Tips for Maintaining Healthy Bowel Habits and Strengthening Your Core

"Everyone Poops" is a children's book designed to assist with toilet training. From a rhinoceros pooping to a human being using a toilet, it intertwines humor with the reality that every living creature eats and therefore every living creature eliminates waste.

Elimination should be a natural process and not difficult, but as our diets have tried to acclimate to processed food, additives and pesticides, our digestive systems have not. This has resulted in a multitude of problems with elimination including constipation, excessive gas and bloating, irritable bowel syndrome and more. If you suffer with these issues, you are not alone. Many elimination issues can be linked to Irritable Bowel Syndrome, or IBS, which is a functional condition of the large intestine/ bowel and is the most chronic health disorder in the US, Canada, UK, Australia and New Zealand, affecting more individuals than asthma, diabetes and depression combined! In addition, 75% of individuals diagnosed with IBS are women. IBS is often diagnosed after other medical issues or diseases are ruled out, which involves many invasive tests and procedures, contributing to the emotional component of the disorder. Symptoms that require further medical testing include passing blood, swelling extremities and joint pain and are NOT considered to be IBS. IBS is characterized by lower abdominal pain or discomfort, altered gut motility (constipation or diarrhea), gas, bloating and/or nausea.

​Criteria for IBS are based on ROME guidelines and include the absence of structural or biochemical explanation. The ROME guidelines for IBS include:

• >12 weeks of symptoms (not necessarily consecutive) in the past 12 months

• onset associated with a change in stool frequency

• onset associated with a change in stool appearance of form

Symptoms that support the diagnosis of IBS according to ROME guidelines include:

• >3 BMs (bowel movements) a day

• < 3 BMs a week

• hard/ lumpy stools

• loose/ watery stools

• straining to have a BM

• urgency (sudden need to rush to have a BM)

• feeling of incomplete bowel emptying

• passing mucus during a BM

• abdominal fullness, bloating or swelling

I was one of those people diagnosed with IBS, also known as "spastic colon", in my teens after repeated diagnostic tests, including an exploratory laparoscopy, revealed everything was "normal." I had constipation, excruciating abdominal pain and distension, incomplete emptying and mucus in my stool, but no explanation or solution. I probably didn't discover a cure for my symptoms until my late 20s when I began to link my diet to the problem, which I discovered accidentally when my infant son developed a milk protein allergy. Based on the recommendation from the pediatric allergist since I was breastfeeding, I was encouraged to eliminate all dairy products or anything containing casein or whey (milk proteins) from my diet. This was the beginning of a several year journey of discovering my true health potential and getting to the bottom (literally) of my problem. The gut is linked to so many health problems, including the immune system and mental function due to the “gut brain.” Research is confirming that inflammation is at the heart of most disease as it negatively affects all the other systems of the body. As a physical therapist, the musculoskeletal and neurological system is of great importance to me. Gut inflammation can cause myofascial trigger points due to an altered nervous system as nerves are responsible for muscle tension.

One of the problems with constipation is the increased stress on the pelvic floor and abnormal muscle patterns that a person develops as a result. The pelvic floor has to relax in order for the bladder or bowel to contract via the sacral micturition reflex. An individual with constipation is prone to muscle spasms in the pelvic floor from closing off the sphincter and tightening, instead of relaxing the muscles, which should occur naturally during elimination. If a person is tightening the sphincter to keep from passing gas or postponing defecation, the muscle can further develop a spasm or charley horse that can be extremely painful, known as proctalgia fugax. In addition, downward pressure and straining to void can contribute to pelvic organ prolapse, where the uterus, urethra, bladder or bowel can descend into the vaginal canal. Click here to read more about pelvic organ prolapse.

BRISTOL STOOL CHART

I recommend looking at your stool to identify if there is a problem. Type 3 or 4 is ideal for elimination. Type 1 or 2 indicates constipation. Many think constipation means not going in a few days or always straining to defecate. If there is a history of hemorrhoids, I can tell the person has had constipation at some point, from pushing or straining too hard. Incomplete evacuation can occur with type 5, 6 or 7, creating bloating or pressure on the bowel and bladder.

