Poop is significantly and uniquely

correlated to quality of life as we age, and especially as

we have big scary surgical procedures. So

the more that we can make it not so scary and

uncomfortable to talk about, the better. Welcome to open

heart Surgery with Boots, where this February we're

going below the belt. That's right. We're

diving into the surprisingly connected world of heart

surgery and pelvic floor health in this five part

series. Join me and our special guest expert, Dr.

Kelly Sudakis as we talk about everything you're too

embarrassed to ask your cardiologist. From what makes a

happy pelvis, to getting your groove back after

surgery, to yes, even the great post

op debate. With candid

conversations, practical advice and plenty of laughs,

we're exploring the ups and downs of recovery.

Because let's face it, healing happens from top

to bottom. So buckle up for some real talk about the parts

of recovery nobody warned you about. Hi,

Boots Knighton here with Dr. Kelly Sudakis and

we are bringing the pelvis floor

game to you this month for Heart month. I hope you've enjoyed

everything so far. This is episode four. We

released a special one on Friday,

Valentine's Day on sexy time. So if you

missed that, be sure to go back and catch it. We kept it short and

sweet, but if you are able to

get a video of this somehow I know a lot of you just walk around

with me in your ears and thank you. I'm so honored. But Kelly

is rocking a poop hat

in honor of our topic, which is pooping post open

art surgery. I want to do my best to be

professional here and also a human at the same time while I

look at my friend. Yes. So

welcome back, Dr. Kelly. Thank you so much

for having me. Boots. It's an honor to be here. And

part of the reason I'm wearing this hat is

sometimes I don't. I can't believe it. But sometimes people don't like to

talk about poop. I don't know. I don't know. But

it is something that literally everyone poops. You poop, your

parents poop, your friends poop, everybody poops. And so it is something that

we really should feel comfortable and confident talking about.

And poop is significantly and uniquely

correlated to quality of life as we age and especially as

we have big scary surgical procedures. So

the more that we can make it not so scary and

uncomfortable to talk about, the better. So, I mean, me and my silly poo

pat, like, if this helps you be able to think about how often you're pooping

or how much fiber you're eating, like without getting all queasy, then

great. I'm so happy to be able to provide that.

So to set the stage. Love it.

Yes. Like, to set the stage of why pooping is

important. Boots, tell me about your poop experience

post your surgery. Yeah, it was

epic. I couldn't poop

for a minute there. And we hear about that a lot. A lot

of times stool softeners are prescribed post any

surgery. And I went to the hospital expecting

that. So I wanted to be able to have a more natural experience.

So I brought a special tea called I think Smooth

Move. And I. By the time I

drank it, I was. I. And I knew how important it was

to go for like process post open heart surgery. And

so I overdid it. I drank two glasses

of it. So two tea bags. And it. Let's

just say it worked exceptionally well to the point that I needed to

utilize the services of all the CNAs on the floor. And

then what that did was, it was embarrassing. It was in the middle of the

night, which, I mean, they're there to work, but I was so tired, I

needed to be sleeping. I had made a mess. It was just really so

uncomfortable. Mind, body, spirit.

Absolutely, absolutely. And so, you know, I. And we can't

promise, like, oh, had you known this that it would have been different, but. But

it might have been. And you know, there's going to be listeners where this will

make a difference for them, so we are going to have some fun.

Okay, quick question. If I show this to you, is it the

right direction or is it backwards? Boots, it's the right direction. I think it's the

right. Oh my gosh. Cameras are amazing.

So not very many people understand what poop

is. And so we are going to start off just explaining to you how

your amazing, beautiful body makes poop in the first place. And

along that journey, we are going to discover some ways that

we can set ourselves up for success for the best post operative

poop ever. Now, as with most things, the

best time to start preparing your body for the first post operative

poop is two months before your operation. Right. And not

everyone, I mean, or 20 years.

Like, we want to get a poop perfect as soon as our lives as

humanly possible. The second best time to improve our poop

function is right now. So if you're listening to this

and you're 20 years old, medical student. Heck yeah. If you're listening

to this and you're 70 years old after your first surgery and you're terrified

Heck yeah. Welcome. This is going to help everybody. So those of you that are

just listening, I'll, I'll take some amazing pictures of this and boots. We can put

them in the show notes so people can download. But my first

picture is all about poop.

