Squatting - I think I hurt myself!

Body: 

Hi, I've been lurking awhile but this is my first post. I have a cystocele and a rectocele that I developed shortly after the birth of my second (and last) child, who is now 2. I've been told they are pretty mild, but not given a grade.

The other day I was thinking about whether squatting to eliminate would be healthier for my pelvis, and specifically if it would help a problem I have with leaking a little stool about 10 minutes after a BM. It's just enough that I have to go back and wipe again (so annoying!). I started googling it and thought about buying a platform, but decided to give it a home-made try first.

So yesterday I tried squatting on the toilet seat (at great personal risk, I'm sure) twice for BM and once for urinating. I could feel the pressure on my cystocele, but couldn't tell if it helped the rectocele.

Last night I looked at myself in a mirror and both are MUCH MUCH worse!! They are bulging out more than I have ever seen them! And, all of a sudden, I have HEMORRHOIDS!! I haven't had a problem with that since pregnancy.

ARGH!!! Is this permanent? Did I irreversibly injure myself?

I've read on this site about the half-squat. I just can't seem to do it - I don't know how to tense my legs enough to hold the position while relaxing enough to go.

Should I just stick to sitting?

Thanks in advance and sorry for the way TMI introduction.

Hi Queenmother

First, don't panic. You might find that you have worsened the POP's but equally, with the right management they may go back to where they were after a few days. Most of us overdo something or stuff up how we use our bodies on occasions, but there is often no obvious longterm harm, particularly when you are using Wholewoman posture, allowing your belly to expand freely inside clothing, eating a good diet and doing appropriate exercise that will strengthen your whole body.

Another thing is that diagnosis of POP is very subjective and qualitative. It also depends on what your POP's are doing on the day, where you are in the month and how hard you bear down during the examination. You are the one who knows best what is happening to your body and you are the one who can affect changes. Yeah, your doctor has confirmed that you have a bit of POP, but that's about all you will get from her/him, no matter how well-trained.

All you can do is deal with your current reality, which is that your POP's may be a little worse than they were. No drama.

There is squatting and there is squatting. If you do a deep squat and it results in your legs squashing into your belly, that can create a lot of extra intraabdominal pressure, particularly if you are balancing on a toilet (interesting visual here!) and do not have good balance, so it is not a very controlled squat. When I do a deep squat my lower spine is quite bent forward in order to keep balance, unless I put my feet in ballet second position and get my knees wide apart and rise on my toes a bit. My fatty belly gets in the way. I do deep squats only when I can stay on my toes and keep my lumbar curve. Otherwise my pelvis tilts back with the flexing of my lumbar spine. This makes my pelvic floor muscles go quite slack and they can open up further than they need to, allowing my pelvic contents to move down further, and I get a lot of pressure in the vulval area, like almost bursting! This is why I don't do them.

Bowel emptying happens from inside. It is done by intestinal muscle waves called peristalsis, not pushing the stool out. I think full squat is like straining, ie pushing down from the top. I find it better to sit on the toilet in WW posture with my wide apart, and bending forward slightly from the hip joints to keep the lumbar curve. This is like a half squat, but it is well-supported and I feel balanced. Then my bowel can just empty by itself. If you are constipated you might need some other tricks as well. Use the search box to find posts about this. There are heaps.Others may not agree with me on technique.

I have become very accustomed to monitoring the sensations in my vulva whenever I am doing something strenuous. As soon as I feel that fullness, which indicates to me that my insides are being stretched, I pull back and find another way to do it.

When you say you didn't feel strong enough in the thighs to hold a half squat, it could be that your leg muscles need some strengthening, and/or that you need to lean further forward for balance. Use the Z shape of your body to advantage for balance. A half squat is somewhat like a plie of the variety that is in the Wholewoman ballet workout. Having strong thighs and strong muscles connecting your pelvis, sacrum, coccyx, lower spine and upper legs, is critical for pelvic stability, spatial balance and your ability to control your body movements. That's why plies and leg lifts in Wholewoman posture are the crux of that workout. They strengthen all those lower trunk and leg muscles without creating an increase in intraabdominal pressure downwards onto the vagina.

The leaking stool is probably related to the impaired function of one of your anal sphincters. Did you have an episiotomy or tear with either of our births? Sometimes one of the sphincters gets damaged as well.

Re the haemoroids (I can never spell that word without the little red dotted line coming up!), they may go away spontaneously with WW posture. Lubricant in the anus may help them to go back. Ice may also help. Not straining or squatting certainly will help them to go back, plus the normal haemoroid remedies.

So sorry this has happened, Queenmother. Try not to beat up on yourself about it. I have done things I have regretted too, but it usually works out OK if you look after your body as it recovers, and learn to trust it once again. The human body is amazing what it can deal with and how it heals itself given the right conditions.

