Maintaining a healthy bowel is one of the essentials of healthy living, so it is important to know what can cause unhealthy and poor bowel habits. Poor bowel habits can lead to constipation, and / or faecal incontinence which is often uncomfortable and can be painful. The following information looks at several key factors, which help maintain a healthy bowel.
Normal bowel function
The bowel is part of the digestive system and its role is to digest the food that we eat, absorb the goodness and nutrients from the digested food into the blood stream, and then to process and expel the waste products from the food that the body cannot use. As long as stools are passed without excessive frequency, with minimal effort and no straining, and without the use of laxatives, bowel function may be regarded as normal.
How often should the bowel be emptied?
There is no right or wrong answer to this. There is a very wide range of ‘normal’ bowel function between different people. Only a minority of the population has a bowel action once per day. Some people go several times a day and others have several days between bowel actions.
Be aware - some medications can have an effect on how your bowels work. If in doubt, organise a review of your medications with your GP or pharmacist. Medication such as pain killers, antidepressants and iron tablets can cause constipation. Medications such as diabetic tablets, antibiotics or antiacids can cause loose stools (poo) which can lead to faecal incontinence. Discuss your laxative use with your healthcare professional and always let them know about medicines you buy from a chemist or on the internet. More than one laxative may be used to relieve your constipation. Too much laxative can make your stools loose. Your clinical nurse specialist will complete an assessment and support you with treatment and / or bowel management to reduce the risks of constipation, poor emptying and / or faecal incontinence to enhance your quality of life.
What may go wrong?
A number of things can go wrong with your bowels that may cause constipation or faecal incontinence. The nurse specialist will discuss with you what is wrong in your case.
What will help to make your bowel healthier?
- Morning routine
- Toilet position
- Defaecation techniques
- Medication review
Fibre is the non-digestible part of plant foods which passes through the stomach and bowel providing bulk. Fibre is important for maintaining a healthy bowel and can improve stool consistency and regularity. Most of us do not eat enough fibre in our diets. You can improve your fibre intake by including more of these foods:
Bread and cereals
- Start the day with a high fibre cereal (e.g. weetbiscs, wholewheat cereals, porridge, muesli) or wholemeal or wholegrain bread.
- Stock up your cupboards with wholegrains such as cereals, oats, brown rice, rye, seeded wholewheat crackers and breads.
- Add oats, nuts or seeds in your cooking e.g. crumbles, toppings.
Brace and lift technique
The brace and lift technique is used to help coordinate defaecation. We teach this technique with the toilet position. Your nurse will show you how to do brace and lift in clinic and may teach you step by step or ask you to practise daily away from the toilet. Over time you may find you have fewer problems in achieving a complete defecation.
- Keeping your shoulders down, take a deep breath that makes your tummy and waist widen like a bellow effect.
- Hold that breath and push out your tummy like a beach ball. You have now created extra abdominal pressure.
- If you now say ‘idge’ you will sense your anus bare down momentarily. This is the first part of the technique helping you to poo.
- Practise the above away from the toilet. How can we use breathing to help with pooing?
- To poo, you need the bottom muscles to be relaxed.
- Give your anus muscle a squeeze so that you have lifted that muscle and then relax. Relax again - this is the correct position for pooing.
- From step 1, try saying ‘idge’ at the same time as relaxing your bottom to enable pooing.
You can repeat steps 1 and 2 several times to help pooing.
Bristol Stool Chart
Type 3 and 4 are classed as normal, easy to pass but also easier to hold on to.
Type 1: Separate hard lumps, like nuts
Type 2: Sausage-like but lumpy
Type 3: Like a sausage but with cracks in the surface
Type 4: Like a sausage or snake, smooth and soft
Type 5: Soft blobs with clear-cut edges
Type 6: Fluffy pieces with ragged edges, a mushy stool
Type 7: Watery, no solid pieces
Fruit and vegetables
Aim to eat 5 portions of fruit or vegetables daily. Fresh, frozen, tinned or dried and juices are all good sources of fibre.
- Eat the washed, edible skins on fresh fruit, such as apples and pears.
- Enjoy fresh, tinned or stewed fruit as a pudding after your main course.
- Add some fresh or dried fruit, nuts or seeds to your breakfast cereal.
- Have some dried fruit, nuts or seeds as a snack between meals.
- Try to have two vegetables with your main meal e.g. carrots and broccoli.
- Add extra vegetables to soups, stews, casseroles and pasta.
- Avoid overcooking vegetables.
- Serve salad vegetables with sandwiches, snacks and packed lunches.
Pulses E.g. peas, beans, pearl barley and lentils are an excellent source of fibre. These can add bulk to your stool.
- Have them in stews, soups and casseroles.
- Use baked beans and mushy peas or garden peas with your meals.
It is very important to drink plenty of fluids. Have at least eight cups, mugs or glasses daily (11 /2-2 litres, 3-4 pints). Increase the amount of fluid you drink in hot weather and when exercising. A variety of drinks all contribute to your fluid intake.
- Fruit juices
- Flavoured water
- Herbal teas
Drinking less than 8 cups could be a cause of constipation. However, over hydrating will not resolve constipation.
Do not ignore the call to have your bowels opened.
Putting off the call to go can be a cause of constipation or lead to urgency. Try to work with the body’s natural rhythm (emptying the bowel first thing in the morning).
The best way to sit on the toilet is:
- Legs apart
- Knees higher than hips by either using a foot stool or slowly bring your feet in to tip toe position (avoid doing at speed so as not to contract your pelvic floor)
- Sit upright with your body leaning slightly forward (rest elbows on your thighs).
This position is the best way to assist with complete emptying of the bowel. Privacy and comfort will assist in the complete emptying of your bowels. Try to work with the body’s gastro-colic reflex (body’s natural rhythm) - it is at its most powerful first thing in the morning and secondarily post other meals in the day.
1. Start the day with a hot drink, like water, lemon, tea or coffee. This helps kick start the body’s rhythm.
2. Eat breakfast! This helps to move stools in the bowel, which will in turn help fill the rectum, and increase the urge to have your bowels opened.
3. After breakfast, wash and dress or do 10 minutes exercise such as walking or stretches.
4. Then sit on the toilet to encourage bowels to empty at a regular time each day (for no longer than ten minutes).
The morning routine can be used with all meals including lunch and dinner.
When increasing fibre in the diet, introduce the changes gradually, as a sudden increase can cause discomfort and bloating. Aim to increase the number of fibre rich foods you eat gradually over 3-5 days. It is important to drink plenty of fluid when increasing your fibre intake. Fibres and fluids work together to ensure a regular, comfortable bowel movement. Try to eat regularly, 3-4 meals a day will improve bowel regularity.
Whatever your activity level, increasing the amount you do will improve your bowel function. Aim for 30 minutes of activity a day e.g. walking, aerobics or chair aerobics, gardening, housework, cycling, swimming or team sports.
If you are unable to achieve this for health or mobility reasons speak to your GP for advice.
Eat well guide