What your stool (or lack thereof) says about your bowel health, and what you can do to make it better.
I talk about all kinds of "T.M.I" designated topics in my practice. In fact, when my patients start a conversation with, "This is probably T.M.I but...", I like to put their mind at ease by explaining that there is no such thing as T.M.I. in my sessions (or even in my home, for that matter). Among the daily conversations regarding sex, bladder health, pelvic organ prolapse, pain, breathing, lubrication, and general vaginal self care, there is almost always the rather casual interrogation of one's poop habits. I want to know how often, what it looked like, how big it was, did it hurt, did you feel empty, and are you leaking. It's pretty standard stuff. So standard, in fact, that the health field has designated a medically accepted and standardized chart dedicated specifically to the topic of poop. Meet my friend, The Bristol Stool Chart:
Yes, it's the pediatric version, but I find it to be the most fun (and descriptive). I can glean a ton of information from this little chart. For example, if you are more in the ranges of #1-#3, it tells me there is either a hydration component, lack of fiber, or both. Likely also some issues with slow or poor transit. If you are more #5-7, we may need to consider bulking up on some fiber, specifically soluble fiber, to give your stool some improved consistency. This looser, more watery consistency is also more consistent with signs of an irritated bowel; perhaps by something in the diet (there may also be a huge stress component as well). #4 is considered the perfect poo, and newer research suggests that consistency of stool is actually more important than frequency. Meaning, having daily bowel movements of #1 is less beneficial than 3x/week bowel movements of large #4.
Why is poop so important to me? It affects almost everything! When I worked in pediatrics, constipation was the most common driver behind a majority (if not all) of their little woes. Not only is it incredibly uncomfortable, but it can impair body awareness and lead to leakage of stool and urine. With my adults, constipation can directly impact urinary continence, urgency, frequency, pain (with urination, bowel movement, and even sex), fecal continence, and pelvic organ prolapse. Chronic loose stools can also lead to leakage issues, skin breakdown, infection, decreased social interaction which also impacts quality of life, and may indicate poor absorption of important nutrients. No matter what issue(s) brings patients to my practice, the number one most important issue to tackle in the beginning is bowel health. So, fair warning: If you ask my advice, I'm gonna ask about your poop.
General Tips for Improving Bowel Health
You’ve heard it before: Drink More Water! Our cells need water in order to function properly. When our system senses that we are dehydrated, one of the first places it looks to steal water from is our bowels. This is typically what causes the dry, hard, cracked presentation of stool (#1-3) and one of the leading causes of chronic constipation. In addition to affecting our bowels, dehydration also causes our lymphatic system to become more sluggish, decreasing the cleansing and detoxing processes that are important for keeping us healthy. Backup in the bowel and lymphatics leads to bloating and general abdominal discomfort, not to mention difficulty zipping you pants! You can calculate daily required water intake by finding your body weight in kilograms (pounds divided by 2.2). Water is 1 ounce for every kilogram.
Tip: Drinking lemon water (or any other citrus fruit) can help boost the function of the bowels by activating the liver. Plus, it’s yummy! (Note: may not be a great option for those with bladder urgency and frequency). See my article on bladder health for more info.
Fiber and Fiber Supplements
Natural dietary fiber can only be found in whole plant foods! Diets rich in dark leafy greens, veggies, fruits, seeds, nuts, legumes, and whole grains like rice and oat are ideal for bowel health. However, some diagnoses such as Irritable Bowel Syndrome (IBS), Diverticulitis, Crones, and many others make it difficult to consume a variety of necessary foods due to the side effects they can cause. Therefore, it is important to understand the difference between types of fiber, how they affect the body, and what things you should include or avoid for optimal bowel health and quality of life. Supplements can also help bridge the gap where diet may be lacking.
The basics of fiber: soluble fiber is good for both constipation and diarrhea, and may be consumed alone. Insoluble fiber (think roughage) is good for constipation, but can be irritating to the bowels. It can be consumed with soluble fiber, but should not be consumed alone in those which irritable bowels.
Personally, my favorite fiber supplement for bowel health is a powdered form of the acacia plant - a soluble, non-thickening, and flavorless supplement which is safe for most gastrointestinal issues. Companies like Heather's Tummy Care also carry teas and peppermint oil supplements designed to assist with gas, bloating, and nausea. When I worked in oncology, many of my patients found relief of their GI symptoms with these products, and my patients undergoing chemotherapies have told me that they worked wonders for their nausea.
