First published Winter 2018


 

With the invention of the water closet, defecating became a very private affair; so much so that bowel movements became something one did not discuss. We find out why we should

 

Three years ago, in an article about food fears (Optimum Nutrition Summer 2015), an interviewee whose only consumption of fruit was via an occasional tin of tomato soup or the tomato puree on her Margherita pizza, and who ate no vegetables at all, confided that she had a bowel movement “once a week, a week and a half — two weeks”. Yet she did not think that her diet of chips, pizza and cake gave her “issues”. She did not know that one bowel movement once a week or fortnight was not generally considered to be optimal and said at the time: “Nobody ever talks about it”.

This is true and a mighty shame, because many dietary and gut-related problems could be flagged up just by discussing what every living creature does (nearly) every day.

There is a selection of choice words for the waste that we excrete from our bowels, but for the sake of sensitivities let’s call it ‘poo’ for the duration of this article. And let’s be clear: nutritional therapists typically love to discuss poo. Registered nutritional therapist Naomi Langford-Archer says: “I love talking about poo and talk about it every day with clients. I don’t usually find any barriers here, as I am so open and comfortable talking about it myself. However, I do find that people rarely link their stool type and bowel movements to the health of their body and mind.

“It’s the best free diagnostic tool that you have — so use it!”

The Bristol stool scale is a chart that was designed to help people talk about their bowel movements. Developed by gastroenterologists in the late 1990s, it has since been used as an aid for communication — because it can be much easier to point to a picture than go into details. The scale details seven types of bowel movement; from severe constipation to severe diarrhoea.

“...I do find that people rarely link their stool type and bowel movements to the health of their body and mind”

Langford-Archer says the scale provides a great way to assess the health of our digestive system, which can be affected by diet, hydration, medication and stress. An “ideal” stool type, she says, would be a three or a four. One and two indicate constipation, and five, six and seven indicate diarrhoea and urgency. Also, the “ideal”, she says, would be to have up to three bowel movements a day, although it will vary from person to person.

Signs and symptoms

“If [bowel movements are] coupled with pain, cramping or mood changes then I would recommend a comprehensive stool analysis to assess inflammation levels, immunology, commensal bacterial levels (healthy bacteria), digestive secretions (how well the pancreas is working), fat absorption (indicating liver and gallbladder health), as well as any bad bacteria and parasites that may be residing in the gut,” she says. For anybody who has noticed blood or mucus in their stools, she would advise speaking to a GP — and not to be embarrassed.

“Talking about poo around the table of a friend’s dinner party might not be the optimum time to discuss your bowel movements, but talking to a qualified practitioner or GP is definitely ok,” says Langford-Archer. “Don’t be embarrassed about talking about this because we talk about it all the time. If you are experiencing pain, it could be that you have an intolerance to certain foods which can easily be resolved, or it could be something slightly more serious such as ulcerative colitis or Crohn’s disease — which can both be reversed. If you experience pain, blood or mucus in your stools, chronic constipation or diarrhoea, then don’t be embarrassed and wait — as your problem will most probably be getting worse and could result in a devastating outcome. Seek help and talk about it.”

Diarrhoea or urgency

“Diarrhoea is your body’s way of naturally expelling anything that shouldn’t be there or doesn’t agree with you,” says Langford-Archer. “If your stools are type five, six or seven, I would be considering [a range of factors including] ‘leaky gut’ syndrome, inflammatory bowel disease such as Crohn’s disease or ulcerative colitis, coeliac disease or gluten sensitivity, lactose or dairy intolerance, food allergies, dysbiosis of gut bacteria, parasites, infection, stress and anxiety.

“There is no one size fits all approach to addressing diarrhoea — firstly we have to ascertain the cause. For example, if you have been diagnosed with IBS that is stress-induced, we would need to focus on calming your nervous system down first. Or you may have been away on holiday and experienced diarrhoea which is ongoing, in which case you may have picked up parasites or bacteria that need to be eradicated.”

Langford-Archer offers some general tips for anyone experiencing acute episodes of diarrhoea:

Avoid dairy because this can be hard for the body to digest.

Avoid gluten. For some individuals it can be pro-inflammatory and impair the gut lining.

Avoid added sugar and artificial sweeteners because ‘bad’ bacteria love to feed off these. Have your sugar cravings increased since suffering with diarrhoea? If so, it may be that you have some ‘bad’ bacteria that need eradicating. A stool analysis may help to identify possible causes.

Avoid caffeine because it stimulates further bowel movements.

Stay hydrated — you may be thinking that drinking lots of water is that last thing you should be doing when pooing water, but you lose key electrolytes as well as water when you have diarrhoea. Langford-Archer suggests drinking coconut water, bone broth and filtered water.

