Apples are high in both sorbitol and fructose (two FODMAPs). Those two sugars rapidly ferment and produce gas, resulting in worsening of your IBS symptoms such as abdominal pain, distension, and bloating. So, they can do more harm than improvement in your IBS-constipation
How to relax sphincter muscles for constipation (Dr. Farahat).
By Dr. Farahat.
Hi, I’m Dr. Farahat, A gastroenterologist and IBS sufferer. I had attacks of constipation before.
Today, I will share with you the most complete step-by-step guide to relax your sphincters when you have constipation.
This actionable guide is a result of the perfect combination of my professional knowledge and personal experience with constipation.
I hope it will help you master the bowel training for constipation.
Before you start:
- Passing a hard poop can painful experience if you fail to relax your sphincter muscles.
- This guide is super detailed, in-depth. When you implement it, you will be able to defecate smoothly without pain.
- Focusing on relaxation instead of straining is the key idea of this guide.
- The best time to start this relaxation practice is when you feel the urge to poop.
- Some people with chronic constipation may not have the urge. If so, you have to choose a scheduled time every day (ideally 20 to 30 minutes after your main meal) to retrain your bowel.
- You may fail in the initial trial to relax your sphincter. Don’t give up, Try again and again until you optimize the process. It is a learning curve, you just need more time to master the relaxation of your anal sphincters and pelvic floor muscles.
How to do Bowel retraining with conscious relaxation.
1- Take the squatting position.
we (humans) are designed to poop in a squatting position. squatting will relax your pelvic floor muscles and sphincters (showed in the video below).
How squatting can greatly relax your sphincter muscles (ref):
- it relaxes the puborectalis muscle, this allows straightening of the angle between the rectum and anal canal.
- Helps to generate more abdominal pressure to push the poop out.
- It lifts the kink in the sigmoid colon (straightens the angle between the rectum and sigmoid colon).
You can take a squatting position by:
- sitting “on” your toilet (be careful if you are overweight or your toilet is unable to carry you).
- Using a conventional footstool: if you have any food stool, you can use it to elevate your legs to simulate a squatting position. But it has to be at least 7 to 9 inches in height.
- A permanent solution (squatty potty): is to purchase a tool that can fit your toilet set curvature and helps you to set in the perfect squatting position (has optimal height).
This video explains the effect of squatting using a squatty potty:
This is the best squatty potty solution to help you with the easier relaxation of the anal sphincter.
2- Get over the pain mindset.
The greatest part of the defecation process is not under your conscious control. In particular, the internal anal sphincter relaxation (ref).
Relaxation of your internal sphincter is under the control of what is called “the autonomic nervous system (parasympathetic and sympathetic).
Unlike your somatic nerves, your autonomic nerves are greatly affected and controlled by emotions such as fear and pain.
Fear and pain from the passage of the hard stool and constipation may be the principal cause of spasm or failure of relaxation of your sphincters.
so, you have to get over the fear of pain, self-awareness of your thoughts and expectation.
Believe that the moment you stop the fear is the moment when your sphincter will relax and the pain goes away.
3- Don’t overstrain.
As we explained before, any wrong move resulting in painful poop can result in more spasm in your sphincters.
The most common wrong move is rapid, forceful straining. Overstraining can result in severe pain which leads to the failure of relaxation of your sphincters.
Not only this, but overstraining with hard poop may also lead to (ref):
- Anal fissures: a small tear in the lining of the anal canal which is very painful. It may bleed and cause bright red blood on the outside of the stool.
- Hemorrhoids: continuous overstraining overtime may lead to congestion and dilation of veins inside your anal canal and rectum leading to hemorrhoids.
- Deep anal tears can happen especially if you strain while you have a large hard mass of poop inside your rectum (fecal impaction).
- Rectal Prolapse: overstraining may cause a small part of your rectum to stretch and protrude into the anus or even to the outside of the anal canal.
So, The first step to relax your anal sphincters and pelvic floor muscles is to stop the conventional forceful straining.
4- Close your eyes.
After you set in a squatting position (preferably using a footstool or a squatty potty), close your eyes instead of straining.
closing your eyes helps you to get rid of distractions, and start focusing on relaxing your sphincter to help constipation.
While closing your eyes, start a slow, deep breathing exercise, this is because:
- Practicing conscious breathing exercise puts your body in a relaxing mode (just as meditation or yoga).
- Helps you to start gaining control over your fear of pain.
- Shifts your focus towards your sphincters and makes you aware of how much relaxed they are.
- Keeping slow, conscious breathing through the process of defecation will provide you with full control over your sphincters.
And here is how you can practice conscious breathing exercise:
- With your eyes closed, bring your awareness to your breaths without trying to change how you are breathing.
- Start with slow inspiration for about 4 seconds (or 4 counts in your head).
