel diseases (IBD) such as Crohn's and Ulcerative Colitis, plus diverticulosis and diverticulitis. Heather's Tummy Fiber is NOT a drug, it is NOT a laxative, it is NOT an anti-diarrheal medication. Acacia is simply an organic, prebiotic soluble fiber supplement with absolutely nothing else added, and it normalizes bowel function naturally in the same manner as soluble fiber foods. Directions: Add Acacia to cup, then add liquid or add Acacia to moist foods. 1 level teaspoon = 2 grams soluble fiber. 1 lb. has 180 teaspoon doses. Start with a low dose and gradually increase. Take 1-3 times a day.
Get It Going Herb Tea for Regularity No. 2, 36 Tea Bags, Republic of Tea - Republic of Tea created this naturally caffeine-free herbal blend of organic rooibos and senna leaves to help you "get it going" gently. Senna is known for its mildly laxative effects. Let's just say its natural compounds help move things along. As for the other annoying effects of constipation, we've added ginger to help reduce cramping that often comes along with this whole uncomfortable situation. Finally, sweet licorice soothes and coats the gastrointestinal tract. Preparation & Serving: Heat fresh water to a rolling boil. Place one tea bag in the cup and pour boiling water over it. Infuse tea bag for five to seven minutes. Remove tea bag and enjoy Sip by Sip. For iced tea, double the amount of tea used. Cool and serve over ice.
Bowel Balance Wellness Oil, 2 fl. oz. - This oil works wonderfully for constipation and also for Irritable Bowel Syndrome. With regular use you will create a healthy, balanced digestive system. Directions: Apply to abdomen in a clockwise direction as needed. For external use only, keep out of reach of children. Ingredients: grapeseed oil and an essential oil blend of rosemary, orange, black pepper.
MoonDragon's Client Handouts about nutrition and diet for pregnant and breastfeeding mothers are available at the links below. Examples of sample diets and menus are given, including some holistic suggestions. Nutritional analysis for various foods and nutritional therapy information is also available.
POSTPARTUM CARE INFORMATION
Postpartum Care: Index
Postpartum Care: Weight
Postpartum Care: Diet
Postpartum Care: Bowel Movements & Urination
Postpartum Care: Bathing
Postpartum Care: Breasts & Breastfeeding
Postpartum Care: Perineal Care
Postpartum Care: Vaginal Bleeding (Lochia) & Menstruation
Postpartum Care: Exercise & Back Care
Postpartum Care: Sexual Intercourse
Postpartum Care: Contraception
POSTPARTUM VISITS
PostPartum Visit: Day One
PostPartum Visit: Day Three
PostPartum Visit: Day Seven
PostPartum Visit: 4 to 6 Week Visit
POSTPARTUM CONCERNS
Baby Care & Concerns
Fatigue & Exhaustion
Postpartum Depression (The "Baby Blues")
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or your family member has questions about postpartum care.
You or a family member develops any unexpected and/or unusual symptoms.
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