And the first thing that's involved in poop

formation is what food and water go

into the system first. Friends, if you're not eating

enough food, you are not going to be able to poop. Okay?

Food is fuel for your beautiful body. So

we got to get fuel in. If there's no fuel in, you will not have

stuff to push out in the poop. Additionally, we need enough

water. Water. If without water we are going to not have great

cognitive function, our bladder is going to be pissed off and we're going to have

little rabbit turds. Without enough water, we will be

constipated. But I could just interject. Yeah, yeah, yeah,

let's go back. Way to like Super 101.

Like pooping is so important because it

gets toxins out of our body.

So. Yes, so yes. But

more importantly, pooping is a

reflection of how well our

microbiome, and I will take that even back one step further in a

second. How well our microbiome is digesting our food. Food to

actually give us nutrients. So the microbiome is a, is

a biota. It's little tiny bugs, not bad bugs,

good bugs that live inside the tubes in your stomach

and they help digest the food. When they

digest the food, that's what makes these nutrients available for

us to actually receive nourishment. And guess

what? Those good little bugs that live inside of

us, they need fiber. Fiber feed

your microbiome. So if you don't eat any fiber, fiber is not

just the stuff that forms the poop. It feeds your microbiome. If you don't

eat any fiber, there's a chance that food could go through and you're

only pulling out a little bit of the nourishment. So that's not okay

either. Right? Like all of us, I think as I go through this

full thing, that particular part will make a little bit more sense.

So the food that's going in, we need enough food to actually form

poop. So that's the first thing we look at. And as far

as fluid ounces, we take your body weight in pounds

and divide it by two and that is your target

number of baseline ounces of water to take in a

day, 75% of it, preferably non

caffeinated, to make sure that we're actually getting hydrated stuff.

If you live in a high altitude, if you're breastfeeding, exercising, then you actually

need a little bit more than that bare minimum. But that's how you find your

bare minimum for what your body needs. Fiber. We

want 10 grams of fiber at every meal or meal

snack combo for 20 to 30 grams

a day. And most Americans specifically are woefully

inadequate in fiber. But that's the basic that we need.

As we're going to see as we travel down the poop's journey, that fiber is

what's going to actually feed the good bugs that live in the tubes in our

stomach to break down the food for us and get us nourishment.

So food and water go in. We chew it with our very sharp teeth right

here, chewing it and the saliva starts to

break down the food so that those little bio tas, those little

buggies, good buggies, can break, can get us the nutrients.

It goes down the tube into the stomach where it gets all churned up

with acid. Woo hoo. And if we have a gallbladder,

a little extra shot of bile to further break stuff down.

And now it's like a sludge, right? I know, it's, it's very, very fabulous.

The sludge leaves the stomach and goes into your small intestine,

which I have shown is just a little swirly do here. The

small intestine is where those lot of those

microbiome, those good bugs live. And they're going to eat the

fiber. When they eat the fiber they're going to release all sorts of stuff that

helps our body break down the food and absorb the

nutrients. And if we don't have enough fiber, those little

bugs can't do their job. And number one, we're not absorbing

the food. And number two, the speed with which the food is going through

the tubes is going to slow. And that's a problem.

After the food goes through your small intestine,

it goes through something called your cecum to your large

intestine which is where water is

resorbing. Now it's going to switch from sludge to looking more what we

think poop should look like. The very

end of the tube it's going to go through your sigmoid

colon which is not to scale, but it's two 90 degree

turns. Randy, the rectum here, hey.