Hope this helps to explain what is happening.

Cheers

Louise

hi, queenmother, and welcome

when I first found this site, there was a lot of discussion about the 'nature's platform' for full squatting during defacation. I decided to try the squat-on-the-toilet thing to see what would happen. I was pretty well balanced up there, as I had practiced full squat throughout my third pg, and delivered my baby in that position as well (not recommending that, by the way). anyway, shortly thereafter, I developed a rectocele (I started out with a cystocele only). now, I think the rectocele was already in the process and was inevitable at that point. did the squatting help it along? I think so.
do I *ever* full squat anymore? NO WAY.

louise's post is full of good information, and I want to reiterate something she said (its so worth repeating!). we all do things that exacerbate prolapse symptoms from time to time. amazingly, with some tlc, you can practically count on the body's ability to recover to baseline.

so I don't think you've done any permanent damage. and yeah, do the plie workout for the thighs.

Thanks, Louise, for your advice and reassurance.

I have never known really what the stool leakage is all about. I did have a 3rd degree tear from an episiotomy straight to my anus with my firstborn. Afterward I had a lot of bowel urgency and some leakage (but only after a BM) and the urgency improved a lot with pelvic floor PT. I don't think I really brought up the leakage issue with my MD at the time - I was embarrassed and kept thinking I wasn't cleaning myself well enough. Finally after my 2nd birth (2nd degree tear) I started seeing a gynecologist I was more comfortable being frank with and she said the rectocele could be causing it, by holding on to a little stool that isn't getting passed with the BM. (That's why my mind thought maybe squatting would help - like it might help empty everything out better? I don't know...)

If the anal sphincter is damaged, is there any treatment beyond Kegels or surgery? I read that sometimes the muscle is torn deep inside, and no amount of kegeling will ever fix it. But I don't feel the problem is severe enough to go to a surgeon about it - I'm mostly coping with it.

I recently watched "The Business of Being Born" and I couldn't help but cry through much of it. I never really wanted anything but a hospital birth, although the first one was without meds (and I regretted it!). But now, as I'm just a little older and wiser I can't believe how misled I was about the way my body is supposed to function. I am so angry with the doctors who put me flat on my back in stirrups to deliver, who have brushed off my chronic cough for YEARS as nothing to worry about, who didn't suggest any treatments for the EXTREME constipation due to Zofran during pregnancy, and who told me I could keep picking up my 35-lb child right after delivery. And who then, when I found big bulges coming out of my vagina, said it was no big deal.

Sorry, I guess that was a rant.

Yes, my quads are very weak. I have always struggled with that and I am working on it a lot with yoga lately. I read Christine's Yoga for Women post and I will try to incorporate that (I think I already was doing some of her suggestions without realizing it)... I'm going to study it some more and keep just staying in tune with what feels right when I'm in a pose.

My PT for the pelvic floor emphasized a lot working out the transverse abs, which I think is also what you exercise in the Nauli (which I cannot remotely do yet). But it seems like the WW posture calls for relaxing the transverse abdominal muscles. Which is why I feel like I don't quite get it yet. I should probably post a new topic to ask about that.

Thanks again - it is nice just to have been able to share this.

Sarah

Granolamom - Yeah, my DH thought squatting was an idiotic idea and would put too much pressure down there, but I was swayed by the "nature's platform" sales pitch. When I told him what happened he said, "I'm not going to say I told you so, but I'm really sorry I didn't have more time to discuss this with you before you tried it." He's a sweet, smart guy :)

Sarah

Hi Sarah

I too have had physio and exercises to strengthen my transverse abdominus muscles, but as a way of corseting bulging lumbar discs. It didn't work, though I did end up with very active transverse abdominus muscles. It was in fact useful to learn to isolate them. Anyway, now I use Wholewoman posture my bulging discs bulge no more, methinks. I was trying to straighten them out too much. That is why I think they were bulging and wouldn't heal. Now I think my spine is a much more natural shape and I no longer have the back pain problems I have had for much of my adult life.

I have given much thought to these muscles, and have come to the conclusion that I can still brace them if I have to while in WW posture. I do this when lifting heavy objects. There is also a thing called the 'abdominal balloon' brace, where you lower your diaphragm by breathing in (or vv) then brace the TA's, which makes the abdomen into a kind of firm lump, held in check by the TA's, that stretches out the front surface of the spine and prevents the discs from being compressed when lifting the load. Does this make sense? The things you find when googling, eh?

