I never thought, when I was starting out as a physio, many (many) years ago that constipation would be such a feature of my professional life (happily not my personal life, although I will say, I have been known to whip out a mini Bristol Stool Scale at dinner parties…)
Bowel function is one those things, like the absence of pain, that we take for granted until there’s a problem with it. And SO many people have problems with it! Just walk into any pharmacy and behold the groaning shelves of remedies.
So, what is ‘normal’ bowel function? How often should you go? Why is it a problem when you don’t (or can’t?) Does constipation really matter…YES! YES IT DOES!!
Before I climb up any further on my soapbox, let’s talk about why constipation matters – especially for women. There are strong links between GI dysfunction and back and pelvic pain in women, and straining to have a bowel movement can increase the risk of pelvic organ prolapse – when the organs that normally live up in your pelvic begin to make their way down and out to places they shouldn’t, usually through your vagina. But ultimately, having regular healthy bowel movements is important because it is one of the main ways your body gets rid of waste products – and if those waste products sit around for too long in your bowel, then there’s the possibility of those waste products, including excess hormones getting reabsorbed back into your body. After all, your body was trying to get rid of them for a reason…
There are two main reasons for constipation – delayed transit through the bowel, which means too much water is reabsorbed back into the body and the stool becomes hard and dry and difficult to pass, or pelvic floor issues, namely the pelvic floor muscles don’t have the coordination to open up the sphincters and allow the rectum to empty. There’s an easy way to check your bowel transit time – don’t eat sweetcorn for two weeks, then have a serving of it with your dinner. The following day when you have a bowel movement, check the stool for any corn (its going to be quite visible as corn isn’t broken down very well by the digestive system)
I think it is optimal to have a good bowel movement every day. The official definition of bowel health is that you shouldn’t be having more than three bowel movements a day or fewer than three a week. I think at least one a day is a good goal to aim for – ideally first thing in the morning, so you can let go of old sh*t before a new day begins!
How long should it take for what you eat to come out the other end? There are a couple of different schools of thought on this, but the average transit time from mouth to toilet bowl should be 24-48 hours
What should it look like? Using the Bristol Stool Scale as a guide, I get my patients to aim for a Type 3 or Type 4. I always think it is a good idea to look before you flush -if you’re one of my patients, I’ll be asking you about what you see in the toilet bowl, but I do recommend that you always check for any blood in the stool as this could be an early sign of bowel cancer and needs immediate medical attention (it could also be a asign of hammorhoids, which incidentally can be caused by constipation but generally also benefit from some attention!)
Does what we put into our bodies affect what comes out the other end? Well, again…YES! YES IT DOES!!
We know that certain foods have a ‘binding’ effect – I would say dairy is a prime culprit here, but I’m also going to cast aspersions on processed and fried foods too (but we know we shouldn’t be eating those anyway, right?!). Meats, especially fatty meats can have a similarly restrictive effect on bowel transit. Some of my patients have reported citrus causes constipation, others have found it can help ‘get things moving’. There’s a certain amount of trial and error but these same to be the major culprits that my patients report.
So what should we be eating to stimulate good bowel action?
Well if you check out ‘The Constipation Cures’ in the Resources section of the website, you’ll get a list of pretty much every thing I’ve tried that works! But there are a couple of additions that I’d like to make…
Make sure you are drinking plenty of water – this sounds too obvious to be effective but it really works!
Move throughout the day – we have evidence that a 20 minute walk can be a great way to get your bowel moving!
Try a shot glass of prune juice before you go to bed at night
When you wake up, have a warm beverage. Coffee is great, as caffeine is a bowel stimulant, but any warm beverage will have a stimulating effect due to the gastrocolic reflex
Although I’m talking about supplements here there a couple of important points – I highly recommend talking to your healthcare provider before starting to take supplements BUT food choices are generally safe!! The added benefit on focusing on food as medicine is that you’ll be increasing your intake of fruit, vegetables and nuts, seeds and beans, all of which are great sources of FIBRE which acts like a scrub brush in your colon to get things moving and provides prebiotics for your friendly gut bacteria – win/win/win!!
400-600 mg magnesium citrate before bed, or up to 600 mg magnesium citrate twice daily until it starts working, which should be in a just a few days after starting it.
If your stools get on the looser side, drop back a dose – the proper dose is one that gives you a healthy, soft but firm stool daily
NB Mg can lower BP so if on medications, check with doctor. Do not use if you have kidney disease.
Good food sources of Magnesium include nuts, seeds, greens and beans (especially black beans!)
Depending on the condition being treated, recommended therapeutic doses of vitamin C range from 450 to 6,000 mg and up
Most people will reach bowel tolerance between 2,000 and 4,000 mg – you’ll know you are reaching the upper limits of your tolerance when stools become loose! You may find that if you are fighting an infection or a cold, that it may take a higher dose to create an effect on your digestion. For instance, if you normally notice bowel changes at 2,500 mg, during your cold you may take 4,000 mg before noticing any change in bowel movements
Vitamin C is considered a safe supplement for most people. If you are or could become pregnant, it is best not to exceed 6,000 mg vitamin C daily
Good food sources of Vitamin C include: bell peppers, dark leafy greens, kiwifruit, broccoli, berries, citrus fruits, tomatoes, peas, and papayas
One of my favourite sources of additional fibre for women is a daily serving of ground flaxseeds. The Latin name for flaxseed is ‘Linum Usitatissimum’, which roughly translates into ‘most useful seed’. The whole seeds contain anywhere from six to 12 percent mucilage. Mucilage is a slimy, gum-like compound that provides a temporarily soothing and protective coating along the entire digestive tract. Flaxseeds also contain Omega 3 fatty acids, which can be useful anti-inflammatory allies. Flaxseed has been studied in the treatment of heart disease, cyclic mastalgia (painful breasts around your menstrual cycle), diverticulits and breast cancer. Three tablespoons of ground flaxseeds a day is the amount that is regarded as helpful – sprinkled on soups or salads, baked in bread or muffins, mixed in your morning porridge – the choice is yours! A quick word of caution though – do buy the whole seeds and grind them yourself, As the pre-ground or pre-milled seeds can turn rancid very quickly. You can do it in a coffee bean grinder, a food processor, use a pestle and mortar or my favourite, put them in a ziplock and whack them with a rolling pin (good for venting frustration, bone density as well as releasing Omega 3’s!)
You can watch me being interviewed here by Rachel Holmes about the importance of bowel health for a happy healthy pelvis!
In Part two of this blog (coming soon!), I’ll talk (and share a video) about the evidence based method of abdominal massage to stimulate bowel movements – a lovely way to practice self care first thing in the morning, especially when you use some bowel stimulating essential oils… I’ll also talk about good toileting technique, pelvic floor function and dysfunction and steps for making sure you have a happy and healthy bowel movement EVERY SINGLE DAY!!!
In the meantime, if you’d like to check out my upcoming courses in the U.K., the U.S. and of course online – have a look HERE!!