Promoting Bowel Health

What are normal bowel habits? 

A normal bowel habit is having your bowels opened from a minimum of three times a week up to a maximum of three times per day, remembering that bowel habits can vary from person to person.  Changes to your normal routine can affect your bowel habit, such as dietary, environment and emotions. If there is an unexplained change to your normal bowel habit you should inform a health professional. 

Bowel problems 

Although there are several bowel conditions the most common complaints are constipation, loose stool and irritable bowel syndrome (IBS). 

Loose stool 

Loose stool is often defined as having loose, watery stools often with urgency and frequency.  Factors that relate to this include illness, medication, inadequate diet and stress. 

Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome is defined as having an upset in your bowel habit, often fluctuating between loose stool and constipation, accompanied by stomach pain and bloating.  Factors that relate to this include food intolerances, stress and anxiety. 

Constipation 

Constipation is defined as having your bowels open less than three times a week, with hard, small stool and needing to strain, often with pain and discomfort.  Prolonged straining can damage your pelvic floor muscle.

Pregnant women may have constipation as the gut slows down in pregnancy, and it is a common problem following childbirth or surgery.  Factors that relate to this include poor diet and fluid intake, lack of exercise, ignoring ‘the call to stool’, stress, illness and medication. Constipation is a symptom, not a disease.

Common causes of constipation are:

• Irregular meals and not enough fibre in the diet
• Lack of physical activity
• Medications e.g. pain medications
• Irritable bowel syndrome
• Changes in life or routine such as pregnancy, aging, and traveling
• Ignoring the urge to have a bowel movement
• Dehydration
• Problems with the colon and rectum
• Problems with intestinal function (chronic idiopathic constipation)

Fluids 

Fluid intake is very important in maintaining a healthy bowel.  An appropriate fluid intake is 8 glasses (2-2.5 litres) per day. It supports stool consistency and maintains bowel motility.  Remember that when undertaking exercises, or in hot weather or when unwell this may need to be increased slightly.  The types of fluids that you can drink can affect your bowel.  Consider gradually reducing caffeine intake and avoid alcohol and fizzy/carbonated drinks. 

Diet 

A well-balanced diet is essential to maintain a good bowel routine and reduce possibility of developing bowel disease in the future. Individuals need a balance of fruit and vegetables (soluble fibre), aim for five portions a day, and wholegrain foods such as cereals, brown bread and pulses (insoluble fibre) 

Golden Linseed/milled flax seed of the flax plant has both soluble and insoluble fibre in it and is also rick in Omega 3.  These seeds sprinkled over food such as cereal, soups and salads can be beneficial in regulating bowel habit if taken daily. It should be sprinkled in quantities of 1-2 tablespoons.  Drink a glass of fluid when you take Golden Linseed/milled flax seed. 

Table 1: Example of Food sources – Fibre 

Soluble Fibre – dissolves in water within the bowel and forms a soft gel-like substance, which draws water into the stool and eases their passage through the bowel.  

Insoluble Fibre – does not dissolve in water, it helps draw water into the stool to soften it up, speed up stool transit time.  

*The recommended target of fibre is 30g per day for those 15years or older* *Increasing fibre intake requires adequate and recommended fluid intake*  

Following the link below for more useful information: - How to get more fibre into your diet - NHS

Routine 

Bowels like routine and regular meals.  Starting the day with breakfast can help to stimulate the bowel.  It is important to respond to the urge or ‘call to stool’, because if it is ignored on a regular basis it can lead to constipation and long-term bowel problems. Sitting on the toilet routinely, particularly after meals, can encourage your bowel to open. 

You should allow time whilst sitting in the correct position to encourage bowels to open and empty fully. The correct position is to have your knees higher than your hips and your feet on a firm surface (you may need a foot stool to achieve this). 

To avoid straining, the ‘Brace technique’ can be used. 

This method uses the abdominal muscles to encourage a bowel movement without straining: 

• Sit in the correct toileting position with feet elevated on a stool 
• Brace (tense) your abdominal muscles 
• Bear down into your rectum 
• Breath out slowly 
• This can be repeated several times 

Lifestyle 

Regular exercise is beneficial for your general health and bowel health. Physical activity can stimulate the bowel.  Practicing pelvic floor exercises will strengthen your muscles giving you more control of your bowel. 

Smoking damages collagen in the muscles and therefore causes poor muscle tone.  It is also known that smoking is linked to cancer of the bowel. 

If any regular medication you may be taking is affecting your bowel habit, discuss these concerns with your GP.  If you are using over the counter medication for your bowels, it is advisable to discuss this with your health care professional. 

If you have read the advice in this leaflet and implemented the changes but continue to struggle with your bowels and would like further support. You can make a self-referral to the perinatal pelvic health service via the following website and filling out the self-referral form at the bottom of the page https://bswtogether.org.uk/maternity/pelvic-health/