Episode Transcript
Speaker 0
Hi there. Volva speaking. We need to talk. For years now, you've been calling me the wrong name. I'm the vulva, not the vagina. I'm all the external bits you can see. My neighbor, the vagina, she's the internal tunnel connecting me to your uterus, you know, the baby highway. Different parts, different names. It's pretty hard to address dry uncomfortable situations when you don't even know which one of us needs the attention. Now that we're properly introduced, can you please hook me up with some Iris? Their water based moisturizer and lube are exactly what I need. No irritating fragrances, just clean ingredients to keep me happy and well hydrated, not dry and disgruntled. Eternally grateful for the hydration and finally getting my name right. Signing off, x o x o, your vulva.
Speaker 1
And right now, our listeners get twenty percent off all purchases at love my iris dot com. Just use code t I p twenty. That's t I p two zero at l o v e m y I r I s dot com.
Speaker 2
Welcome to this is perimenopause, the podcast where we delve into the transformative journey of perimenopause and beyond. I'm one of your hosts, Michelle.
Speaker 1
And I'm your other host, Michelle. And we know firsthand how confusing, overwhelming, and downright lonely this phase of life can be.
Speaker 2
Join us as we share real life stories and expert advice to help you navigate this journey and advocate for your best health.
Speaker 1
We used to think menopause signaled an end, but really, it's just the beginning. When's the last time you had a really good poop? If you can't remember or if the word poop just made you cringe, then this episode is absolutely for you. Because today we're going where few podcasts dare to go, straight into your toilet bowl with pelvic floor therapist, Aliyah Dhalla. Her expertise spans the full spectrum of women's lives from puberty through postmenopause. And she loves talking about uncomfortable things that we don't talk about, but absolutely should, like our bowel and bladder health. She's also the host of the popular podcast, Not Your Mother's Pelvic Floor, and the founder of Box Wellness Co. Today, we're sharing constipation confessions, hemorrhoid horrors, and our most mortifying bathroom experiences. It's totally a train wreck and you won't be able to turn away, but you'll also learn a lot. So flush your embarrassment, embrace your inner potty humor child, and join us for a conversation that's literally full of shit and packed with great insights and information that will help you poop like a pro. Aaliyah, welcome to this is perimenopause. Aaliyah, we're so excited to have you here today. Welcome to the show.
Speaker 3
Thank you so much for having me. I'm really honored to be here and I'm excited to get to know you better and to chat all about the things that, you know, maybe we're all experiencing on our own, but we don't wanna talk about together.
Speaker 1
Absolutely. And we've got a really awesome topic. This is one thing that I mean, maybe we talk about it a little bit. We're talking poop today, so that probably is something that isn't always talked about loudly anyway.
Speaker 3
Oh, I love talking about poop but you're absolutely right.
Speaker 1
We do too. We talk about it with
Speaker 2
each other but no one else. So we're pretty excited to have somebody else into our little poop chat. So welcome.
Speaker 3
Poop chat. Thank you. I I think that sometimes people just need permission to talk about poop. So everybody poops. So, you know, everybody can talk about it. We should talk about it.
Speaker 1
We should. Like, yes. So many things went through my head. Why don't we start, Aliyah, just for our listeners who don't know you yet, can you tell us a little bit about who you are and what you do?
Speaker 3
Yeah, of course. So, my name's Aliyah. I'm a pelvic floor physiotherapist and I have a clinical practice in Toronto. And, so I spend a lot of time in my treatment room working mainly with women who are going through all the different phases and stages of life, like from, you know, preconception to pregnancy, postpartum, perimenopause, menopause, and any and everything in between. People come to see me for some support with bladder, bowel, sexual dysfunction, pelvic pain, preparing for birth, figuring out what the hell's going on down there during perimenopause. So that's what I do with part of my time. And with the rest of my time, I spend it sort of educating and talking about pelvic health and talking about the things that we don't talk about, basically online. So, I spend a lot of time on my Instagram, I spend a lot of time on my own podcast and, sort of teaching and talking to whoever will listen to me talk about this stuff.
Speaker 1
I love it and that's how we found you actually. We have a similar sponsor, Iris, who's an amazing, company that produces moisturizer and lubricant. But I was listening to you interview Dolores Fernandez, Doctor. Dolores Fernandez, their founder, on your podcast which is called Not Your Mother's Pelvic Floor. Is that correct?
Speaker 3
Yeah, you got it. Not Your Mother's Pelvic Floor.
Speaker 1
Such a fun name. Yeah, it's a great podcast. So anyone who is interested, any of our listeners, they should take a listen there as well. It's really good.
Speaker 3
Thank you. And I can't wait to have you both on the podcast
Speaker 1
too. Oh, yeah. In case you haven't heard, ladies, we're going to be, joining, Aaliyah on her podcast very shortly or maybe it will launch before ours. I'm not quite sure, but, we're we're sharing. We're doing a little tag team here.
Speaker 2
Okay. Yay. Looking forward to it. You know, it's funny when I think when I used to think pelvic floor, you don't often associate pelvic floor with poop. So I am really delighted today that we're gonna have this conversation and maybe we'll start with the very basics. Aliyah, how often should I be pooping?