The poop comes down and then when it's ready to be stored before

we eliminate it, it makes two 90 degree turns and then

pressure of that formed poop

on the internal anal sphincter

tells us if we have to fart poop or if

we're about to have a poop emergency and run to the

bathroom. Holy heck, isn't that crazy pants. Thank you

for the, the amazing drawing. And for those who are only

listening and can't see, I'll make sure I even post some of these back

pictures on Instagram for you. But that's a

really helpful model. And you know, I wonder if that's even covered in

health in high school these days. I don't even know to be

honest. It's certainly not covered. You know, I went to PT school over 20

years ago. We didn't cover functional medicine. Food

is medicine at that point. And so much of that, you know, people think

that it's just fiber to like just form the poop and so they

oh, I'm just going to take this Metamucil and no, it's about so much more

than that. It's about fueling the body, you know, and then there's a

whole nother step. We have another of Dr. Kelly's famous stick figures

here, like that rectum piece that

when the poop's kind of entering in that holding zone, if we

are dehydrated without fiber, that poop is going to spend

way too much time in that tube. I'm going to feel

ucky. And then when the poop comes down, if that

rectum is resting too tight, it's very hard to open

the door and relaxing the rectum. We

talked about this in one of our first videos together. But we're going to recap

because some people are just going to be here for the poop. They want to

get the shiz on the poop. The

pelvic floor muscles are like an elevator that's meant to live

on the ground floor of a four story building. And most

pelvic problems, including constipation. A part of that problem is the

pelvic floor resting too tight. And that too tightness of the

rectum puts the brake on all of this shiz traveling

through the intestine. So it keeps the stuff in the tube more longer than it

should, which makes it harder. Boo. But

additionally, when that pelvic elevator rests on

the ground floor, which is where it's meant to be, and we can do something

called bearing down, which is not straining. It is a gently

blossoming of just your pelvic floor muscles. That dropping

and opening of the rectum is the cue for your colon to

push your poop out. So just like your

bladder pushes your Pee out. We should never strain to pee. Your

colon should push your poop out. You should never strain to have a

poop. And then technically your uterus should push a baby out. So, you

know, talk to, talk to me later about that.

But if someone's dehydrated and they have this tight pelvic floor and they're

sitting, sitting on a toilet that's really high

and their hips are higher than their knees, that actually also makes it

harder for the body to succeed. So shifting

gears. If we didn't know about all of this before

our surgery and now we're really scared about the

first post operative poop, things that can help. Take the stool

softener. Absolutely. In the hospital

bathroom, get a squatty potty or a small stool to put your feet

on so that your knees can be high than

your hips. Relax your pelvic

floor to the best of your ability. Do some of these nice belly breaths

where the belly gets bigger and the pelvic floor softens and

drops down. And if you feel like you have to

push, don't push. That's too much pressure, especially if you've had the

sternotomy. So take a couple of folded sheets

and push them against your

lower belly like so while

you breathe out and try to relax

and blossom the pelvic floor. Those are the things

that you can do to help set yourself up for

success. Does that make sense? Boots. Do you have any questions? And we

also talked about that. The risk of cardiac events if you

bear down. Oh, my gosh. Yeah. Your doctor never wants you

to. Yeah. If we squeeze. And there

have been instances of people having cardiac events on the toilet

when they're just trying to force poop out. And that is something that

is completely avoidable if we just know to talk about it

and know that there's help. And if all of this is feeling a little

overwhelming, like, please don't let it be overwhelming, see this as a blessing

and a gift. That. Oh, wow. I can't believe how much I didn't know. And

seek to learn more. Um, you know, my online courses teach you about relaxing

your pelvic floor. Boots and I, after this, we're going to guide you through a

specific pelvic floor relaxation. There's probably pelvic floor pts

near you. I, I have a great blog, how to find a pelvic floor PT

near me. Go look at it. You know, email me if you have

questions about trying to find someone near you. Because this is something

that beyond just heart clients. This is important for everyone,

but it's especially important. Important for her clients.

Now the one other thing we can do, boots to set ourselves

up for this great post surgical poop or to

jumpstart our poops is the best belly massage

ever. Oh my gosh. And guess what? Yeah, I

drew something. Oh, man,

you really brought your A game today. Thank you, girl. Thank you.

I know. We'll make sure you guys all have downloads of these. I'll. Maybe I'll

sign a couple. We can like frame them. So yeah, put a TM

or a copy, right? Oh my gosh.

It's amazing. So what that and those of you who

are watching, you got to see this. Those of you listening again, come find boots

show notes because you'll get a downloadable for that PDF. But

belly massage is important for

a million reasons. Number one

is heart surgery stressful. Life's stressful.