Supplement — she recommends Saccharomyces boulardii, a yeast that acts as a probiotic, to help alleviate diarrhoea.

 

What’s your gut feeling?

If you’re wondering what your gut is telling you, this handy humorous swatch guide by Matt Roach could help. Know Your Sh*t: What Every Type of Turd Says About Your Health is filled with toilet humour and a dash of wit to describe different types of bowel movements — from “No poo” to “Poodini”.

Know Your Sh*t started life, says Roach, as a swatch guide to baby poo, which he made for a friend who had become a dad.

“I’d heard that all new parents become obsessed with their child’s nappies because it’s such an important indicator of their health. My friend found it so funny and useful, I decided to send copies to publishers and it was Penguin Random House UK’s idea to publish a guide for adults as well. So, although this one is out first, it’s actually book number two. Know Your Baby Poo: A Parent’s Guide is coming out in March 2019.”

So far, says Roach: “It hasn’t received any c**p reviews, although my grandmother was rather taken aback when I showed it to her... I did explain the concept beforehand, but she obviously didn’t understand what I was talking about. I think she was expecting a novel.”

Use your judgement on whether it is suitable for younger readers (it has plenty of toilet humour and uses the word b******. Yet it made an impression on one small child. “The guy who illustrated the swatch has a five-year-old daughter who has memorised the names of all the poo types,” says Roach. “Apparently, she regularly runs out of the toilet shouting, ‘Daddy, I’ve done a Turdinator!’”

Jokes aside, it does have a serious purpose. “The guide should teach you some fascinating facts about your faeces. Most importantly, you’ll learn to spot signs of illness such as bowel cancer — more than one in three people aren’t aware of any of the symptoms. And of course, I hope all the gags and puns entertain people along the way.”

Know Your Sh*t: What Every Type of Turd Says About Your Health, by Matt Roach. Vermilion. £8.99.

 

 “..A very common reason as to why many people struggle to pass easy and regular stools is stress. When the body is in flight or fight mode it is far less focussed on bowel movements due to the much bigger issue your nervous system thinks it needs to address”

 

Constipation

If you are regularly suffering from constipation (Bristol stool scale types one and two) there can be several causes. Laxatives and stool softeners can be helpful in this situation, but it is possible to use diet and lifestyle to address the problem. Langford-Archer describes problems she would look for:

Stress: “A very common reason as to why many people struggle to pass easy and regular stools is stress. When the body is in flight or fight mode it is far less focussed on bowel movements due to the much bigger issue your nervous system thinks it needs to address... [Try] stress reducing techniques such as yoga, meditation and breathing exercises.”

Diet: “Low-fibre diets that are high in processed foods, sugars, alcohol and unhealthy fats such as trans fats cause harder stools to form.... Eat foods that are natural, avoid artificial sweeteners, eat plenty of green leafy vegetables, beans, nuts, seeds and oily fish. Some people who have not been diagnosed with coeliac disease may also experience improvements with a gluten-free diet.”

Fibre: “Another common cause of constipation, the typical Western diet lacks adequate amounts of fibre. Soluble fibre allows more water to remain in your stool, making it softer and easier to pass. Insoluble fibre adds bulk to your stool which triggers movement through your bowel... Eat foods high in insoluble fibre such as flaxseeds, okra, asparagus, sweet potatoes, broccoli, kale, Brussels sprouts and the majority of vegetables. Foods high in soluble fibre include wholegrains, oats, berries, pears, beans and pulses, nuts and seeds.”

Hydration: “Stools need adequate water to pass through the colon without difficulty. If you are increasing your fibre intake you also have to increase your hydration intake too as fibre needs water to pass through the digestive tract... Drink 1.5-2 litres through the course of the day. Herbal teas such as fennel and liquorice are particularly good at getting the bowels moving.”

Thyroid problems: “Hypothyroidism or inadequate thyroid hormone levels can cause a sluggish bowel... If you are feeling lethargic, tired, lacking in energy, with poor bowel movements, book an appointment with your GP and request a thyroid test. This can also be done privately through a registered nutritional therapist.”

Magnesium deficiency: “This reduces peristalsis (the contraction and relaxation of muscles moving stools along the bowel) in the colon... One way to address this is to soak in an Epsom salt bath for 20 minutes three times a week. Alternatively, you can take magnesium supplements; there are many different magnesium compounds but for constipation take magnesium citrate.”

Imbalance of gut bacteria: “A healthy gut microflora is so important for gut health and regular bowel movements. Antibiotics can cause imbalance (dysbiosis) of healthy gut bugs... By increasing your fibre intake you will be providing prebiotics (food) for your good gut bugs to feed off and multiply. However, if you have taken antibiotics I suggest taking a quality probiotic supplement (make sure it is a good quality one as there are many on the market that cannot withstand the stomach acid) every day for a month and then move on to fermented foods and drinks.”