Speaker 3
This is a good question. I think that if we were to look at, like, you know, the recommended medical guidelines for what's constipation and how many times we should be pooping, I think you can find anything from, like, you know, three times a week to a couple times a day as being within the range of normal. But I like to kind of subscribe to the notion that we should be eliminating at least once a day or with something that's a little bit more regular and I think a lot of my sort of pelvic floor physio friends and kind of gut health friends might say the same thing. So, you know, we should be going with regularity, I think is more important than like how frequently maybe, and also we should really be trying to make sure that our poops are soft, smooth, and easy to pass. So, you know, if you were to tell me, okay, I go every day, so I'm great, right? I'm regular. And then if I dig a little deeper and I'm like, what does it look like when you poop? And you're like well, little small, hard little pellets but
Speaker 1
I'm going every day. Well then I'm like we have a problem
Speaker 3
my friend. So I think it's less about like are you going every day? But when are you going? Are you going regularly? Like do you get an urge to go? Yeah. And then when you go, is it fairly easy to actually poop or are you putting a lot of effort in there and then after you go, do you feel good? Like we know, we all know what it feels like to have that great poop where like you feel empty.
Speaker 1
Oh my god. It's the best.
Speaker 3
So I think that's actually like a better picture as to sort of like are you pooping enough? Are you pooping right?
Speaker 1
So what if I am going every morning? I'm going every day but I'm pooping after my coffee or because I took a fistful of magnesium the night before. Like, does is that still, like, fine?
Speaker 3
I don't know. I think it's fine. Like, personally, this is not medical advice, but I think it's fine. Sometimes if we need a crutch, whether your crutch is like a cup of coffee or like Metamucil or psyllium husk or chia seeds that you have in your smoothie, like if you need some bulking up of your dietary fiber, you need coffee to like stimulate your bowels, I kind of feel like that's okay. There's many of us that that do that. Coffee is a stimulant in that way. I think that's okay. And also what's neat to know is that like, you know, you said you go every morning after you have a cup of coffee, that's like a really nice rhythm to get into for bowel routine is capitalizing on that. Like, first thing in the morning, your digestion has been kinda going all night, you can stimulate it by having a hot beverage. So whether it's coffee or tea or hot water, and kind of like allowing that that hot beverage to like stimulate your bowels, that that can be helpful for many people. So I think that's fine. I see no problem with that.
Speaker 2
I feel like sometimes part of the problem is you need to go, like, in the middle of a meeting at two o'clock in the afternoon. No. And that's not happening. So then you're anyway, I digress, but you get worse.
Speaker 3
Yeah. No. I totally get it. And it's so common. Right? Like, oftentimes, we'll get an urge to go, and it won't be the right time, so we'll ignore the urge. Or we'll be somewhere we don't wanna poop in at someone else's bathroom or, like, whatever it is. Right? So we like repress the urge.
Speaker 1
This is a common humanity problem, right? Nobody wants to like clog someone's toilet or stink up the toilet or have someone hear them poop, even though we all poop.
Speaker 3
And what happens actually, is that eventually if we stop responding to the urge, we stop feeling the urge. So, if we're getting into this pattern, and we maybe want to establish a good bowel routine, it can be nice to try to catch that morning window, but I think that there's sometimes, like there's some things maybe that we need to do to optimize to establish a routine, right? So, you know, if we can allow ourselves some kind of like quiet, like low stress time, right? Like we're not gonna wanna poop unless they're like anxiety poops or like stress poops if we're stressed, right? So like waking up, trying to have maybe carve away ten or twenty minutes just for yourself, maybe do some breath work or yoga or read a book, like whatever, journal, do your thing, allow your body some time not to like jump right into your day. Have a hot cup of something while you're waiting for that time and then ten or twenty minutes after that, if you don't feel the urge, I usually recommend to my patients like go sit on the toilet anyways, like give your body the opportunity. You might have the urge, your bowels might be ready, but you just might not be hearing the message that they're giving you. So sit on the toilet, but don't like strain and push something out, just sit and just offer the opportunity to feel the urge. And then if you feel the urge, like you know when you sit on the toilet for most of us like it's not like the poop comes out right away at your butthole, like it takes like Sometimes. Sometimes.
Speaker 1
Depending on how many fistfuls of magnesium I had the night before. Sometimes you're lucky if you get your butt down, but most of the time
Speaker 3
we're gonna it's gonna be like a short amount of time, right? So I often say like offer yourself five or seven minutes to sit on the toilet and just practice in like slow deep breathing and just like see. You probably at the beginning you're not gonna have a poop. Right? But you're setting up the stage, you're setting up this routine. And I think it's important to like allow enough time for it, right? We've all been in this situation where like you kinda have to go but you're not quite ready, but you only have ten minutes before you have to do whatever, so you go and you sit on the toilet and you try to make it work, so that's not what I'm suggesting. I'm suggesting setting up like some time. And if you can't catch it in the morning, try after each meal. There's this thing that I think is really helpful for us to kind of know that exists and then we can like optimize on this, especially if we're irregular with our bowel movements or often ignoring the urge. It's called the Gastrocolic Reflex. It's the urge to empty our bowels when we have just eaten something. So, when we eat something or we drink something, we stimulate our digestive system, like the food waste is like, you know, it's going in the stomach and it's like doing its thing and then it's moving along to our digestive system and what that triggers is like a reflex to empty whatever is kind of at the bottom of that digestive system. So, it's really common to have a small urge to go, like maybe twenty minutes or so after a small meal or a snack and that reflex is strongest in the morning, which is why I suggest try in the morning if you have the time. Maybe you gotta get up a little bit earlier, but if you can't catch it in the morning, catch it after a meal or snack. And not sitting and straining and pooping and like trying to poop when nothing's there, but just offering the opportunity.