I have concluded that it is the rectus abdominus (as much as the TA's) that we allow to relax in WW posture. That makes more sense to me. Actually, both the TAs and RA's will be relaxed in standing easy position. Otherwise the body is not relaxed/easy. If I brace my RA's into a six pack (actually a six cushion for me!) it is impossible to stand or sit in WW posture, because the RA's literally block the lumbar curve from moving forward, and prevent the sacrum from relaxing into a more horizontal orientation. The RA's actually tilt the pelvis back by pulling the pubic bone upwards, ie suspending it from the sternum and rib cage. Try it and see what you think.

BTW, you are allowed to vent here. We understand that it is just a rant, but sometimes clues emerge during a rant, so it is important to do it occasionally.

Cheers

Louise

I'm not sure I totally get the lifting posture, I'll have to practice it. But I haven't really had back problems so far (knock on wood!).

It does actually make sense to allow the muscles to relax when standing, although it's hard to overcome years and years of trying to suck it in. While pregnant the second time I would often find that by mid-day my lower abdomen really hurt. Pretty soon I realized it was because I was keeping those muscles tensed, trying to hold everything in. As soon as I just relaxed and let my belly be a belly I would be fine.

I actually have a very pronounced curvature to my lower back which has always made any kind of ab-work on my back nearly impossible. I just don't see how those exercises (like bicycle situps) could really feel natural to anyone...

Thanks again for your advice!

Sarah

I am so glad this was brought up. I have been thinking about the idea of squatting during BMs for a while now. I had heard that in some cultures where squatting for BMs (India and Japan specifically) is commonplace, there is little to no experience of hemmerhoids. (Louise, i got a little red dot line too. I am ignoring it. :) ) But, now I want to go back and find the sources for that info. Queenmomma had a clearly different experience and it goes contra to several of your comments, WW ladies. So, I am glad. I have been thinking about this lately, but I am going to forget it. What Louise has to say about the inner-abdominal pressure is so clear. How could it not put pressure there?

As for squatting, I used to teach childbirth classes. We taught that it is useful for special cases where the pelvis needed that extra percentage of opening, where there is shoulder distocia (although the Gaskin maneuveur is an effective alternative that does not compromise posture) or complex presentation (hand and elbow on head or crazy head presentation.) But, it is not presented as an idea for everyone for everytime, though, being in the field of childbirth for a number of years, I have heard of the wonders of squatting in theory many times. In practice, most women prefer either semi-squat in water or a forward-leaning wide-kneed kneel (a low-bottomed hands and knees type.) There is a lot of pressure in squatting and probably NOT ideal for every case, but there are special cases where it can help avoid unique circumstances. Granolamom and others, I am so glad you shared your experiences. :) This info needs to get out there.

Love,
BGB

Just want to clarify a point to make sure we’re all on the same page, cuz I think bgb said a full squat has been suggested in special cases “where the pelvis needed that extra percentage of opening.”

Pelvic floor dimensions are at their greatest when the tailbone is lifted and the sit bones widened. This configuration occurs in a half-squat, on hands and knees, and most maximally in a wide, deep, second position plie.

When the legs are totally folded into a full squat, the pelvis counternutates, the tailbone tucks under, and the back of the pelvic outlet becomes smaller in total area. We’ve tried to explain this to Jonathan at Nature’s Platform, but he hasn’t been exactly receptive. :)

Thanks for clarifying that. In my experience (just as a mom), the childbirth education community is still really pushing the full squat - this information needs to get out there!

I wish childbirth educators also taught more about which positions might slow things down. My first was at -3 station when I started pushing and was born less than 15 minutes later. I learned afterward that maybe being on my side would have allowed my perineum more time to stretch.

And have they investigated whether the soft tissues stretch better in one position or another? I had my babies in the lithotomy position, which I certainly won't recommend. But it seems like on all fours or on your side, or even in a half-squat, the perineum is more relaxed and then would stretch more naturally, whereas I feel like it is kind of stretched already in a full squat and maybe not in the same way that the baby's head will require. This is totally nonscientific and just based on my own sensations in those positions.

-Sarah

Hi Sarah

My personal experience was first birth whole labour lying down, second stage in lithotomy with stirrups and heavy epidural (not by choice), no pushing possible. I had forceps and a very large episiotomy.

Second birth was very active first stage, second stage on my side. A little grazing in my vagina from the birth but no tear, very relaxed and it all haplpened from the inside.

Third birth was very active first stage with hands and knees for each contraction, posterior presentation. Baby flipped over at transition and I continued on hands and knees until I was told to push him out once I was completely dilated, so I straightened up a bit, with the bottom of the delivery table lowered so I was kind of half kneeling and my feet wide apart for second stage I think, and consciously pushed him out from there. It was an effort. He felt like the biggest poo in the world and I was in no hurry. No sensation of wanting to push, but he came out reasonably quickly once I started pushing, with no damage to either of us. This was pretty relaxed too.

