Bowel Habit

The Healthy Bowel

A normal and healthy bowel pattern is different for everyone. One person might have a bowel movement every three days, while another person might have more than one bowel movement every day. Both patterns are healthy and both are normal. A persistent change (as in continuing for more than 6-weeks) in your personal bowel habit may signify a serious medical condition and an early appointment with your General Practitioner should be sought.

There are many ‘non-serious' causes of a transient or short-lived change to your bowel habit including dietary change, many viral illnesses, medications etc. The key thing to remember here is that if the change is persistent you must see your doctor.

What follows in this information leaflet is a guide to maintaining a healthy bowel and a regular bowel habit.

How to keep your bowels healthy

Your diet is the most important factor in maintaining a healthy bowel. Eat a variety of foods from each of the four food groups with an emphasis on the fibre and fluid content of your diet:

• Eat regular meals throughout the day. When you eat often, stool keeps moving through your bowel. Do not skip breakfast; it is one of the most important meals of the day and probably the easiest time to take high fibre foods.
• Try to eat 25 to 30 grams of fibre each day (see the table at the end of this leaflet). Fibre absorbs water, which keeps the stool soft and increases its size, making it easier for the body to push it through the bowel.
• Drink at least six to eight glasses of fluid each day to keep the stool soft. Milk, juice and water are good choices. Coffee, tea and soft drinks contain caffeine, which makes your body lose a substantial proportion of the fluid you consume by acting as a diuretic (produces more urine). Alcohol has a similar effect. You can drink all of these but do so in smaller amounts and increase the non-caffeine/alcohol fluids in your diet.
• Try to avoid the use of laxatives. Most people with a balanced & healthy diet will not need to use them, especially if following the advice in this leaflet. After prolonged use some laxatives will cause the bowel muscles to become lazy and will make bowel problems worse. Concentrated fibre sources are safe to use every day, but again are not necessary if following the advice in this leaflet.

Try to be active every day. Exercise helps with digestion and helps stool move through the bowel.

What is a ‘normal' bowel habit?

Most people tend to have their bowels open once a day, usually in the morning. If your bowels don't work like this, do not worry! Your bowel habit may be different from this. It is not necessary to go once a day in the morning, despite what your Granny may have told you! Some people may go every other day or twice a day etc. The important thing is that your bowel habit is ‘normal' for you. Generally it is unhealthy to have you bowels open less frequently than 3 times per week or more than 3 times per day.

Another myth to dispel is that you should remain on the toilet until you have ‘completely emptied' your bowels. Generally it is not advisable to spend longer than 2-3 minutes on the toilet. Spending longer periods on the toilet reading the morning paper should be avoided as this encourages the pelvic floor muscles to relax and any subsequent straining will allow the lining of the bowel to descend lower than normal. This may make you more prone to rectal prolapse or prolapsing haemorrhoids (piles). In general excessive straining should be avoided for the same reason.

What bowel symptoms should I worry about?

If you have any of the following you should arrange an appointment to see your doctor at your earliest convenience:

• A definite change in your ‘normal' bowel habit lasting more than 6-weeks.
• Persistent rectal bleeding on a frequent basis
• Rectal bleeding with a change in bowel habit to looser faeces and/or increased frequency persistent for more than 6-weeks.
• Dark red as opposed to bright red rectal bleeding
• Any bleeding that is mixed in with your faeces

All of the above may be entirely innocent but should be checked out by a qualified doctor.

Fibre

Fibre (also known as roughage) is the structural part of the plant, it is the framework that supports and holds the plant together and is therefore only found in foods of plant origin. Many research studies have shown the beneficial effects to our health of fibre in the diet. Despite this the western diet has shown a gradual deterioration in the amount of fibre in foods and the amount of fibre we consume.

• Fibre is extremely hardy, you can chew it, swallow it and subject it to stomach acids, yet most of it passes through your body unchanged.
• Fibre acts in the bowel to:
• Increase faecal weight
• Increase colonic transit
• Increase frequency of bowel evacuation

There are two types of fibre in our diets - soluble and insoluble; each has a different effect on the gut. A healthy diet will contain a combination of these 2 fibre types.

Soluble Fibre

Food types, which are predominantly high in soluble fibre, are:

Soluble fibre is effectively broken down by certain types of colonic bacteria producing energy and gas. The fibre forms a gel-like substance in the stool, which can bind to other substances in the gut having additional benefits such as lowering cholesterol levels.

Insoluble Fibre

Foods predominantly high in insoluble fibre are:

• Roughage foods with skins, husks and peels
• Fruit and Vegetables with their skins and pips
• Wheat
• Rice
• Nuts and some Legumes
• All other cereals

Insoluble fibre is less easily degraded by colonic bacteria but holds water very effectively (up to 15 times its weight in water) thus contributing to an increase in stool weight and size

How much do we need ?

There is no simple answer to this question. It should be noted that it is possible to have too much fibre in the diet, leading to bloatedness, abdominal pain, and increased wind and in some cases diarrhoea. The recommended average total fibre intake should be in the order of 20 - 35gramsms per day. It is important to stress, as with a ‘normal' bowel habit these recommendations may not be appropriate for you.

Increasing the amount of fibre in your diet

• Follow a healthy natural high fibre diet. This is the best option as it will ensure that not only are your fibre sources natural and varied but also that your diet will contain the correct balance of other nutrients.
• Eat fibre-enriched foods such as specially produced high fibre muffins and biscuits etc. These will most certainly increase your insoluble fibre intake but will not rectify any other dietary imbalances. Be careful to ensure that such items are not too high in fat and sugar as is often the case.
• The limited use of fibre extracts or supplements in the form of bran, tablets, powders and granules. The use of bulk forming laxatives (eg Fybogel ™, Normacol ™) can be beneficial in the early stages of dietary manipulation but only until the higher fibre healthy diet is established and should not be viewed as a long-term solution.
• Be patient! It may take a few days or a couple of weeks for the effects of the high fibre diet to be noticed by your bowel and an improvement made.

Fluids

High fibre diets are not the only answer to a happy healthy bowel. Without fluid, and without increasing the amount of fluid when changing to a high fibre diet then dietary fibre cannot do its job. Insoluble fibre in particular acts like a sponge absorbing water, increasing in stool weight and size, thus putting pressure on the bowel wall and making it easier for the bowel to move the stool. Without increasing the amount of fluid the high fibre diet is pointless and will only constipate you further.

How much fluid?

• Drink at least 1500-2000ml (3-4 pints) per day. Suitable fluids include all non-caffeine and non-alcohol based fluids like water, herbal teas, well-diluted fruit juices and fruit squashes.
• Aim to drink a glass of suitable fluid every hour
• Have a bottle of water on your desk and with you all the time, in the car, on the train etc.
• Decrease the amount of tea, coffee and alcohol to not more than 3-4 cups per day.
• Drink when exercising

Fibre content of different foods

Download this leaflet as a PDF file -