Speaker 2
Okay. And you meant you mentioned a few key things that I'd really like to circle back on. Smooth, easy to get out. Mhmm. What should my poop what's your what is healthy poop? What is a good poop? Perfect poop? I don't know. Looks like I don't know if there's such thing as perfect poop, but
Speaker 3
No. There is.
Speaker 1
Okay. We
Speaker 3
want the perfect poop to be formed. Right? We want it to be soft and squishy. So think about like a banana, like a ripe banana. Okay. So it's gonna hold its shape. It's gonna be soft and squishy. One piece is great. That would be like a good poop. Now, if we get those like small little pellets right, then we're quite constipated. Those are like dry very hard or sometimes we can get like bigger kind of chunks, you know, sometimes we have those poops that are like really, really large maybe we've been withholding for a long time or we're very, very dehydrated. So those are not ideal, those are really hard to pass, like to pass through our butthole. It's really hard. And it can be really traumatic, let's just say, but it's also a lot of work for like our pelvic floor to sort of hold up and support a rectum that's full of really hard poop. So those soft smooth ones, easy to pass, meaning we don't have to usually apply a lot of like force or straining and then we're able to get like a nice full empty, that's a perfect
Speaker 2
poop. Amazing. What about, the poop's good but it's like a pencil like stool. What what it what causes that and what does that mean?
Speaker 3
Yeah. That's a good question. So definitely, there's things that could be going on with your digestion is suddenly your poops are becoming skinny that would definitely be worth checking in with your GP, okay? So, again, this is not like me making blanket medical advice but for sure, if we have hemorrhoids, right? Hemorrhoids can be either internally, so inside the anal sphincter we can't see them on the outside or we could have hemorrhoids that are on the outside of our anal sphincter, we can see them or feel them when they're swollen. If those hemorrhoids are kind of like taking up a little space along the canal, like the doorway that the poop comes out of, it could change the shape of your poop if it's a squishy poop. But, of course there's other things I could do that too like, you know, a mass somewhere within your colon that could be again making the space smaller. So, it's always good to check-in if things are persistently weird and different for your bowel movements. But, you know, from my line of work, pelvic floor dysfunction or muscles that are having a really hard time sort of like relaxing to allow the bowel movement to pass, that could sometimes result in poops that are really, really skinny and sometimes people have this kind of like instead of relaxing the muscles of the anus, we sort of constrict or tighten those muscles, and that can sort of close that hole but the poop will still come out it just might be a little bit skinny. So it could be something like that absolutely some kind of functional constipation or difficulty relaxing the muscles to get the poop out.
Speaker 1
Can I ask you a quick question? Squatty potties, is that something that you think is helpful in in a situation like that? And what is a squatty potty?
Speaker 3
Yeah. A poop stool is the best thing. We should all have a poop stool, and we should all use a poop stool, and even just kind of like MacGyver a poop stool, so like maybe us three will understand what MacGyver is or who he is. Maybe. Absolutely.
Speaker 1
All of us in perimenopause,
Speaker 3
even though. So MacGyver, right, you have to make yourself a poop stool if you're pooping outside of the home. Poop stools are great. I love them. So, yeah, there's like a squatty potty, which is like a a stool that's marketed just to kind of fit around your toilet bowl. But honestly, I use one from the dollar store. You can use whatever you have. You can use like yoga blocks under each foot or toilet paper like rules if you're stuck. Tip a garbage can sideways. The point is is that getting your body while you're sitting on the toilet in sort of a squat position, can help you pass your poop a little bit easier and I'll explain why. So ultimately, you want to get your feet up on something so that your knees end up being higher than your hips. When our knees and our hips are at that configuration, where our knees are at the level of our hips are lower, there is a muscle that loops around our rectum. It's one of our pelvic floor muscles, so it's internal, we don't know it's there, but we love this muscle even if we don't know about it because it stops us from pooping our pants when we're sitting down or standing up or moving around. So, at, you know, like normally, yeah, normally this muscle kind of like chokes the rectum. It's a little bit tight, so it stops even if there's poop that wants to come, it has enough tone that it prevents the poop from kind of coming out towards the sphincter. So we like it, but we want the muscles to be relaxed when we're trying to eliminate our bowels. Right? So when we sit on the toilet without a stool, that muscle is still in a tightened and shortened position. Okay? So when we put our feet up and when we get our knees a bit higher, just that angle, that change in the angle, it results in that muscle that loops around the rectum. It just results in it being sort of like looser or not so tight in choking the rectum. So, there's actually more space for the poop to pass through. Now, if we're constipated that's gonna be super helpful, if we're someone that has to strain a lot that's gonna be really helpful, but even if we have soft and smooth poops, it still can make it really easy. So, it's very, very, it's like a universal tip, we should all have some kind of poop stool and use it all the time.
Speaker 1
I use one and I bought one. My husband and my son think I am insane, and I have to hide it when we have guests and like it's like it's like a thing. Although I have seen some designer poop stools now.
Speaker 3
There are some really nice ones.
Speaker 1
Gorgeous, like, very mid century modern designer ones. Do you have any messaging I can use to to convince my husband or my son that this is something they should try?
Speaker 3
Well, like, if they like their butthole and they like to poop
Speaker 1
and they don't want hemorrhoids or any other problems, like this.
