Pooping 102

Here’s the second part of  Poop 101

What should my poop look like?

Have you ever heard the expression ‘you are what you eat’? Well, it’s true! What we put into our bodies affects the health of our gut, which has more neurons than is in our brains! Say what? So, it’s helpful to occasionally take a peek at the color, shape and size of your poop.

The chart above reflects this. Imagine if you’ve barely had any water all day, as you are busy rushing from place to place. Maybe you grabbed a sandwich or pizza for lunch. Your stool may end up looking like Type 1, separate hard lumps, difficult to pass because you are dehydrated. The stool is hard because the intestines have absorbed all of your fluid, leaving nothing behind but what looks like rabbit pellets.

If you’ve ever had a stomach virus, you may have had type 7 or diarrhea. Your body also may have trouble digesting certain types of foods such as products with lactose or artificial sweeteners. Generally, softer stools are associated with inflammation.

Normal, healthy stool is type 3 or 4, sausage shaped which is not too lumpy and stays together as one solid mass.

If your stool is not diarrhea, but comes out in soft blobs with clear-cut edges, you may be lacking fiber in your diet. Fiber can prevent and relieve both constipation and diarrhea. Insoluble fiber moves bulk through the intestines and balances the intestinal pH, whereas soluble fiber binds with fatty acids and slows transit time. The best form of fiber is from natural sources, such as fruits and vegetables.

How frequent should I go?

The frequency of a bowel movement (BM) varies frequently from once a day to every 3 days and that can be completely normal. Again, you do not need to poop every day to be normal and healthy. Remember, it takes up to 72 hours for the stool to pass through the large intestine alone. Everyone has their own version of normal. Now, what is abnormal?

Diarrhea is defined as loose stool more than 3 times per day. Constipation is defined as straining to pass stool or a feeling of incomplete emptying with a frequency of bowel movements less than 2 times per week.

As a general rule of thumb, the longer digestive contents are in the intestines, the harder the stool and greater chance of constipation. The opposite is true of diarrhea. In other words, if the intestines don’t have time to absorb fluid, the feces are more likely to be soft or liquid. Remember, the intestines absorb 1000 – 1500 mL of liquid leaving just 100- 150 mL for the stool. If the body doesn’t have time to absorb this liquid, diarrhea can occur.

What factors affect intestinal motility?

  • Amount of feces
  • Chemical makeup of feces
  • Intestinal hormones
  • Nervous input to intestines
  • Female hormones
  • Emotions
  • Visual and olfactory input
  • Time of eating, schedule
  • Systemic diseases – anorexia, diabetes myelitis, hypothyroidism
  • Activity level

What Can I Do To Poop Better?

 

You can improve bowel regularity through exercise;  find out the side effects of medications, especially beta-blockers and opioids; learn some easy ways to relieve your stress and eat regular meals.

Other helpful tips to stimulate a BM:

  • drinking warm water w/ lemon in the AM to stimulate the bowels
  • do an “ILU massage” or self-intestinal abdominal massage
  • taking a morning walk or do some yoga poses

An example of a self-intestinal massage is shown above. Provide light strokes in the direction in a clockwise direction as shown for 1-3 minutes or until you hear a “gurgling” of your stomach.

References

Doughty, D. (2002). “When Fiber is Not Enough: Current Thinking on Constipation Management.” Ostomy Wound Management 48(12):30-41

Force, A. (2005). “An Evidence-Based Approach to the Management of Chronic Constipation in North America.” American Journal of Gastroenterology 100(S1):S1-S22.

Hawkey, C.J., Bosch, J., Richter, J.E., Garcia-Tsao, G., &Chan, F.K. (Eds.). (2012). Textbook of clinical gastroenterology and hepatology. John Wiley & Sons.

 

POOPING 101 – Part 1

What is one thing we all have in common? What brings us all together? We all poop!  How much do you know about your bowel movements? What does it mean when your stool is a different color, shape, texture? What leads to constipation or diarrhea? How can we have a healthy bowel movement and how often should we have a bowel movement?

 

I am writing this blog in two parts to help you have a better understanding of the mysterious #2, because pooping is an integral part of our daily life and can tell us a lot about our health.

