Written By: Lisa Charron, PT, DPT, on August 30, 2022
If you have ever struggled with constipation or loose stools, you know how much bowel issues can impact your quality of life. Many people struggle with bowel health for years before seeking treatment because the symptoms can be difficult or embarrassing to talk about. However, bowel issues are quite common. Although it is estimated that 9-20% of people in the United States are living with chronic constipation without a known cause, 3 out of 5 people with constipation have never discussed their symptoms with a medical provider.1 Meanwhile, it is estimated that about 8.3% of American adults (not including those living in nursing homes or other residential facilities) have accidental bowel leakage, otherwise known as fecal incontinence.2
Some people self-manage their symptoms with over-the-counter medication, or they may receive a referral to a gastroenterologist or colorectal surgeon. However, pelvic physical therapists play a critical role in treating bowel issues due to their unique expertise in evaluating the muscles in the pelvis and abdomen that influence bowel movements. A pelvic physical therapist will also evaluate habits and lifestyle factors that impact bowel health. Here are a few simple lifestyle tips that I often share with my patients to help them achieve better bowel health.
1.) Go to the bathroom at a regular time every day
Have you ever been busy with your daily tasks, waiting for the “call” to go to the restroom, only to find that it never comes? Perhaps you used to feel a signal to go to the bathroom, but outside circumstances, such as discomfort with public restrooms or lack of time prevented you from listening to these signals. Over time, this can lead to the loss of an urge or sensation to go to the bathroom when you need to.
Alternatively, have you ever felt like you are constantly returning to the bathroom to attempt a bowel movement or that bowel movements take an excessive amount of time? Do you strain and push, only to produce very little stool?
In either case, you may benefit from forming more regular and predictable bowel habits. This means finding the best time of day to sit and relax on the toilet. You may find it helpful to try to have a bowel movement 30 minutes to an hour after eating. This is when the colon is stimulated to get moving and push the bowels along. You may also find it helpful to do some gentle stretching/movement or take a walk to get your bowels moving.
2.) Don’t strain – breathe!
Our instinct is often to strain when we are feeling constipated. While some abdominal pressure is often needed to have a bowel movement, straining can cause the muscles around your anus to tighten or squeeze, making it difficult to let the stool out. This is like squeezing a tube of toothpaste as hard as you can but keeping the cap closed. Instead, some people find it helpful to take a breath into their belly and breathe out through their lips like they are blowing up a balloon. This technique may help the muscles around your anus (the pelvic floor muscles) stay relaxed while the belly is applying some gentle pressure downwards to help push the stool out. This might take more practice or guidance, which is where an evaluation by a pelvic health physical therapist can be helpful.
3.) Use a stool under your feet while seated on the toilet
Before toilets were invented, people used to squat to eliminate their bowels. This is because having your knees above your hips helps to relax the muscles that surround the rectum and anus, allowing for stool to pass more easily. You can replicate this by using a stool under your feet to help elevate your knees above your hips while seated on the toilet. Whether it is a stool in your house, or a stool specifically made for going to the bathroom (there are many on the market these days), this is often an effective solution for easier bowel movements.
4.) Watch your fiber and fluid intake
The benefits of fiber for our health are numerous – for example, fiber helps lower cholesterol and controls blood sugar. Appropriate fiber intake can also help with both diarrhea and constipation. This is because it draws in fluid from your body to help make stool not only more formed but also easier to pass. The recommended daily amount of fiber for most adults is 25-35 grams/day. The fiber content of packaged foods can be found by looking at the nutrition label, while the fiber content of common fruits and vegetables can be found with a simple online search. Most people do not eat enough fiber, but it is not recommended to add fiber too quickly, as your gastrointestinal system takes time to adjust to higher amounts of fiber. As you increase your fiber, it is also important to increase your fluid intake with non-caffeinated fluids. While caffeine is great for getting your intestines moving, it also pulls fluids from your body. Our bodies need non-caffeinated fluids like water to soften stools, which is particularly important as you add fiber to your diet.
The above tips are a great place to start on your journey to better bowel health, but a more thorough assessment from a specialist may be needed. Speak with your primary care provider about any bowel health concerns you have, particularly if you have experienced a recent change in your bowel movements, have blood in your stool, or have unexplained abdominal pain. It may also be helpful to consult with a pelvic health physical therapist to evaluate your pelvic floor and abdominal muscles, discuss your bowel habits and give you an individualized treatment plan to improve your symptoms and get you back to better bowel health.
References: 1.) Oh SJ, Fuller G, Patel D, et al. Chronic constipation in the United States: Results from a population-based survey assessing healthcare seeking and use of pharmacotherapy: Results from a population-based survey assessing healthcare seeking and use of pharmacotherapy. Am J Gastroenterol. 2020;115(6):895-905. doi:10.14309/ajg.0000000000000614
2.) Whitehead WE, Borrud L, Goode PS, et al. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology. 2009;137(2):512-517, 517.e1-2. doi:10.1053/j.gastro.2009.04.054