I felt very open for both the latter births and found the positions I wanted quite intuitively, though the third midwife was totally puzzled about how to deliver a baby when the mother was on hands and knees. As it turned out I felt I knew what I was doing. My husband caught him anyway, and the doctor only arrived in time to cut the cord. It was quite a comedy! The midwife was not amused. I was extremely happy. The first birth was a complete mystery; I could feel nothing at all. Seeing this first baby being extracted from me was like somebody else opening my Christmas present for me cos I couldn't do it myself. It was like I was watching a spectacle from the outside.

I couldn't have done a full squat to birth any of them. Even during the pregnancy, rehearsing the birth, a full squat was not comfortable. There was no room to breathe and I couldn't balance. I felt like my perineum would burst if I did a full squat, not nice.

I would probably do either on my side or hands and knees again, but at 55 I don't think I will have that opportunity. ;-)

Cheers

Louise

I have not posted for a while, was wearing a pessary which came almost out during a bowel movement after having it in for four weeks, so when that happened I had to take it out as it was half out. It was one of the gelhorn ones and I got told I had a uterus prolapse which was tugging my rectum down. I am now trying hard with the posture and keeping my belly relaxed rather than tensed up, but it's too soon yet to notice any improvement maybe. I posted on this thread because I keep getting this fullness feeling in my left buttock about an inch from anus (sorry if tmi) but I am a bit worried as I have not come across it written in the forums here so wondered if anyone else has this fullness feeling, and if so is there some exercise or moves that helps. I have the Saving the whole woman book, but I did not order any Dvd's yet as I'm in the UK so the postage is very expensive but was going to get the second wheel dvd on order from the practitioner over here (lindy Roy). It's the only one I can afford at the moment.Im not sure if I should get some other one first as I'm not sure which one to get.? Note to EVERHOPEFUL who posts he: you asked in one of your posts if there was any UK members so I am in Scotland. Where are you?

Sorry my typing is so bad. Meant to write EVERHOPEFUL who posts here I'm in Scotland.

Hi Charlene,
All the dvds are really great, but the First Aid for Prolapse would be the best one to start with because it also has so much practical information in it as well as excellent strengthening exercises. The book also has very similar exercises, so you may want to try those while you are waiting for dvds.
I also have the uterine prolapse and have never used anything other than the whole woman work to mange it. I have tried to keep a pretty steady routine of doing the dvds about daily, whole woman walking, plenty of jiggling and firebreathing, keeping a good diet, and good toilet practices that don't pull or put pressure on my prolapse. And, of course most important, try to stay in posture all the time throughout the day, giving yourself time to rest when you need it.
So it can be done for us too, we just really need to keep on it, and the benefits will reveal themselves slowly but surely.

Thanks Aging gracefully. My screen has frozen so couldn't send my last message. I assume you don't get the fullness feeling I described? I am just wondering if no one else with prolapse is experiencing it then maybe it's hemmerhoids and not prolapse. My fear was that everything fell down on top of my buttock, i.e uterus, intestines, bladder etc. and that was causing the fullness, but if that was the case I'm sure others would experience the same. I'm glad you are managing your prolapse so well and gives me inspiration to keep going, but so wish to be rid of this fullness feeling.

The rectocele bulge is felt and described different ways by different women, but I am wondering if you have aggravated rectocele by wearing the pessary (they are really no good with rectocele and tend to make things worse, assuming you can keep them in at all). Everyone with rectocele feels the fullness or bulge, maybe we have different ways of describing it. I guess what I'm saying is, this just sounds like rectocele to me. - Surviving

Hi Charlene,
Yes, initially I did have a bulgy or as you say fullness feeling down there. My uterus was slouching at the opening of my vagina and dragging everything else with it. My vagina itself was really sagging front and back, but I didn't feel anything right in either buttock though. Maybe it is just your description of it.
You did have a pessary in all this time too. It could have just been a shocker when it fell out. Not sure, but makes sense.

And what surviving has said above makes even more sense.

Thanks surviving and aging gracefully for replies. This fullness on the left side of buttock is only present in the past few months but it was there before I got the pessary fitted so maybe if you ladies are not having that feeling it may be a hemmerhoid internally. The fact the fullness feeling is only on one side on the left makes me think it's not the prolapse as gynacologist said I do not have rectocele. I will try some suppositories to see if it shrinks down.

Charlene - if your doc is so sure that you don't have a rectocele, then surely he would be able to tell you whether or not you had a hemorrhoid! I guess that's not gyno territory. In any event I really would like to see you forget about wearing a pessary (doesn't sound like it's going real well anyway, and it certainly isn't helping your prolapse), and really throw yourself into the posture work. Get the basic dvd and get started...don't wait another 2 years. - Surviving