DIGESTION

Lets start from the beginning, how food travels from entry to exit:

1. ORAL CAVITY & ESOPHAGUS Digestion begins in the mouth, as saliva helps break down starches. The esophagus is the portal to which the contents travel to our stomach. No digestion occurs here, but “heart burn” can occur when there is backflow from the stomach up into the esophagus through the cardiac orifice seen above.

2. STOMACH Now that the food has made it to the stomach, acids break down proteins. Food spends approximately 2-4 hours here before traveling to the small intestine through the pyloric sphincter

3. SMALL INTESTINE  In the small intestine, over the course of 4-6 hours, our body continues to break down starches and proteins and tackle a new molecular compound called carbohydrates. Juices secreted from the pancreas and liver help break down starches, fats and proteins.

4. LARGE INTESTINE What’s next? You guessed it, the large intestine, which absorbs 1000- 1500 mL per day, leaving 100-150 mL along as hardened feces to the rectum. Digestive contents spend the longest time here, approximately 24-72 hours. It travels through the ileocecal valve up the right side of the abdomen through the ascending colon, across the transverse colon and down the left side into the descending colon.

5. RECTUM Using strong peristaltic waves, our bodies push stool into the rectum. That’s when we have our first urge to defecate. We have stretch receptors which tell our bodies to relax an involuntary muscle called the internal anal sphincter while we close our external anal sphincter (EAS) to keep feces from coming out until we are ready.When we sit on the toilet, our EAS relaxes along with our puborectalis muscle. This relaxation combined with a gentle increase in intra-abdominal pressure pushes fecal matter out. Placing our knees higher than our hips, via a squatty potty or stool, helps relax the puborectalis muscle even more, allowing from easier elimination as shown below. The external anal sphincter (EAS) changes its tone based on what it senses. If it senses liquid, such as diarrhea, the EAS increases its tone. If it senses, gas, it allows that to be selectively released. If it senses solid stool, our body can override our urge to defecate until we are at a toilet, so we can hold it in when necessary.

When we sit on the toilet, our EAS relaxes along with our puborectalis muscle which surrounds the rectum tightly at rest creating the “anorectal angle”. When the puborectalis relaxes it allows the rectum to have easier passage. This combined with a gentle increase in intra-abdominal pressure pushes fecal matter out. Placing our knees higher than our hips, via a squatty potty or stool, helps relax the puborectalis muscle even more, allowing  easier elimination.

GOOD DEFECATION TECHNIQUE

A healthy bowel movement (BM) should not involve straining or pushing. The action of defecation is a part of the parasympathetic nervous system, which helps the body soften and relax. The first step to a good BM is making sure you are in a comfortable, safe place. Have you ever noticed it’s easier “to go” at home versus in an unfamiliar place?

If we lose our ability to properly relax with a bowel movement we may start to strain with defecation, which over time is injurious to our body.

Here are some quick, easy tips for a healthy BM.

  • Sit with your knees above your hips, feet resting on  a child’s step stool or “Squatty Potty”
  • Place both hands on your abdomen, or, if you have jaw tension, support your head in your hands
  • Draw up or contract your pelvic floor muscles as though you are trying to hold back gas
  • Relax your pelvic floor muscles as though you are trying to release gas
  • Note how the stomach muscles relax and bulge forward
  • Relax the pelvic floor muscles and think of widening the rectal opening
  • Imagining your body is a tube of toothpaste, pushing from the top down, brace and breathe out
  • You can use certain sounds such as “grrr” and “shhh” to help gently increase intra-abdominal pressure to pass stool

If you feel like you are unable to perform an easy BM even with taking fiber, drinking water, or are spending too much time in the bathroom, straining often, or experience frequent constipation and bloating, consult a pelvic floor physical therapist.  We’ll assess if restricted pelvic floor, abdominal muscles are hindering your function. We perform gentle manual therapies to restricted muscles/fascia of both internal and external pelvic areas, visceral mobilization  to help the organs move optimally and “do their thing”,  use biofeedback to retrain the pelvic floor muscles so they don’t contract when they are supposed to relax, teach breathing techniques and other home exercises.

Stay Tuned for “Pooping 101 – Part 2”!