Speaker 3
They need that. But maybe, like, you know, maybe your husband and your son like to sit on the toilet for a long time, like, scrolling their phone. Then why would they need to be more efficient? You know? Fair. I don't know. Fair.
Speaker 1
Okay. Gotcha. Yeah. I have no time. So for moms, every every mom needs this squatty potty poop stool. Like, we all
Speaker 2
need one. Okay. I gotta look into this. I do not have a squatty potty.
Speaker 3
Yeah. You have homework?
Speaker 2
I do have homework. I also have another question. When you poop, you're done and you wipe but it just like it just wipe
Speaker 1
it and wipe it. What is that?
Speaker 3
So commonly that will show up when we have hemorrhoids, especially hemorrhoids that are kind of internal slash external, sometimes we can get the ones that, when they're not kind of swollen and inflamed, that they're inside our butthole, so we can't see them, we can't touch them, right? So, but when they're swollen sometimes they're kind of like right on the border, or they like plop out of our butthole. If we have hemorrhoids, just understand that they don't usually go away. They kind of go from a state of being aggravated and swollen, which is usually when it's like tender, itchy, or painful, and then when they're no longer like that, then they kind of become like a skin tag, so they move from like a blueberry to a raisin. Okay? So even if you have a hemorrhoid, and it's not bugging you, right? It doesn't you don't have any trouble, it's still probably it's kinda skin taggy. So, if we have that concern and we're sitting on the toilet and we wipe and we wipe and then like maybe we like get more toilet paper and we're just gonna wipe one more time and we're like what the heck where that come from? It could be that like there's a little bit of poop that's like left on the little hemorrhoid and then as you're sitting there gravity is kind of pulling that hemorrhoid and plopping outside of your bum, or sometimes we can get like fecal smearing, which is when you're clean. Right? Like, you wipe yourself after bowel movement and there's no poop anywhere on the toilet paper. You put your underwear back on, you move along with your day. A few hours later you go to the bathroom, you should go pee, and you look on your underwear, you're like, why do I have a little poop stain there? Right? That could be also like could be hemorrhoid, same idea. Right? That you were clean.
Speaker 1
But then
Speaker 3
as you moved around your day, your hemorrhoid might have like slipped out or a little bit of poop might have been left around there, and so it's kinda tricky. But also, pelvic floor muscle dysfunction can result in that same problem where we're wiping and wiping and wiping and it's sometimes the inability of the muscles to like truly kind of like let go and be open and let the stool fully pass. Sometimes the muscles are tight. They almost like squeeze the butthole and stop the poop and the poop's not totally done, so there's some poop that's like hanging out right there, almost like right at that external anal sphincter, because we have two muscles that kind of close the door to our anus. We have our external anal sphincter, which we can like if I tell you guys, okay guys, squeeze your butt like you're trying to hold in a fart. Right? Like you can do that. Right? It's a muscle. You can control it. We also have an internal anal sphincter, which is more so controlled by our nervous system in our brain. So, if you have poop that's like in between those sphincters, right, it could end up like kind of as you're wiping is like coming and coming and coming or even end up with fecal sparing too. So, sometimes it's more like we need to focus on allowing the butthole to really relax when we're taking a poop and then like really allow it to stay relaxed until we're done cleaning. So sometimes those are like the two biggest culprits, the hemorrhoids and kind of those types of muscles that just won't relax.
Speaker 1
Can I I'm gonna look I'm gonna share something with you, the two of you and half the world, because half the world listens to this podcast, but I haven't shared with anyone, but I'm cause half the world listens to this podcast, but I haven't shared with anyone? But so occasionally I get this insane pain in my rectum, insane pain. Like I can't even tell you, I can't like I can't function. I sit out like I am in the bath for like an hour. Just keep adding hot water. Like I pop Advil. Like I can't even describe the sensation. And generally afterwards though, I do release there's like after my body relaxes finally, then there's poop there. Is that the poop getting caught in between the two sphincters? Is there something?
Speaker 3
It could be for sure, but what it sounds like you're describing is like a spasm of the pelvic floor muscles, like at the back. And it is a common problem that does happen to people sometimes like throughout their monthly cycle or also sometimes randomly and it can feel like very very painful, like it takes your breath away, it comes out of nowhere.
Speaker 1
I've had to cancel a point, like I've canceled meetings and stuff because of it, like it's excruciating.
Speaker 3
Yeah that's what it sounds like. That's what it sounds like to me, and sometimes that kind of like spasm, right? Spasms, muscle spasms anywhere in your body are so painful and when you have them like in your butthole it's very painful. And so this can show up for many reasons, I think, generally speaking, but, I think like you would be a great candidate for learning how to like breathe into your butthole.
Speaker 1
Okay. Which is which is my most common piece of homework for my patients is
Speaker 3
you need to breathe into your butt hole.
Speaker 1
Oh, my God. Okay. So at the end, is there a technique you can teach everyone at the end? Yeah. Sure. Okay. I love this. We were going to talk about hemorrhoids a little later on, but I feel like we should just keep going with the roids. Mick? The roids.
Speaker 2
I think. The roids.
Speaker 1
Yeah. I because Mikkel and I talk about hemorrhoids I've had them for
Speaker 2
a long time.
