APRIL 23, 2018
We all know that what we put into our bodies, says a lot about our health, however, not many of us pay much attention to what things look like on the other end. What comes out, and how often and easily it comes out is also incredibly important to our well-being. Most people probably realize that poop is the trash that’s left over after our bodies use the “good stuff” from the foods we eat. Many, however, have probably not given much thought to the negative effects of letting that trash pile up inside.
There are a wide range of poop related problems out there, but perhaps one of the most common, and the primary focus of this discussion, is constipation. Constipation reportedly affects 30% of the population at any given time, and can be related to a number of anatomical, mechanical and / or digestive abnormalities. Diet, lifestyle, activity level, stress, general body mechanics and muscle tone or trauma can contribute to constipation symptoms. Constipation can be acute and transient, or can become a chronic problem, increasing the risk of further related complications including, but not limited to: urinary or fecal incontinence, hemorrhoids, pelvic organ prolapse, abdominal pain / bloating and pelvic pain. Managing constipation is key to decreasing the risk of experiencing any of these problems, and is even more essential to address if any of these symptoms are already present.
In many cases, increasing fiber and water intake, participating in regular exercise and establishing a daily routine of allowing oneself the opportunity to have a bowel movement is enough to get things back on track. For others however, success does not come so easily. This can lead to increased frustration and anxiety, which often contributes to further constipation.
In order to understand why or how things might go awry, it’s helpful to have a basic understanding of how our bodies are designed to work. Digestion begins when food enters the mouth and continues until it exits as stool through the anal sphincter. Defecation (having a bowel movement) is controlled by multiple parts of the autonomic nervous system and involves both sensory and motor components. The colon processes, absorbs and stores stool as it travels to the rectum. The rectum (under optimal circumstances) fills to the point of gently stretching, then sends urges to the brain that it’s time to empty, and does so. Repeatedly ignoring these signals (which may be due to anything from inconvenient timing to abnormal sensory input and inability to recognize the signals) can result in over-stretching of the rectum and set one up for chronic issues with constipation. Another lovely feature of our bodies, contributing to this process is a built in reflex, known as the gastrocolic reflex, designed to help keep things moving so to speak. This reflex is responsible for initiating peristalsis (wave-like movements in the colon responsible for propelling food through the digestive system) which occurs in response to stretching of the stomach after a meal.
So, how often should we poop and how do I know if things are normal or not? Bowel movement frequency varies from person to person and anywhere from 3 times per week to 3 times per day can be considered normal, provided there is no significant change in the frequency or complaints of discomfort. Stool consistency, can also vary somewhat as well, but should ideally be type four on the Bristol Scale (see image below). The color of stool also varies from light to dark brown, or greenish, however, in the event of black / tarry stool, excessively light colored / white stool or bloody stool, one should be evaluated by a medical professional.
It’s also important to realize, that bowel movements should never be painful or hard to pass, and you should never feel like you are straining to have a bowel movement! Proper positioning for a bowel movement includes sitting in a relaxed position with the knees apart and slightly higher than the hips, mimicking a squat position. This places the muscles of the pelvic floor in a more relaxed position, and changes the angle of the rectum to allow for easier emptying. Focusing on keeping your anus in a relaxed and open position, your face relaxed and your mouth slightly open is also helpful to decrease breath holding and resultant straining. Use this link for an easy to understand, and somewhat comical explanation.
The ability to expel stool is intricately related to the control of muscles in the pelvic floor, but is also dependent upon ability to coordinate these muscles with companion muscles in the abdominal region and with the muscles that help you breathe. More specifically, the ability to have a bowel movement with ease is dependent upon the ability to relax the muscles of the pelvic floor allowing the body to expel fecal matter, without straining and without pain. In an optimally functioning system, bowel movements occur easily, relatively quickly and without much thought or effort. Unfortunately, when the system is not functioning optimally, it can be very challenging to trouble shoot to determine what’s not working and how to change things. Pelvic floor physical therapy can help persons of all ages improve awareness of these muscles in order to help improve bowel control, and as a result, improve quality of life.