Being constipated is stressful. Stress

elevates the tone of that pelvic floor and heightens our sympathetic nervous system,

which is fight or flight, which slows

digestion. So rubbing

your belly, especially while we are practicing

relaxed breathing, calms that sympathetic

system. It helps promote rest and digest

to move poop through the tube faster. So

post operatively, you can be laying in

bed and I'm going to show this for those of you watching. You can have

a hand, you know, at the bottom of the sternotomy incision so we know we're

nowhere near there. And you can rub your sweet

little belly very gently in little clockwise

circles all the way around your belly

button. This gentle rubbing and you're going to do

that with soft belly breaths wherever it feels comfortable.

And if you're not comfortable touching the skin for whatever

reason, do it over your hospital gown at even the

most gentle pressure will stimulate your lymphatic system, which

is extremely beneficial. And doing that sunflower

massage is what we call it for three to five minutes

helps improve the mobility of all of the nerves that

go to the colon to help make poop.

And that belly breathing helps

calm the fight or flight system. The belly breathing

stimulates rest and digest. It helps you relax your pelvic floor.

All things that are going to help the body move the literal

crap through the system. Right. And post operatively

clearing the medical crap. Absolutely. We need to get that

med. The medicine was amazing while you were knocked out. We got to get it

out of your system now. So you would do that?

Can I interrupt? Because I have a question? Yeah, yeah. And I'm thinking about

everyone who's listening with me. So like for me and This

I think will be for most open heart surgery patients. I had two

tubes coming out like probably at

least 2 to 3 inches below my boobs, but in the center.

Right. And so can you still do that massage? So that's a

great. Yeah, no, that's a great call. I forgot about the ports for drainage.

Yeah, so you could. But thank you. It would just be right down here if

you have those ports. I was, I was honestly thinking more of angioplasty when we

went up through the groin. Forgive me, but yeah. So you

would do these little circles more down like again, like wherever the

ports are. Hand on the ports and just beneath the belly

button. Then. Thank you. Boots. So that there's no tension on

where those ports are coming in. Right. If for any

reason your doctor says no, again, everyone's going to be

unique, then just the lightest hand pressure over

that lower inguinal groin region is going to be

extremely beneficial. That is one of your main

lymphatic dump areas and

there's a whole lot of lymph clearing that needs to happen. And

then once the ports, once the drains come out,

then we can talk with the surgeons about exactly what happened in your

case. Typically it'll be that light pressure is going to be

allowed as soon as things are covered up and sealed. And then

soft tissue healing wise, anywhere from four to six weeks

post procedure when we would start to use kind of a deeper pressure around that

area. But that's where an in person medical provider can

really help you there deciding when you can start to put more pressure. But

that lower area, belly button and below is typically fair

game. Right? Well, and something

else that I've noticed in my own journey, I'm just thinking

just a simple act and I'm asking your professional opinion

here. I'm just finding just simple. The simple act of putting your hand

even right around the drains in the hospital and just sending it

like love and talking to your body.

Because like for instance this morning I went to the gym before this

recording and I'm working on a few. I mean I'm always

working on something in there. But like I should be

like kind of my go to now is I like visualize the

movement before I do it and then it's amazing like, and I

talk to my body parts that I'm trying to get to move and

executing that movement. And I can only

imagine just a simple act of setting and sending an

intention to that part of the body to,

to work, get to healing. Post open heart surgery, I would need to

be Reminded if I were like, I'm just putting my, you know, it's four years

ago today that I had my surgery, and I just

remember how much of a fog I was in. So I would need someone to

overtly remind me to do that. But, like, we

have power to heal ourselves is my point. Yes. And even

just that power of your hand over the drainage spot, or just your hand,

or a partner or a loved one's hand on your lower

belly and belly breathing, that helps

show your brain that it's okay to pay

attention to the body again. The brain does not understand what just

happened in that open heart surgery. It. It doesn't know that that just

saved your life. It just knows. Holy shit, that was scary.