Speaker 3
You do? I call them Hemis. Okay. Roids sounds like very aggressive. Hemis sound like cute,
Speaker 1
like your little friends who hang out in your asshole. Oh, can I swear? Oh, yeah. Yeah. Yeah. Please. Yeah. Yeah. Yeah.
Speaker 2
Let it rip. Fuck yeah. No.
Speaker 1
Yeah. Hemis is that is yeah. That is cuter. For sure. That's cute. But you want to call them roids, you can call your hemorrhoids whatever you want to call them. I don't have a positive relationship. They're not cute to me.
Speaker 3
Maybe you need to, you know, change your mindset, Michelle.
Speaker 1
Speak to them with love. I'm gonna try. I'll try. Embrace the hemorrhoids. Embrace the hemorrhoids.
Speaker 2
Clearly, we have
Speaker 1
hemorrhoids and we know what they are,
Speaker 2
but maybe you could just, for everybody's benefit, what are hemorrhoids?
Speaker 1
Okay.
Speaker 3
It's a good question. Hemorrhoids are simply just like blood vessels that, kind of the walls of those vessels get really thin and they kind of swell, they fill with blood. And hemorrhoids are things that can happen when we're creating a lot of sort of like force or downward pressure onto those blood vessels and structures. So you can think about like someone who's a chronic cougher. That person might be having some hemorrhoids maybe, they would be at risk of that. Someone who's like lifting with improper technique, so putting a lot of strain downwards and super common when we're constipated and we're chronically constipated or even just like one bout of constipation that'll do it. It's just kind of like prolonged or like really you know severe downwards pressure. So yeah, con Bursting
Speaker 1
a vagina.
Speaker 3
Birthing a vagina. Even being pregnant. Yeah, even being pregnant and for sure giving birth vaginally, those are big pressure moments. They're very common, like obviously men have them too. And yeah. They're kind of like those things that when they show up they they're kind of gonna be there,
Speaker 1
Like forever and ever?
Speaker 3
I mean, yeah. Awesome. I think that like lifestyle stuff is really impact full when it comes to prevention of hemorrhoids and also to like managing hemorrhoids, right? So, you could have hemorrhoids and they could, you could have them flare up like once and then they could, you know, arguably never flare up again and that would be great, but in many cases we're just trying to figure out what lifestyle strategies can help to keep them at bay, so that they don't flare up and I think we're all gonna have different triggers. Some of us may have like very physical triggers, right? So if you get if you have external hemorrhoids, if you're for example wearing a thong and it's like rubbing your asshole all the time and your hemorrhoids right there like it's not gonna feel nice. Or if you're you know if you're having hard poop and you're straining a lot, like that's not gonna be good for either internal or external hemorrhoids. So some people if they have external hemorrhoids and they're sitting a lot or even standing a lot, like that might be a trigger sometimes for people like stress and kind of this like emotional stuff can really have a impact on their gut health and and what's going on, so yeah.
Speaker 1
What about diet? Because Mikel has a theory about her hemorrhoids. Mikel, would you like to share?
Speaker 2
Yeah. Fastest way to raging raging roids versus cute hemis for me is like like dairy, like milk or cream or
Speaker 3
Yeah. Is it
Speaker 1
like is that a thing? Or we just Is it because you get diarrhea?
Speaker 3
May maybe? Because if you're, like, if you're constipated, we can all like visualize, right? Like we can imagine a hard poop is like very aggravating. It can like literally physically like hurt the hemorrhoids on the way out and it could flare them up. But if you have like looser stools and you're going more frequently and you're wiping because you're having a watery stools or even like looser, that could for sure flare up your hemorrhoids too.
Speaker 2
Well, maybe that's maybe that's what it is, but there there definitely is a big connection there. I haven't I mean, this is not scientific. No one has diagnosed this. This is not medical. This is just my, you know, I just I can have certain cheeses, but if I get into the real, you know, cream, milk, not good.
Speaker 3
But I think that that's that's exactly it. Like, what you're doing, Mikaela, is I think exactly what we all need to do. Like, I also have Hemis. Thank you so much. When I gave birth to my child, the the doctor that came to check on me, like, the next morning to check on, like, my my sutures, I guess. I don't know what happened to her, but she, like, lost her bedside manner or something. Or or they were just so impressive, but she, like, took one look and she was like, woah. You really you really, like, blew up your head voice.
Speaker 1
I'm like, lady. I'm not sure what to tell you, but I don't think that's how you're supposed to say that to your patients. Were you already a pelvic floor therapist at this time? Oh,
Speaker 3
no. No. I wasn't. I was a physio, so I didn't become a pelvic floor physio until my son after he was born because
Speaker 1
That's how you needed to know. I fucked shit up down there. And that was like
Speaker 3
ten years ago. So no. At that time, I was like,
Speaker 1
Thanks, lady. Thanks, lady. Wow.
Speaker 3
Thank you. Thank you for your service. So I also have this problem. And I think what's important, Mikael, is that like we figure out what our own triggers are, right? Like there are lists of common things, but if you know that you eat dairy and like cream and some cheeses and like your hemorrhoids are flared up, like that's enough, that's enough for you. That's enough information.
Speaker 1
And are there creams or anything I can be I do have something actually because I went for a colonoscopy last year or two years ago I guess when I turned fifty and, so he's like, oh you have some small hemorrhoids and so he gave me this thing for whenever they flare up.