- Then a small pause (for one count).
- Then a slow expiration for 4 counts.
- Repeat the cycles of conscious, slow breaths until you get used to it (4 to 5 cycles).
- Continue with the same conscious respiration through the whole steps below.
6- Bring your whole attention to the pelvic floor muscles and sphincters.
- After getting used to conscious slow breathing, start to focus on your sphincters and pelvic floor muscles.
- Focusing means you have to exactly know where they’re.
- by focusing on your sphincters and pelvic muscles you will start to feel the degree of their tension.
- Bringing your conscious mind to feel and connect to your sphincters is your first step to gain control over them.
7- Start imagining.
Now, after making your brain aware of your sphincter tension and feeling, it’s time to control it.
- Closing your eyes, continue the slow deep breathing.
- Now try to make an order to your sphincter to relax.
- And start talking to your brain that “relaxation” is your power that will get over pain and spasms.
- You can use this affirmation to help you imagine “relaxation”:
Now, I am feeling my sphincters, and taking control over them. My brain can totally control and relax my sphincters progressively. Any pain will go away every time I relax no matter how great it is.
- imaging that your sphincter is totally relaxed and you are passing hard poop without any pain will help you to relax more.
8- Attach your sphincters to your breaths (Gentle straining with expiration).
A very effective and powerful tactic is to attach your sphincter muscles to your breaths.
- During inspiration, focus on the maximum relaxation of your sphincter muscles.
- During expiration, slowly and gently push your poop down.
- At the end of expiration stop pushing (straining) and hold the position even if you start to feel some pain.
- At the next cycle of inspiration, start to relax your sphincter muscles more and more again (without pushing down).
- And then, gently push down again with expiration (use your abdominal muscle to help to push)
- REMEMBER, Be very gentle & very slow (Relax with inspiration, Gentle pushing with expiration, eyes closed).
9- Take a pause (Never let your sphincter contract again).
After continuing progressive sphincter relaxation and gentle pushing, the poop starts passing through your sphincter.
At this time, pain sensation may increase. And pain is the biggest enemy against sphincter relaxation. This especially evident if the poop is too hard and too dry.
So, DON’T EVER LET YOUR SHINCTERS SPASM AGAIN. THIS WILL PUSH THE POOP BACK INTO RECTUM AGAIN.
Instead, Focus on relaxation while the poop is inside your rectum and take a pause.
This pause while the poop is still in the middle of its way out has many advantages:
- It will give you more time to relax and take control of your conscious breathing and conscious relaxation of your sphincters.
- More inline with your anal sphincter physiology, as its relaxation is a gradual process.
- It gives time to your anal canal to accommodate the large-sized poop of constipation.
- Also, it greatly decreases the painful sensation and allows your brain to develop the power of pain tolerance.
- REMEMBER, DON’T EVER LET YOUR SPHINCTER SPASM EVEN IF YOU FEEL PAIN. JUST PAUSE THE STRAINING.
10- When comfortable try to push again.
After somewhile (usually, a few seconds), your sphincter muscle will relax more to accommodate the poop hold inside the anal canal.
After getting used to the new position of poop, start the cycle of inspiration-relaxation and expiration-gentle pushing again.
11- Repeat, optimize, and never give up.
When you feel pain again, hold it, breath, relax, tolerate the pain, and when you get used to it, start the gentle pushing with expiration again.
It is a game of mind control over pain. As with any game, it has a learning curve.
Don’t get frustrated if you fail to relax or your sphincter spasm in the middle of relaxation.
Get over it, be aware that it is completely normal to fail with this relaxation exercise at first.
When you start over again and repeat, you will learn to take control of your mind and sphincter muscles.
Relaxation is your key to a smoother poop process.
Bonus tips to help sphincters relax:
1- High fiber diet.
Eliminating hard stools is the best way to prevent sphincter muscle spasm, and the best way to make your poop softer is fibers.
it is recommended to take 20 to 25 grams of fiber per day, especially soluble fibers (ref).
Fibers (particularly the soluble type) help to hold more water and forms a built which stimulates more bowel movements.
You can obtain it by eating high fiber foods or obtaining a soluble fiber supplement, best is psyllium (Metamucil).
RECOMMEDED PRODUCT, #AD:
Metamucil (psyllium) is the best soluble fiber for chronic constipation, as it adds bulk to stool and keeps water inside your colon.
2- Be hydrated.
Fibers need water to work, if you are not drinking enough amount of water, your colon will absorb more water for the poop inside it.
This will make your poop more dry and hard to pass. soluble fiber holds water and forms a gel-like substance that softens your stool.
3- Be physically active.
Take a 30-minute daily walk or light exercise at home helps to stimulate colon motility.
A sedentary lifestyle is one of the biggest risk factor of constipation.