Conscious Eating and Chewing
Many of us have very busy lifestyles which require us to acquire our nourishment either on the go, as quickly as possible, or a combo of the two. Digestion starts as soon as food comes in contact without our mouth (and sometimes even before; salivation in response to the aroma of food is a process of digestion!) In order for our bodies to properly process the nutrients that enter our body, we must first become more aware of how we are introducing these nutrients to our system.
Be a Conscious Eater:
This means eat. Nothing else. (TV, work, reading, etc.)
How does your food smell?
What is the presentation?
Appreciate the texture and temperature as you chew.
Appreciate the flavors and take the time to enjoy/savor your food.
**Studies show this can help reduce over-eating, slow food intake, and improve overall satisfaction of having finished a meal, which means we don’t feel deprived by the eating experience.
Chew, Chew, Chew:
Aid digestion by breaking down food as completely as possible before it moves to the stomach
Most food should be chewed on average 30-40 times before we swallow
Saliva contains enzymes which assist with the breakdown; the more we chew, the more saliva we produce, and therefore the easier the food is to digest
Place your fork down between bites to ensure proper time is taken to chew
**This can reduce likelihood of reflux/heartburn or stomach upset
Probiotics
These are live organisms that are consumable and can assist with improving or rebuilding a damaged gut flora (natural bacterial and yeast population that lives in the bowels and is responsible for digestion, immunity, and mental health - did you know 80% of your serotonin is produced in the gut?!). There are many brands to chose from and I do intend to write a more elaborate post on this topic in the future, but for now I will mention that I both use and highly recommend Flora Bloom and Fem-Dophilus for their L. Reuteri and L. Rhamnosus benefits.
Pop-a-Squat
How you sit on the toilet actually plays a huge role in pelvic floor relaxation. Traditional seating is not conducive to how we are designed to empty the bowels naturally, and as a result, we use poor toileting habits such as straining and breath-holding which can lead to hemorrhoids, anal fissures, hernias, increases in back and pelvic pain, and worsening pelvic organ prolapse. Did you know you were actually meant to squat when you empty bowel and bladder? Squatting allows relaxation of the puborectalis muscle within the pelvic floor, making bowel elimination possible with little to no straining or pain (when the stool consistency is right).
The Squatty Potty company has a clever little device specifically for this purpose, assisting you to easily achieve an optimal toileting posture with the feet flat (not dangling or on tip-toes) and knees elevated slightly higher than the level of the hips to allow the pelvic floor to relax. For the majority of my patients (and my family) this simple device has made a tremendous difference in their bowel and pelvic floor health. We have one in every bathroom of our home!
Squatting may not be appropriate for you if:
You have post-surgical hip precautions
You have poor knee or ankle range of motion
You have had recent abdominal/organ surgery
You have vertigo or dizziness
**In these cases, a Women's Health Physical Therapist can work with you to find the best toileting posture for you!
Body Awareness: Relaxing at both ends of the digestive system
The body is a system and a chain. Everything is connected. Tension at one end of the body can effect the opposite end, and the digestive system is no exception. When seated on the toilet, you may adopt a process of going though your body and running a few “checks” to look for increased tension. Once you are in your appropriate position on the toilet, start from the top and work your way down:
Jaw and mouth position – the beginning of the digestive tract
Tension in the jaw, neck, shoulders, abdomen, glutes, legs
Position of the Anus (opening of the anal canal) – the end of the digestive tract
Focus on relaxation in each of the areas as you run your mental checks down the body. Practice slow, deep, diaphragmatic breaths. Part your teeth comfortably and place your tongue gently into the groove within the roof of the mouth. Performing a slow lift or contraction of the pelvic floor (anal opening) can help you to better detect if tension is there, then breath deep and try to release the muscles. Take it slow and try not to strain!
This is a lot of info and it's still only scratching the surface, ladies! We didn't even cover the importance of breathing and exercise on bowel health. Those are much bigger topics for another post...or five. So, not only do we discuss and address bowel health from a physiological and nutritional approach in my practice, there is also a great deal of mind-body training (and re-training). Again, we know now that a high percentage of the body's immune cells and serotonin (happy drugs) are produced in the gut. Considering a holistic and comprehensive approach to bowel health is crucial in addressing pelvic health and overall wellness as a whole. You know what they say - you are what you poop. Ok, maybe only I say that.
And if you know me personally, just know that if I ask about your poop, I do it with love <3
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