And how the brain's going to protect us is going to be to separate, to

dissociate from whatever it can. And that dissociation

is what results in a lot of these musculoskeletal

changes that we can address

calmly and specifically and gently. But it's, you know,

one step at a time. So, yes, just that gentle hand pressure there while you

belly breathe. If we don't feel comfortable touching, maybe you're not allowed to.

Maybe you had something happen up the groin. Right. There's lots of things that can

go up the groin during these surgeries. Right. Just putting the hand on the

belly can be very beneficial to speak to the

visualization. There is so much

science behind that in athletic

performance, in healing, in life, when you

visualize something happening, nearly all of

the same sensory motor pathways are

stimulated as when you actually do it. So you're helping your

brain. You're visualizing standing up, easy, walking to the bathroom, sit down,

having the best poop of your life standing up. Again, it does all of

those things without the metabolic demand of actually

making the muscles work. So it's great practice.

And, you know, so that is that visualization. And then it has your

body practice going through that poop scenario without

terrible pain, without the blowout, and that helps it

gain confidence. So that is, yes, so valuable. Thank you

for bringing up that visualization. I actually recorded a whole

episode on Visualization way back towards the beginning of

this podcast because I, I visualize my

surgery going well and I visualize myself thriving

post open heart surgery. And it works. So important, so

important. And again, in the Western medical model, we are a

sickness model. We are not a primary preventative

wellness, and we are not holistic as we should be. So thank

you for bringing that out to people. Now,

later, post heart surgery, like, you know,

we're past four to six weeks, all the drains are out. We're doing pretty good.

Then you can advance to the full

blown best belly massage

ever. And that's where we start off with

three to five minutes of that whole belly going

in clockwise, circles, clockwise around the belly button.

Belly breathing the whole time. And we are mobilizing

skin on fat, on fascia, on

organs, on muscles, on fascia, on organs,

on all of the things. And it is so healing.

And what you're feeling for is you're feeling for these sweet belly

tissues to feel like perfect bread dough or

soft pizza dough. And if you've never made bread or pizza, that's your homework.

You got to go make some so you understand what we're feeling for. And when

you sit down and you relax, that's what your beautiful tummy should feel

like. And the first time you do this, like six weeks post open

heart surgery is not going to feel like soft belly

dough or soft pizza dough. It's going to feel like peas and

carrots or like strings or like you're going to

push on a spot. I have a little adhesion here and like, instead of like,

here's good. There's like a little weight. If you can see, great. If you can't

listen, I'm pushing on one side of my belly and there's like a wave of

tissue and then I get to the midline and the wave stops and there's like

a little divot in. I have an adhesion there. I can

work on that gently. I keep it because it's perfect for

demonstration purposes and it's not

causing me any functional issues, so I don't care. I keep it there. But

we notice that. And then we do this for about three to five

minutes while we belly breathe. And then we put our flat hand

right over our belly button or a bit lower and we do

what very technically called smushing. We push to the

right and then to the left and gentle pressure,

whatever feels comfortable. We're never going to push into any, like, sharp pain.

And I see what way it goes further. And usually it's

going to go further in one direction than the other. That's the way

I want to push to. I'm going to push into ease. So if I

go left and then right and it's harder for me to go

right, I push into ease and I belly breathe

for again, three to five

minutes. Friends, what this is doing.

We have fascia throughout our whole body.

Most of us are familiar with the it band and the knee that's

a big band of fascia. It's gristly tissue.

Fascia of the legs and the arms. Like, we can be kind of

rough with it, and it will respond. Fascia of your

belly is protecting very vital organs. So if you

poke in there aggressively, it will actually

tighten further. And this is a

contractile tissue that you're not in charge of. This is just something that happens. So

if I do that smushing and I push to the

left and push to the right, and the right's hard, and I just kind of

try to force it, the body's gonna sense

maybe something's not right. It's gonna keep tension. But if I smush

into ease the way it wants to go and belly

breathe, it says, oh, this is okay. And after three to five minutes,

it will soften at that fascial level. And

now you've reduced compression forces on these nerves that are going to your

digestive bits. And your poop system's gonna work better,

folks. It's amazing. It's dang near a miracle. And it's

minutes, not seconds. You could then repeat it in another direction.