Speaker 3
You know what? You can get a lot of these types of things like preparation age or anu Sol at the pharmacy and I think they're great when your hemorrhoids are swollen because like honestly from my perspective, like as someone who has them and someone who, you know, this is my work too, is like number one goal has to be to like settle them down, to stop them from being a pain in your butt and stop them from being swollen. So when you get these ointments from the pharmacy, they often have like a corticosteroid in them, right? So sometimes you need something to kind of like get them under control and then there's other products out there like, that are like more natural so I know some people have reservations about using like medical stuff when not needed. There's other ointments that can help with like soothing the area or like if it's itchy, have you guys ever tried Tux Wipes? Have you ever seen those?
Speaker 1
I've heard of them, I've never tried them.
Speaker 3
Oh, you should try them, they're great. So they're these like little, I don't know, think about like makeup remover wipes that are presoaked, right? And they have like witch hazel and other ingredients that are supposed to soothe tissues and they actually do feel really nice. So usually what I recommend to my patients is that like after you've gone to the bathroom and you've cleaned, take a wipe and like kind of wipe the area and then throw that one away and then take another wipe and then kind of it comes in, it's like a little circle and then kind of like fold it in so it's like a narrow rectangle and like literally put it against your butthole and your butt cheeks will hold it there and then just put on your underwear and move on with your day.
Speaker 1
Just walk around and hope it doesn't drop out.
Speaker 3
Yeah. It'll it'll be there between your butt cheeks
Speaker 1
or your underwear but it kind
Speaker 3
of just gives you like longer sort of like relief, especially if like people will do anything when their hemorrhoids are flaring. Yeah. No. This is not a big ask.
Speaker 1
Find me up. I'm I'm buying. I'll come on my way to the store after this podcast. Michal, we know someone we went to university with and he was having a sweaty bum at work and he folded toilet paper up. I don't know why too much information, but we were good friends. And he stuck it the same spot just because I guess he didn't I don't know. He didn't want a sweaty bum, and it fell out of his pant leg later.
Speaker 3
Like Oh, yeah.
Speaker 2
The vivid memories. Lots of occasions.
Speaker 3
I mean, maybe he was wearing, like, those baggy boxers or not wearing underwear?
Speaker 1
Oh, probably he had baggy boxers
Speaker 3
on. Because I think okay. So, like, I've done this myself, but I have underwear on and not a thong. And so my butt cheeks are big enough that they're gonna hold that thing in there. But if they don't, it will just, like, sit in my underwear, and then I'll be like, oh, it's not there anymore, and then I'll go dispose of it. But, hey. This is a risk you have to be willing to take.
Speaker 1
I'm in. I'm in. We have been talking an awful lot about constipation and this is a topic like near and very, very dear to my heart because I think for the first twenty five years of my life, I was constipated. Mikelle, you lived with me for several years and I was constantly like, oh my God, I haven't pooped. Like, I've tried it all. Why? Why do some people get constipated more than others? What was I doing wrong? Like, what what is tell me about con let's talk constipation for a bit.
Speaker 3
Yeah. Okay. That's a good question. So, I mean, I don't know why you were constipated, but I can make some educated guesses and I'm sure you can too. But I think, like, generally speaking, as a population and, like, if you guys were in university when you were when you're talking about this, like, I'll put money in the fact that you do not have enough fiber in your diet because we should all be getting, like, twenty five to thirty five grams of fiber and so many of us, like, I think I don't remember the number. I'm really bad at remembering statistics, but it's I think the majority of us are not getting anywhere near that. And we need good dietary fiber in order to have the right type of, like, consistency or quality of our stool. Not to mention the fact that, like, having adequate fiber is really protective for us for many things, like one of them, speaking of poop, is like colorectal cancer, right? Like we wanna make sure we have enough dietary fiber and I know like in this menopause space, we're all hearing about protein. I don't
Speaker 1
know if
Speaker 3
you guys are like on this protein train. I'm on the protein train too but like honestly no one's dying from like protein under consumption maybe, right, but having enough fiber is really important for many many systems of our body. So I would guess you weren't getting enough fiber, maybe you weren't drinking enough water, and maybe you weren't responding to the urge. Right? So when we don't respond to the urge like I mentioned earlier, the urge kind of gets quieter and quieter and then we don't hear it anymore.
Speaker 1
Well I definitely like issues in pooping in public and like not wanting to poop and and and yeah.
Speaker 3
Mhmm. So it could just be kind of that and then you know I have you know a number of patients that will come in to see me for something else and obviously I always talk about poop with all of my patients and then we unpack the fact that okay you're coming in to see me because of this but oh, you've never had like a nice soft poop in your life? You never even knew that was impossible? You never we don't know that our bowel habits are normal or not because often we're not talking about them. So, if we've always been kind of constipated, if we don't go regularly, if we are always pooping really hard pellets, even sometimes people who are like very chronically constipated, they'll sit down to go for a pee and a little poop will come out, like a little hard nugget will come out. And that's normal for them because they don't know that people are sitting down for one poop and having a nice soft poop and it being, you know, pretty easy and and and all of that. So anyhow, if we're like raised to not know or to not talk, that could be why too. Right? You didn't know there was a problem.
Speaker 1
When do we go talk to our doctor?
