A Physiotherapist and Dietitians Guide to Good Bowel Health
We’ve all been there, when we think we can take on the ‘extra hot’ vindaloo curry, until the toilet trip afterwards tells us otherwise… Or the extended family member who asks about your bowel frequency over dinner. Most of us can appreciate a joke about poo but going to the toilet to move our bowels is a very important and an essential part of our digestion.
Having good bowel habits comes down to a lot of different factors: diet, fluid intake, exercise, weight, medications, positioning, muscular and/or sphincter control, sensation etc.
Movement, Positioning and Bowel Health:
Firstly, let’s talk anatomy. The digestive track starts with the mouth and ends at the anus. After our food enters the stomach, it enters and moves along into the small intestines. It is in the small intestines where nutrients from our food are absorbed into the blood stream, with the ‘dregs’ becoming a thick liquid paste (the consistency of thick pea soup - delicious!). It is from here that our ‘pea soup’ enters the colon or large intestines. This is where water is absorbed, and stool (poo) is formed - moving along the colon into the rectum ready for a convenient time for expulsion.
In more detail, colonic activity or peristalsis are the waves of mass movements that occur intermittently along the colon to send waste (poo) to the rectum. This mass movement will happen approximately 4-5 times per day, often set off by waking in the morning or due to the ‘gastrocolic reflex’ i.e. in response to consuming a warm drink or meal (Hallam, 2019).
Here are two tips on how to improve your bowel routine:
Tip 1: The best time to initiate defecation/moving our bowels is within 30-60mins of waking OR after eating (Hallam, 2019).
Tip 2: Rethink your toileting position. Picture the ‘thinking man’ statue. This position has been found to allow defecation to occur with minimal strain and in an efficient manner (Takano & Sands, 2016).
“The Thinker” Position:
You want knees higher than hips (try a small footrest or 1 toilet roll under each foot)
Keeping your back straight, lean forward placing your elbows on your knees
Relax your abdomen and breath normally
Going to the toilet isn’t always as easy as doing Tips 1 and 2. There can be underlying issues that may need to be addressed. Sometimes it can be as simple as altering your bowel routine, drinking a little extra water or allowing time for ‘evacuation’ to start the ‘movement’. If you are having difficulties, be sure to make an appointment to discuss in person.
As Shane Jacobson “Kenny” puts it – make your number 2 your number 1 priority!
Bowel health and diet:
It is no secret that diet plays a huge role in our bowel health. One of the main components of our diet that impacts our bowel is fibre. When someone comes to see a Dietitian about bowel issues, one of the first things we look at is fibre intake.
So what is fibre, apart from being a word on the cereal box? Fibre is a polysaccharide, which is a form of carbohydrate, and is indigestible to us. As a carbohydrate, it comes from plant-based foods, such as vegetables, fruits, legumes, beans and grains. Fibre passes through our body somewhat unharmed, being ingestible, which is overall good for our health and gut. There are three types of fibre, each with a different function and health benefits.
Soluble fibre helps to slow the emptying of our stomach, helping us to feel fuller and avoid overeating. This type of fibre forms a gel in our gut via absorbing the water in our stomach, which helps manage our waste (we need to get comfortable talking about bowel movements!). Another positive is that it assists in lowering cholesterol and managing to stabilise blood sugar levels. This fibre is found in fruits, veg, oats and legumes (beans/lentils).
Insoluble fibre helps to bulk up our waste and keep our movements regular– think of it like a broom, sweeping away food. It helps to keep us feeling full and generally keeps the bowel healthy. This form of fibre is found in the skins of fruits and vegetables, wholegrain breads and cereals, nuts, kidney beans and chickpeas.
Resistant starch isn’t digested in the upper part of our guts like the other fibres and is moved straight to the large intestine. Here its role is to produce good bacteria and help in overall bowel health. Resistant starch is found predominately in undercooked pasta, under ripe bananas (that waxy feeling!), cooked and cooled potato and rice.
Why do we need fibre?
Fibre is just good for the gut. It keeps us regular, keeps us feeling fuller for longer, helps digestive health and can help to prevent some diseases. Need I say more? Probably, yes. Research has found that increasing fibre intake in our diet is likely to reduce cardiovascular disease risk, diabetes and weight gain. Aune et al. (2011) concluded that a high intake of fibre, in particular wholegrains, reduced the risk of bowel cancer. If that doesn’t make you increase your fibre, I don’t know what will.
How much do I need?
The amount we need varies between males and females, but generally Australian adults require around 25-30g per day. If you follow a varied diet, it will be easy to keep your fibre up. This means including a range of fruits and veg (2 & 5 a day!), choosing wholegrain options in the form of rice, oats or quinoa, and going for wholegrain breads and pasta.
One last thing… water and fibre go hand-in-hand, so remember to keep your fluid intake up daily. It’s simple: fibre absorbs water, so with no water, we can get ‘backed up’, and no one wants that! Eight glasses of water day is the standard recommended amount, but start slow and build your way up.
By
Sarah Champion (BPhysio, Lively Physiotherapy) & Nicholas Veivers (BDietetics, Fuel Your Life)
The month of June was Bowel Awareness Month. Clink on the links below for more about your Bowel Health.
https://www.bowelcanceraustralia.org/
https://www.health.qld.gov.au/news-alerts/campaigns/cancer-screening/bowel
References:
Aune, D., Chan, D., Lau, R., Vieira, R., Greenwood, D., Kampman, E. and Norat, T. (2011). Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. British Medical Journal, 343(nov10 1), pp.d6617-d6617
Hallman, T. (2019). Anatomy & Physiology: The Defecatory System, day 1, topic 1 notes [PowerPoint slides]. Retrieved from 2019 WHTA Pty Ltd: Women’s Health Physiotherapy 5 Day Intensive Introduction.
Takano, S., & Sands DR. (2016). Influence of body posture on defecation: a prospective study of "The Thinker" position. Tech Coloproctol, 20(2), 117-21.