Diet plays a large role in inflammation and bowel dysfunction. To learn more about reducing inflammation in the gut, click here. Magnesium deficiency is a problem in most Western diets according to many experts. Magnesium plays a role in the health of both smooth and skeletal muscle tension. If you have muscle pain and/or trouble eliminating, you might benefit from supplementing with 400 mg of magnesium oxide. Our family allergist recommends modifying the dosage until stools are soft, but formed. Others recommend taking chelated magnesium, since it is more easily absorbed. My recommendation is to use what works for you! This is not to replace medical advice, but as an adjunct and natural way to avoid taking medications and something you should discuss with your doctor or provider.

SELF TREATMENT TO INCREASE GUT MOTILITY

Colonic massage - I learned the "I Love U" massage from an infant massage book and have used it ever since on my children, myself and patients. It can be done daily or as needed. The colon (large intestine) is shaped like an upside down U beginning with the right side and going clockwise. 1) Begin with a deep stroke from the left side of the abdomen downward towards the hip to create a capital "I". 2) Return to the right side of the ribcage, making an "L" to the left and down towards the hip. 3) Return to the right lower abdomen making an upside down "U" on the way to the left lower abdomen (see illustration). Repeat the cycle up to 5 times. This can work immediately to promote an urge or at night before going to bed for better elimination in the morning.

Ileocecal Valve Release - I learned about the ileocecal valve after taking a visceral mobilization course for pelvic pain. I was astonished how effective it was at relieving gas pain. The valve is a one way opening. If a person has adhesions, this valve may be stuck, keeping stool in the small intestine longer and contributing to more pain, bloating, and/or bladder pressure. This is the typical bloat many experience and can be reduced in just one treatment. The ileocecal valve is located halfway between the belly button and the bone on the front of the hip, is the size of a dime and feels like the tip of your nose under your skin. It is often tender, which is another way to know if you are in the right place. (see photo below). Press hard while turning it clockwise, then release and repeat. For severe constipation, several minutes may be required until it is no longer as tender, or until an urge occurs.

PELVIC FLOOR RELAXATION EXERCISES

Proper elimination requires learning how to relax the pelvic floor muscles. This can be accomplished through specific hip and groin stretching and deep diaphragmatic breathing or what we refer to as reverse Kegels. Schedule an evaluation with a pelvic floor physical therapist for customized exercises to address pelvic floor tension.

DEFECATION MECHANICS

I cannot finish this blog without emphasizing the importance of bowel mechanics. This is simply physics in action and I discovered it when my kids were toilet training. My kids would use the sink stool to put their feet on while using the toilet or I would find them squatting behind the couch. By altering the anal rectal angle, they were able to eliminate easier. Adults can do the same thing by leaning forward while on the toilet or placing the feet on a stool. There are some that might argue that the invention of the toilet actually altered this important relationship and anal rectal angle and there are less problems in cultures where elimination is performed while in a squatting position. Another suggestion includes utilizing the gastrocolic reflex and attempt to void 15 to 20 minutes after a meal (ever notice an urge after eating?). Another way to relax the pelvic floor is by opening up your mouth as if saying "ah" instead of clenching or bearing down. Since all sphincters basically communicate with each other, by opening up the oral sphincter, the rectal sphincter will open. If no urge is present, you can also try wiping since the stimulation of the perineum can relax the muscles and create a contraction or urge within the colon.

In summary:

1. Utilize the gastrocolic reflex by attempting to void 15-20 minutes after eating or drinking something warm such as coffee or tea.

2. Sit on the toilet with the body and legs less than 90 degrees; for example feet on a stool or leaning forward.

3. Open your mouth as if saying “ah” to relax all the sphincters, beginning with the oral sphincter.

4. Try wiping if no urge is present.

5. Repeat the steps and leave the toilet after 10 minutes if no stool has passed. Avoid bearing down or holding your breath! Do not sit there and strain!

Normal elimination is essential for pelvic floor health. If you are unable to normalize elimination on your own, look for a pelvic health physical therapist in your area, who can evaluate your pelvic floor, provide manual therapy and customize an exercise program for you. You may also benefit from consulting with a nutrition or functional medicine practitioner who understands allergies, inflammation and the importance of normalizing your stool. A healthy core is only possible with healthy bowel habits. Learn more by scheduling an appointment with a Healthy Core expert at (330) 528-0034.

References:

Lecture Notes from the Institute For Brain Potential, Preventing and Managing Chronic Inflammation: Special Focus: Nutritional Interventions (2014) presented by Nicholas Hall, Ph.D., Director of the Center for Psychoneuroimmunology, University of South Florida.