Speaker 3
If things are like different suddenly, right, and they don't make sense, right? Like, okay, let's just say, Michele, you decided that you are gonna be eating cheese and dairy and then you have the shits, that makes sense, right? You understand why that happened. But if you're if you've had like sort of regular bowel movements and suddenly you're constipated and it doesn't resolve in like a reasonable amount of time and you can't understand why or same with diarrhea, like it's always good to go check-in, if it's been some time and the regularity or the consistency of our bowels are different than they used to be. I think if we ever have blood in our stool, right, even if we know that we have a hemorrhoid, that's something that we should absolutely be talking to our doctor about just to be on the safe side. Meeting with someone like a pelvic floor physio can be helpful just for, like, lifestyle strategies. It doesn't replace a a visit to the doctor just to rule out more sinister things, but a lot of the work that I do in my in my treatment room is, like, how to teach people how to poop.
Speaker 1
Okay, so tell us a little bit more about that.
Speaker 2
And how do we breathe through our butthole?
Speaker 3
So, first things first, no one knows how to poop because no one's taught anybody how to poop, right? And for most of us that's fine, but for some of us we might realize that we're, you know, we're holding our breath quite a bit.
Speaker 1
Maybe you
Speaker 3
know you do a little audit of like what your body and your breath and your butthole is doing the next time you go to the bathroom and maybe you realize, oh my gosh I hold my breath to strain, like I take a breath in and I, you know, like you push down, you bear down, even though my poop is soft, I'm doing that anyways. Maybe you don't need to, right? And maybe you realize that at that same time my butthole is like squeezing even though I'm trying to get something out, right? We'd have to Sometimes we just need to do a quick little audit of what our body is doing because oftentimes I'll ask people like, what do you do when you poop? And they're like, I don't know, I just poop. Yeah, because you just sit there and you just do what you've been doing everyday for the last however many years of your life. So, what I would say is that we need to get our feet up on a stool. Absolutely. For some of us, having our feet up on the stool, knees a little bit wide open and leaning forward, for some of us that can be helpful. For others, especially if we have like maybe a pelvic organ prolapse, especially like of the back of the rectum, maybe we might feel better leaning back on the back of the toilet. But, I usually say start with your knees open, leaning forward, hanging out, let's see what happens. Okay, so that's the positioning.
Speaker 1
Fascinating. Okay.
Speaker 3
And then when it comes to like actually pooping, what I usually recommend is like, you know, when you sit on the toilet and you get your position in, for most of us it's not like right away that the poop is gonna come out, right? We have that urge and we're responding to the urge and we should have enough time to properly respond, right? It shouldn't be emergent. So, in the time that we're waiting for the poop to like literally be ready to come out, what we can do is we can sit and we can practice this breathing into our butthole. And what that is actually, like, probably the technical term is diaphragmatic breathing, but that's so boring and people are like, I know how to do that, when I will tell you that you don't know how to do that because you've read an article and you don't know how
Speaker 1
to do it. Because it actually is more technical than we wanna believe.
Speaker 3
It's not hard once you know
Speaker 1
how to do it, but most of
Speaker 3
us are not doing it right. So tell us. Yeah. My suggestion is sit and diaphragmatically breathe. And for me, that includes a cue to breathe into your hole. So what it's gonna look like, and we can if you you guys wanna do it, do it. If you're listening and you wanna
Speaker 1
do it,
Speaker 3
let's do it. Take one hand and put it on your rib cage. Take your other hand and put it like on your belly button or maybe just a little bit above. And I want you to take a slow breath in through your nose, but like really slow for four. So breathe in, two, three, four and breathe out. Just like really softly breathing out. Now, the next next time, yeah, wherever you want. Wealth is fine, but don't like, don't force it. Just like let it go. So it's a very passive breath. Now, you keep breathing in for four seconds and out for four seconds and I'm going to give you some things to think about. So in the next breath in that you take, see if you can breathe into your rib cage. So feel your ribs open into your hands. Good. And then let it go. And the next breath, you're gonna try to feel your ribs open into your hand and then also feel your belly kind of open a little bit too. So you're kind of inhaling your whole body with air. It's like a balloon that's filling. So ribs are gonna open, belly's gonna open as you inhale, then as you exhale, your belly's gonna sort of deflate and your ribs are gonna kind of come back in. Okay? And then the next layer on that is like you're gonna get the air all the way to your butt hole. So you're gonna breathe in really slowly, not panicky, slow breath, ribs open, belly fills, butthole kind of relaxes. You feel the whole body sort of filling with air, then you breathe out and the butthole kind of lifts back up, the belly starts to shrink back in, the ribs close. So, that kind of breathing into your butthole is what you can do when you're sitting on the toilet and that's helpful for so many reasons. Number one, it helps to actually relax the muscles of your pelvic floor, especially if when you're breathing in you feel that expansion through your butthole or like your pelvic floor, somebody else who's a little bit more professional than me would say. But you feel that like relaxation of the muscles but also what's really nice is that diaphragmatically breathing, it stimulates the part of your nervous system that sort of governs eliminating waste. So the part we have like the you know the stress side of our nervous system, the sympathetic nervous system, right? Fight or freeze or flight whatever those ones are. Then we have the parasympathetic nervous system which is more like rest and digest, that's another nickname for that. So when we're sitting on the toilet, we don't want to be stressed. We want to actually feel very, very calm. So breathing diaphragmatically actually like helps kind of activate the part of your nervous system that is helpful when it comes to pooping. So it's really a great way to do it. So I would say like sit down on the toilet, breathe into your butthole like that until you feel, okay, the poops like really right there. And then, if you want for some people, you can keep breathing that same way and you'll feel when you take that big inhale, it creates pressure in your belly. If you're doing it right, when you inhale, it does create a pressure moment in your belly. So, if your poop is there and it's soft, sometimes the inhale will start the poop coming out. Like this is very technical. But for some of us who are in the habit or we need a little oomph to get the poop out, then you can do the inhale just like we practiced, right? Inhale, ribs, belly, butthole expand and then exhale can be blowing into your fist. So, so if you do that, you can feel that like your abs almost turn on, like do you feel like Yeah, yeah, yeah. So your abs will turn on, so when you're sitting on the toilet and you blow into your fist, it creates this resistance that helps to create pressure downwards. When you're on the toilet, you do, some of us, maybe you, Mikael, you'll have to really think about like your butthole staying open when you're kind of pushing, but it's an alternate, it's a more pelvic floor friendly alternate to holding your breath and straining to get the poop out. You blow into your fist, so you're getting that resistance, your core is turning on, and if you, for some of us it might just, that might be enough, but for some of us you might really have to honestly like, not only do I tell my patients to breathe into their butthole, but I also ask them to picture their butthole, and I want you to picture your butthole being being open. With
Speaker 1
or without hemorrhoids.
