Straining during bowel movements is a common experience, but it is not a normal or healthy part of elimination. This forceful exertion, which often involves holding the breath and bearing down, increases pressure within the abdomen and can lead to various physical problems. Chronic straining is strongly advised against because it raises the risk of developing conditions like hemorrhoids (swollen blood vessels in the rectum or anus) and anal fissures (small tears in the anal lining). The goal of a healthy bowel movement is to pass stool smoothly and completely without the need for excessive pushing. Achieving this requires optimizing physical position, managing dietary intake, and using proper muscular techniques.
Optimizing Your Position
The design of modern toilets encourages a sitting posture with the hips and knees at a 90-degree angle, which unintentionally contributes to straining. In this position, the puborectalis muscle, a sling-like muscle that wraps around the rectum, remains semi-contracted. This contraction creates a bend, or kink, in the lower digestive tract known as the anorectal angle, typically around 90 to 100 degrees when sitting.
The body is anatomically better suited for defecation in a full or modified squatting position. Squatting straightens the anorectal angle, allowing it to open to a more favorable position, often closer to 35 degrees, which relaxes the puborectalis muscle. This straightening permits stool to pass more directly and completely, reducing the need to push forcefully.
You can simulate this natural squatting posture by using a simple footstool or a commercial toilet aid. Placing your feet on a raised platform elevates your knees higher than your hips while seated. Leaning forward with your elbows resting on your knees further enhances this effect, helping to increase the anorectal angle and decrease abdominal pressure. This modified position reduces the time and effort required for a bowel movement.
Dietary Habits for Easy Passage
The consistency of your stool is a primary factor in whether you need to strain, and this consistency is largely determined by your diet and fluid intake. Stool that is hard, dry, and lumpy is a common sign of constipation, which is the leading cause of straining. Addressing this requires a focus on fiber and hydration to ensure a soft, bulky, and easy-to-pass stool.
Dietary fiber is categorized into two types necessary for digestive health. Insoluble fiber, found in foods like whole grains, wheat bran, and the skins of fruits and vegetables, does not dissolve in water but adds bulk and structure to the stool. This bulk helps stimulate peristalsis, the wave-like muscle contractions of the intestines, accelerating the movement of waste.
Soluble fiber, present in foods such as oats, beans, nuts, and apples, dissolves in water and forms a gel-like substance in the digestive tract. This gel works to soften the stool, making it easier to pass. However, increasing fiber intake without sufficient fluid can worsen constipation, as the fiber will absorb existing water in the gut and create a tougher mass.
Drinking an adequate amount of water throughout the day is non-negotiable for smooth elimination. Water is incorporated into the stool by the fiber, ensuring the necessary softness for unforced passage. Regular physical activity, even moderate exercise like walking, helps promote the natural muscle contractions in the intestines, further encouraging motility.
Breathing and Muscular Techniques
Once the stool consistency is optimal and your position is adjusted, the physical act of elimination should be assisted by specific breathing and muscular engagement, not brute force. The goal is to apply gentle, directed pressure without engaging in the Valsalva maneuver. This is the harmful practice of forcefully exhaling against a closed airway while bearing down, which dramatically increases intra-abdominal pressure and can cause a sudden drop in blood pressure.
Instead of holding your breath, use what is sometimes called a “hard belly” breath. This involves taking a deep, relaxed inhale that expands your abdomen, engaging the diaphragm. Then, exhale slowly while gently pushing the abdomen outward and downward. This diaphragmatic push applies controlled pressure to the colon, helping to move the stool without excessive straining.
Crucially, you must consciously relax the pelvic floor muscles simultaneously with this gentle downward pressure. The pelvic floor muscles must lengthen and open to allow the passage of stool. Trying to force a bowel movement while the pelvic floor is contracted is counterproductive and leads to straining. Focus on a sensation of “letting go” as you use the controlled abdominal breath to guide the process.
When Straining Signals a Problem
While lifestyle adjustments often resolve occasional difficulty, persistent straining or a chronic change in bowel habits warrants professional medical evaluation. Straining that continues for more than two weeks despite proper diet, hydration, and positioning suggests an underlying issue.
Warning signs that require a doctor’s visit include:
- Blood in the stool.
- Unexplained weight loss.
- Persistent abdominal pain and bloating.
- A constant feeling of incomplete evacuation.
Chronic straining can be a symptom of conditions that require specialized medical intervention, such as chronic pelvic floor dysfunction, where the muscles fail to relax properly. Severe, prolonged constipation can sometimes lead to complications like fecal impaction, where a hard mass of stool becomes stuck in the rectum. If over-the-counter laxatives and discussed techniques fail to bring relief, a healthcare provider can identify whether the problem is simple constipation or a more complex digestive or anatomical disorder.