4- laxatives and stool softeners
Taking a laxative, stool softer, or enema greatly helps with the relaxation of sphincters by making the poop easier to pass.
When the poop is too hard and dry, it becomes more difficult for it to pass through the anal canal.
Lubricating its way using warm water enema or inserting a lubricant (such as KY gel) will helps more relaxation and easier passage of poop.
You can insert the lubricant gel to the inside of the anal canal with your gloved little or index finger.
6- Finger relaxation
Another bonus technique you can use with the above method is to use your finger for relaxation.
This method helps people with medical conditions such as spinal cord injuries or dyssynergic defecation.
- Use a latex glove and some lubricant on your index finger.
- While taking the squatting position and relaxing your sphincter, insert your gloved finger into your anal canal.
- At least the half-length of your finger should be inside your anal canal to reach the internal anal sphincter.
- Start circular motions by your finger to relax the muscle.
- Then apply the same technique of relaxation (mentioned above) after removing your finger
This initial step has two advantages, provides initial relaxation to your sphincter and lubricates your anal canal.
7- Pro-tip, the water cannon method:
Using a water spray accessory installed into your toilet can be very effective, It works like a magic with me personally Also, many of my patients also use it.
No one talks about it because toilet water bidets are not common in the USA.
We will release a complete guide on how to use the water canon method soon. stay tuned.
Check the cause of your constipation and eliminate it.
It is important to check what is the cause of your constipation. not all constipation is primary or idiopathic. some medical conditions, medications, and hormonal imbalances can lead to constipation.
Check your doctor for overlooked causes of constipation and eliminated them if present such as:
- Medications: many antibiotics, IBS medications (antispasmodics), blood pressure, anti-anxiety, and anti-depression medications can lead to constipation.
Review the list of medications with your health care provider to determine what is best for you.
- Endocrinal disease: hypothyroidism, hypokalemia, panhypopituitarism.
- Neurological diseases: diabetic neuropathy, autonomic neuropathy, intestinal pseudo-obstruction, Multiple sclerosis, Parkinson’s disease.
Identifying and treating any causes of secondary constipation will help the relaxation of sphincter muscles in the long term.
When to get help? and what is biofeedback?
In some cases, No matter how hard you tried to relax your sphincter, you will fail.
Some people may have other issues such as being older in age or having fecal impaction.
So, if you fail again and again, it is time to visit your doctor. Your doctor may offer another method to relax your sphincter is “biofeedback.
Biofeedback is an emerging and promising technique to treat constipation. Biofeedback basically connects you to your pelvic floor muscles, teaches you to control them, and relax your sphincter. (ref)
Biofeedback’s basic idea is conscious relaxation as the technique I mentioned above. but it takes it to another level by connecting your mind to your muscles with real electrodes or tools inserted into the anus. This allows more consoius and more powerful control over your sphincters.
The video below explains the idea.
Blood on the outside of the stool is usually caused by disease of the rectum and anal canal. The most common causes are hemorrhoids, anal fissures, rectal polyps, and anal or rectal cancer.
A sense of too big stool that is hard to come is a sign of severe constipation or stool impaction. It is better to relax your sphincters and to take a proper laxative or enema to pass stool without hurting your anal canal.
Farting more than 100 times a day is usually caused by ingesting gassy foods or having some degrees of food intolerance such as lactose or FODMAP intolerance. Also, Excessive farting can be a reflection of gut diseases such as Irritable bowel syndrome or SIBO.
A colonoscopy can detect anus cancer by visualizing the anal canal and the rectum. it can also take a biopsy to confirm the diagnosis of anal cancer. However, less invasive methods such as physical examination, anoscopy, or rigid sigmoidoscopy are preferred (ref).
The two main causes of fever after an endoscopy are infection and anesthesia. serious causes can also happen such as aspiration pneumonia and perforation. People that are older in age and with impaired immunity are at a higher risk of fever after endoscopy.
Severe bloating (even after eating very little food) can be due to functional gastrointestinal diseases such as irritable bowel syndrome, functional dyspepsia. Also, severe bloating can be due to food intolerances, gastroparesis, or SIBO.
It is normal to experience some delay in your Bowel movements after colonoscopy. This is because your colon is basically empty (due to colon prep). Constipation or hard stools after Colonoscopy is less common
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Usually, pooping mucus only is a result of severe inflammation or infection of the last part of the colon, rectum, or anal canal. Common causes include is dysentery, STDs of the anus and rectum, inflammatory bowel diseases, anal fissures, or inflamed hemorrhoids.
the causes of yellow stool and abdominal pain can be due to indigestion, infection, functional GI diseases, liver, gallbladder, or pancreatic diseases.
being a female and undergoing prolonged colonoscopy procedure are the two risk factor of pain a week after colonoscopy. read to learn more.