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Why Regular Bowel Movements Are So Important

I think you will all agree that you can start to feel pretty terrible when you’re constipated. When your bowels are sluggish, it can make you feel bloated, cause distension in the abdomen (makes your tummy stick out), cause nasty cramping if you’re really backed up, in addition to making you feel nauseated, headachy, fatigued and just generally yuck! Let’s look at why regular bowel movements are so important.

We need to keep the bowels moving to keep elimination and removal of wastes at optimal levels – I mean who really wants their poo sitting in their large intestine “stewing” for several days or more? Not me thanks!

It is optimal to open your bowels every day, with 1-3 times a day being perfectly normal if your stool has good form – anywhere between 3-5 on the Bristol Stool Chart is considered normal stool form (1-2 and 6-7 is not). If you’re only opening your bowels every 3 days, 4-5 days, once a week, or sometimes even more, this means you are constipated, even if you don’t think you are straining, but especially if your stool form is sitting at Bristol 1 or 2.

NBH Bristol Stool Chart New Nov 2023

Sometimes when I explain this to people, they are quite shocked as they have *always* only pooped twice a week (or less), and they thought it was normal! But let’s face it, we don’t often go around chatting about our bowel habits to our friends, let alone people we work with etc, as most people wouldn’t consider it to be polite conversation.

Also, let’s not forget my previous blog on the importance of gut transit time. Even if you are opening your bowels every day, we need to see how long it is taking for food to move from your mouth into the toilet – if it’s taking days to move through, that’s not great either, as even if you are opening your bowels daily, your gut is very sluggish.

Apart from the well-known, bloating, distention, cramping, abdominal pain, headaches, feeling generally unwell, fatigue and increasing the risk of haemorrhoids and anal fissures, did you know that chronic constipation is linked to increasing the risk of other health conditions?

Health conditions linked to constipation

  • Cardiovascular disease (1)
  • Parkinson’s disease (2)
  • Hayfever (allergic rhinitis) (3)
  • Increased all-cause mortality (4)

So, let’s keep those bowels moving! Here are some tips that I give my patients to reduce the incidence of constipation that they can easily incorporate into their daily diet and lifestyle.

How to avoid constipation

  • Water, water, water! – an adult should work towards an intake of 2 litres of water a day for optimal hydration (more in hot climates, or if you are exercising), which will help to move the bowel and improve elimination. Part of the 2 litres of fluid can also include herbal teas that do not contain caffeine (caffeine is a diuretic and increases water loss). There are many people who do not drink enough fluids in a day, which can slow the bowels immensely.
  • Exercise/movement – it’s important not to forget to include a little movement in your day, as moderate exercise can help to accelerate gastrointestinal transit time, which contributes to keeping those bowels moving.

  • Activia yoghurt – although you may think of this as a processed yoghurt, it is the only place in the world where you will find probiotic Bifidobacterium animalis (ssp. lactis DN-173 010/Bifidus ActiRegularis). This specific probiotic strain may help to speed up transit time in the gut (moves things along), so it can be very beneficial for constipation. You only need one of the small tubs (or approximately ½ cup) per day for a therapeutic dose. You can put in a smoothie a couple of times a week to mix it up a bit.

  • Try to have 2-4 serves of fruit a day – kiwi fruit, fresh pineapple, papaya, berries, dragonfruit, mango and prunes. Kiwi fruit (GREEN only), blackberries, prunes and dragonfruit (you need at least 225g if fresh) are especially good at moving the bowel and are high in fibre.

  • Dragonfruit powder – you can purchase dragon fruit in a dried ground powder online if it is tricky finding it fresh (try an Asian supermarket), or frozen (Creative Gourmet in Australia). It is a stunning colour, and you can mix it in yoghurt or have in a smoothie. The dose you need of the dried powder to help move the bowel is 10g.

  • Ground flaxseeds/linseeds are high in fibre, and very mucilaginous (slippery) so they are great for moving the bowel at 1-2 tbsp per day (flat). You can add to smoothies, mix in yoghurt or sprinkle over salads. Best stored in the fridge to preserve their freshness.

  •  Beetroot (fresh) is a nourishing food (in sandwiches, grated in salads), that is full of beneficial phytonutrients (that feed Lactobacillus spp. and Bifidobacterium spp.). Beetroot dip anyone?

  • Bitter Foods – stimulates the vagus nerve and helps the stomach prepare for digestion; add bitter greens into your diet e.g. rocket, endive, chicory, bitter lettuces (normally in most mixed salad bags).

  •  A good bowel moving combo for morning or afternoon tea is: Activia yoghurt (½ a cup) mixed with blackberries (frozen is fine), kiwi fruit (if you can find in season) or mango and 1-2 tablespoons of ground flaxseeds/linseeds and dragonfruit powder (10g).

But what if you’ve tried “everything”, including what I have listed above, and you always end up constipated again, even if you only drop the ball for a few days with your usual supports? If this is you, there’s probably an underlying reason why, and it is important to figure this out.  You can gain more of an insight into possible underlying causes by testing your gut microbiome using a comprehensive microbiome map from somewhere like Microba (or Biomesight, NirvanaBiome or Ombre if you’re outside Australia), or, depending on your symptom picture and health history, we also need to consider the possibility of testing for small intestinal methanogen overgrowth (SIMO) or intestinal methanogen overgrowth (IMO) which can slow the bowel down dramatically (see this blog for more information on SIBO/SIMO).

And all patients who come and see me for any gut related issues will always be asked, much to their delight, to fill in a stool diary for me as well as completing that all important gut transit test as well, which helps to give me a more complete picture alongside the formal testing.

Of course, interpreting any results and advising on possible supports to improve your long-term constipation picture will require the assistance of a well-trained, gut-focussed practitioner to correctly identify the underlying causes, contributing factors and advise you of your best next steps forward.  And don’t worry, there’s lots of additional supports out there, in addition to diet and lifestyle changes, that may assist you to get those bowels moving and regular again.

References 

1.     Sundbøll, J., et al. (2020). “Constipation and risk of cardiovascular diseases: a Danish population-based matched cohort study.” BMJ Open 10(9): e037080. 

2.     Adams-Carr KL, Bestwick JP, Shribman S, Lees A, Schrag A, Noyce AJ. (2016). “Constipation preceding Parkinson’s disease: a systematic review and meta-analysis.” J Neurol Neurosurg Psychiatry. Jul;87(7):710-6. doi: 10.1136/jnnp-2015-311680. Epub 2015 Sep 7. PMID: 26345189.

3.     Wu, M.-C., et al. (2020). “Constipation might be associated with risk of allergic rhinitis: A nationwide population-based cohort study.” PLOS ONE 15(10): e0239723. 

4.     Sumida, K., et al. (2019). “Constipation and risk of death and cardiovascular events.” Atherosclerosis 281: 114-120. 

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