Speaker 3
Yeah. Just like the hemorrhoids, everything. Just like imagine your cute butthole and then as you're pooping you want it to be open. You cannot walk out of a door when it's closed and your poop cannot leave your back door when it's closed. So sometimes it's like just so simple where you have to break down how you're pooping and you can have like a really easy poop. Okay.
Speaker 2
Great. So important. Yeah.
Speaker 1
So good. If I didn't want like, if I if I was paranoid about someone walking in on me pooping before, I definitely don't want anyone coming in now because it's gonna be like, what the fuck? Anyway, yes. I'm trying it tomorrow. I can't wait. I've already pooped enough today. Today was a poopy day. I pooped a lot today, so I
Speaker 3
think Well, you know, please do tell me how it goes.
Speaker 1
Yeah. I will.
Speaker 2
Leah, before we let you go, what's the one thing you would like everyone, not just women, but everyone to know about their poop or their bowel movements?
Speaker 3
Oh, this is a good question. I think it's that just know that everybody poops and that if you have to poop, you should always respond to the urge to poop. Even if you're not in your home or you don't wanna poop and someone can hear you, like just And oftentimes, if you just tell people, like, I need to poop and I don't want you to hear me, like, they will also just leave the hotel brew or the brew. So, yeah. I think that everybody poops and everybody knows that everybody poops and it's totally common to be nervous about responding to the urge when you're somewhere else, but do it anyway. Be brave.
Speaker 2
Nothing is worth hemorrhoids. Nothing.
Speaker 1
No. Can can I share can I overshare one more time? I feel like this whole thing has been oversharing. So, Mikkel, I don't know if you recall this, and you were def it was not third year. You were you were there. We were at a keg party and I again, I didn't poop for most of my childhood and into my twenties. And so we're at this keg party and I don't know if it was a keg beer, suddenly I had to poop. And I was like, like, oh my God. And I couldn't, like, it was like not near our place. I would have had to like get in a cab. So I like, I decided to buck it up, buttercup. I went to the bathroom there and of course I get there, there's no lineup. So I go in and I do my thing and it's nasty because I haven't pooped in like weeks. And I come out and cute boy is on the other side of the door and he's like, hey,
Speaker 2
oh, wow,
Speaker 1
it smells in there. I'm like, oh my God, I know. I don't know who was there before. Oh my God, it was one of the most mortifying moments of my university career. I totally, like, wanted to, like, snog with this guy, and then instead I'm pooping and yeah. It didn't Okay.
Speaker 2
But you blamed it on somebody else. I'm sure he was like, there's no way she produced that.
Speaker 1
I don't know. Maybe. I don't know. I like, in my head, that was like, he knew I probably was ten shades of red, and it was awful. It was mortifying. Anyway, overshare.
Speaker 3
But you did it. I'm proud of you for pooping.
Speaker 1
Oh, thank you. Thank you.
Speaker 2
Yeah. Everybody's homework. Read through your butthole and poop at a party. Poop at a party.
Speaker 3
Even you can poop at a party. You too. You can poop at a party.
Speaker 1
We should do a whole new social media dress. I just pooped at a party. And done. I don't know. I don't think it's going to trend.
Speaker 2
No, probably not. Probably not. But we'll think it's funny. Yeah. Thank
Speaker 3
you, Aliyah. Thank you. That was really fun.
Speaker 1
Yeah. It was super fun. And informative. Thanks so much for listening to the show. If you like what you hear, please take a moment to rate and subscribe to our podcast. When you do this, it helps to raise our podcast profile so more women can find us and get a little better understanding of what to expect in perimenopause.
Speaker 2
We also read all the reviews, the good, the bad, and the ugly to help us continuously improve our show. We would love to hear from you. You can connect with us through the podcast, on social media, or through our website. Our information as well as links and details from our conversation today can be found in the show notes. This podcast is for general information only. It's designed to educate, inspire, and support you on your personal journey through perimenopause. The information and opinions on this podcast are not intended to be a substitution for primary care, diagnosis, or treatment. The information on this podcast does not replace professional health care advice. The use of the information discussed is at the sole discretion of the listener. If you are suffering from symptoms or have questions, please consult a qualified health care practitioner.
