“The bowel necessities”
We all do it, but not all of us are comfortable talking about it.
Good bowel habits contribute to our health, quality of life, comfort and mood. With 20% of Australians suffering from constipation and many more suffering from incomplete bowel emptying and general gut discomfort, it’s important to discuss the topic and look at our bowel habits.
Normal bowel frequency can be anywhere from 3 times a day to 3 times a week and it should take no longer than 1 minute to start a motion and 5 minutes to complete it. The consistency of our stool should look like Type 3 or 4 on the Bristol Stool Chart.
If your stool resembles Type 1 or 2 on the Bristol Stool Chart (above), you’re probably constipated and need to increase your fluid intake.
Constipation is difficult and infrequent passing of hard or lumpy stool and result from a variety of causes.
Causes of Constipation
- Poor fluid or fibre intake
- Holding on to a bowel motion for prolonged periods which can cause dehydration and hardening of the stool
- Hormonal influences such as pregnancy or pre-menstrual
- Lack of exercise or bedrest
- Dyssynergia (not using the correct technique to generate the right pressure to empty to the bowels).
Hydration and Diet
We should be aiming to drink at least 1.5-2 litres of water a day, and more if it’s warm outside, if you’ve been exercising, or if you’re breast-feeding. Increasing your soluble fibre intake by eating foods such as fruits, vegetables, legumes (beans, pulses, peas), oats and barley will also help to draw water into the stool to soften it. Supplements like Movicol or psyllium husks may also be useful.
Left unchecked, constipation can cause anal fissures, haemorrhoids, bloating, abdominal pain, bladder urgency, PFM weakening, urinary incontinence and prolapse.
If your stool is overly soft and mushy resembling Type 6 or 7, it can be harder to contain as liquids are more difficult to hold in than solids, but it can also be harder to empty completely as a residue may be left behind. In this case, having more insoluble fibre, such as wheat bran, vegetables and whole grains, can help to bulk and form stool.
In general, the recommended fibre intake is 25-30g per day. You should also start your day with breakfast to help stimulate the gastro-colic reflex, which gets your bowels moving.
Posture and Bowel Motions
The correct sitting posture and using the correct method to initiate a bowel motion is also very important in addressing constipation and incomplete bowel evacuation. Straining should be avoided as this can weaken the pelvic floor muscles.
How to achieve the correct position and technique to initiate a bowel motion:
- Sit in a lean forward position, with elbows resting on knees. Keep your shoulders relaxed
- Rest your feet on a footstool to bring your knees higher than your hips, and straighten your spine (this will mimic a squat position)
- Relax, breathe slowly and gently
- Widen through your waist and then feel your back passage relax. Push/propel from your waist back and downwards into your back passage.
A squat position helps to straighten out the last bit of the bowel- the anorectal angle- to enable a bowel motion. The images below show the difference in anorectal angle in normal sitting versus a straighter angle in squatting posture. You can also see in the image that the pelvic floor muscles (puborectalis) wrap around the rectum to create the anorectal angle. When the pelvic floor muscles contract the anorectal angle becomes more acute, kinking the rectum shut. Therefore, keeping your pelvic floor and anal sphincter muscles relaxed during a bowel motion will reduce the acuteness of this angle and make it easier to pass a stool.
If you have had any difficulty emptying your bowels and are unsure whether you are using the correct technique, don’t put up with it! Come and see one of our pelvic physiotherapists to help you find the right plan to get your bowel habit on track for the long term.