Usually we just tell people to do it like one direction at the start for

time, and then the final piece of

mobilizing all the nerves, we call colic

massage. But in reality, we're not actually massaging the

colon. The colon is the name for the large intestine, right. And.

And typically, there's this massage called I love you. Where you go

here at your descending colon here,

transverse, and down. So you go down on the. Wait, rights and

lefts. Here we go down on the left side of your body, and then across

and down, and then you make, like, a big U. But I think the way

that we like to teach it a little bit better, forgive me.

Is we actually try to start down here at the sigmoid colon where

Randy the rectum lives. And if we looked at the

picture, it's that holding space for the poop that has to

do two 90 degree turns. So laying

down sitting with a relaxed tummy, you go deep to your

low left side and you pull

three to five times. If you have zero pain, you

can do medium pressure. If this hurts for any reason, you can just do the

lightest pressure three to five times. And now we've kind of

cleared the sigmoid colon to help the poop move

better. And more importantly, we've cleared the nerves that go

to the sigmoid colon to help it work better. That's actually what we're

clearing. Following that, we do the descending

colon. So we put our hands just below our left rib cage, push

in and down into that sigmoid colon where we started

the last one. And then we release three to five times

straight down. And ideally, you're laying down or sitting down with a

perfectly relaxed belly. Now I've cleared

descending and sigmoid, so now I do transverse. I

go from my under my right ribs straight across

three to five times. This might be the spot that's the most

tenuous if we've had the sternotomy and the

ports. So again, even the lightest pressure is fine, but we do want to

restore normal mobility there. Second to last is

ascending colon, which is lower right hip,

pressing in and lifting straight up three to five

times. And then finally the cecum, which is

where your small intestine meets your large intestine

three to five times. And if we can

do all three of those, oh, my gosh, triple gold

star. But even just one of them with the gentlest

pressure can help that neurological system and help you have the best

poops ever. And this is kind of like a

lifelong thing that we can master it right now and benefit the rest of our

lives. So I hope you enjoy it. Oh, yes. And

I guess order matters. Like, if you're going to do all of

them, you need to clear the bottom first. There is. Yeah, there's

a reason. And then order does matter. And sunflower before smushing,

before colic massage. Yes. And

anything's better than nothing, so don't let you know. Perfection

be the enemy of good enough. Just touching the belly is going to matter

in a positive way. Wow. I know, right? And,

yeah, you are so welcome. Thank you so much for having me.

Yeah. This has been so enlightening, and

I. I hope that for y'all listening that

you will put this to practice. And this

is free. You get to do this for free. And that's the whole point

of the series and of this podcast, is that I want to give you as

much for free that you can do on your own in your. In the

comfort of your own home or hospital bed, to make

sure you have the easiest path forward to

healing as possible.

Absolutely. Thanks so much for having me. And if you guys are also

interested in diving in a little bit more to the pelvic floor.

Floor. I do have a wide variety of online courses

available for streaming from the comfort and privacy of your own

home. We're offering OHS

2025 open heart surgery. OHS

2025. You're going to get 25 off courses.

And there's a lot that are very specific to

surgeries or incontinence. And then there's the Treasure Chest, which

is all of my veritable knowledge. And that's

where Poop Lab will exist. And that's the one that's

all about poop. And that's fun because that's just a low monthly

subscription rate. So we want to help as many pelvises as possible.

Also, our Instagram has a lot of free silly stuff and the blog

is also a treasure trove of information to help you have the best

poop, pelvis and heart of your life life. So I'm

so glad you're here, Boots. Thank you so much for offering me this chance to

be on your show. I just am here for the poop hat. I have one

at work too. I know that won't shock you.

Oh wow. Well, you've heard it here, everyone. Thank you so much for

being here. I hope you've been part of this entire series. If you're

just finding us thanks to poop, then welcome.

We are so glad you are here. Here. And be sure to go back and

get the rest of the series because

it's all. It's all such necessary information that I really

wish I had had when I was facing open heart surgery.

So remember, I love you. You matter. Your heart is

your best friend. Be sure to come back next week for more with open

heart surgery with Boots.