Exercise: “This helps to control stress levels, increase blood flow to the area, and strengthen muscles... Get moving! This might just be a 20 minute daily walk, or 10 minutes of high intensity interval training at home.”

Medications: “Certain medications such as antidepressants, painkillers, antibiotics and antacids, to name a few, can play havoc on our digestive tract... Make sure to take on board as many of the above points as possible. Maybe coming off your medication may be an option if you discuss this with your GP. If you are taking painkillers, for example, discuss with your GP if it is possible to address the root cause of your pain, and whether there is an alternative approach.”

Naomi Langford-Archer can be contacted through: www.gutnutrition.co.uk

 

DID YOU KNOW?

Fast or all-stopping service?

The time it takes for food to pass through the human gut is called transit time. From end to end, food has to travel about eight meters in the average adult.

According to one study, however, the slower the journey, the greater the potential impact on gut health. This is because when the transit time is slow, once carbohydrates — gut bacteria’s food of choice — are depleted, the bacteria then begin to break down proteins instead, which leads to less beneficial by-products such as ammonia and sulphur compounds.

Shorter transit time is associated with substances that are produced as the colon renews its inner surface — and so which may be a sign of a healthier intestinal wall. Rich bacterial composition in stools is also associated with slower transit times, indicating that diverse bacteria in stools may not always be an indicator of good gut health.¹

When will I see you again?

Because transit time differs from person to person, and even then we can experience differences from day to day, there is no single transit time for everybody. However, an ‘ideal’ transit time could range from 12 hours to 48 hours. To find out how long your transit time is, from end to end, eat some sweetcorn — even if you take time to chew, some of it will reappear in due course! To be sure, though, only eat sweetcorn on one day, so when it reappears you know for sure when it started its journey.

Children and babies

The NHS says “it’s likely to be constipation” if you or your child has not had at least three bowel movements in one week — but says that it’s not unusual for a breastfeeding baby to go for a week without having a bowel movement. For children and toddlers it says signs of constipation to look out for are: a lack of energy; being irritable, angry or unhappy, and soiling their clothes.2

Don’t ignore it

Some people fight the urge for a bowel movement because it just isn’t convenient to go. You may feel embarrassed to go to the toilet at work, college or school and so hold on to it until you get home. However, not only is this very uncomfortable, but it can contribute to constipation and difficulties later on.

A fantastic (‘IDEAL’) journey

How long your food can take to leave each stop on its way out:

Mouth 30 - 60 seconds

Oesophagus 4 - 8 seconds

Stomach 2 - 4 hours

Small intestine 3 - 5 hours

Colon 6 - 48 hours

Anus Dependant on loo reading material!

 

Morning routine

Taking time to have a warm drink and some breakfast in the morning can stimulate the urge for a bowel movement. Also, doing a bit of light exercise can help to get things moving — which is why it’s not uncommon for people to feel the urge during or after exercising. So if you are able to shake things up a bit in the morning, this may help to encourage a bowel movement.

Over the counter

There is a plethora of laxatives available over the counter. The NHS states that these are divided into four types:

  • Bulk-forming, these include ispaghula husk and methylcellulose. These act in the same way as dietary fibre — increasing stool bulk by helping them retain fluid, encouraging bowel movements.
  • Osmotic, such as lactulose and polyethylene glycol. These increase the amount of water in the bowels, softening stools and making them easier to pass.
  • Stimulants, such as bisacodyl, senna and sodium picosulfate. These speed up bowel movements by stimulating the nerves that control the muscles lining your digestive tract.
  • Stool softeners, such as arachis oil and docusate sodium. These increase the fluid content of hard, dry stools, making them easier to pass.2

Except when people may have problems with bowel movements because of a pre-existing condition, most over the counter laxatives do only what food, liquid and exercise can do. If you find that you are relying on laxatives, consider addressing your diet. Research has found that although medication can help, successful treatment of constipation can be achieved with lifestyle changes. And if you don’t want to take things out of your diet, think about what you can add in — what vegetables and fruit you can add to your day and which may help to feed your gut. But remember, changing your diet may cause gas and noticeable changes — this may not be something to worry about, and should settle as your gut gets used to new sources of fibre. 

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References

  1. Technical University of Denmark (DTU). Food’s transit time through body is a key factor in digestive health. ScienceDaily. ScienceDaily, 27 June 2016. www.sciencedaily.com/releases/2016/06/160627125525.htm
  2. www.nhs.uk/conditions/constipation