Bowel health can be uncomfortable to discuss, but it provides a good indication of your overall health. Developing and maintaining healthy and regular bowel health routines are imperative for staying healthy.
For some, improper bathroom habits, such as ignoring the urge to defecate, hovering over the toilet, or not allowing enough time to empty the colon, can develop in childhood and follow us into adulthood. Others develop bowel issues as adults through sickness, sensitivities, microbiome changes, pain, or various diseases such as irritable bowel syndrome, Crohn’s disease, and diverticulitis. Ignoring changes, irregularity, or discomfort in your bowel health can mean ignoring larger health issues.
And while there is a wide range of “normal” bowel habits, there are tips to ensure your habits are healthy.
1. Don’t delay the urge
If you have a phobia of public restrooms and try to avoid them, you are not alone. But waiting to defecate can start a sort of “stool hoarding” that leads to habits of retention and an overactive pelvic floor. Over time stool hoarding can overstretch the rectum, making it larger than it should be, and the urge will be delayed as the body accommodates an inappropriately large amount of stool in an area. The rectum was never meant to be a long-term storage area. Bowel movement habits that are considered in normal range are anywhere from 3 times per day to 3 times per week.
Bottom line: Defecate when you get the urge. Be comfortable going in a public restroom or wake early and begin a bowel movement routine in the morning before you leave home. No matter where you decide to defecate, sit down on the toilet to allow all the muscles to relax properly. Do not hover over the toilet.
2. Use proper posture
For the anatomy of the pelvic floor, it is best to squat when you defecate. This allows the muscle to relax around the colon, opening the space up to allow stool to easily pass without straining. The feet should be elevated above 90 degrees up to 135 degrees of hip flexion for best relaxation of the pelvic floor.
Bottom line: Unfortunately, traditional toilet heights do not facilitate the ideal squat. To achieve this position, sit tall through your pelvis, bend at the hip, lean with your forearms on your thighs, and allow the abdomen to relax. If you have trouble getting started after this, take some deep, diaphragmatic breaths (belly breaths) to help relaxation. Try gently tightening the abdomen as you let the pelvic floor relax to void. If you feel you still need to strain, do not hold your breath. Rather, perform short “huffs” out to avoid excessive and unhelpful straining. There are products for sale that can assist in aiding proper position for defecating.
3. Spend time wisely
Avoid excessive time on the toilet. Spending more than 10-15 minutes per toilet attempt to defecate is not recommended. Try getting up, walk around, changing positions, going into a deep squat, if your body will allow, to prompt pelvic floor relaxation, then attempt again. You can also try the abdominal massage technique (see below) to stimulate the colon.
Bottom line: Do not sit and strain the stool out. Changing your straining habits is important to avoid overstraining pelvic ligaments and/or muscles, which can lead to pelvic organ prolapse. Habits like this over time can also cause perineal descent, a condition in which the perineum is overstretched and lower than normal.
4. Perform an abdominal massage
If you are experiencing constipation, a light to moderate abdominal massage can be beneficial to promoting movement of the bowels. You can use this daily as a home program for bowel health.
Bottom line: Starting on the left side below your rib cage, perform clockwise circles from the upper descending colon down toward the left pubic bone. Perform this 5 times. You can also use broad massage strokes straight down the colon to clear this area of any stool that may be present.
Move to the right side of the lower pelvis. Begin circular massage up the colon to the lower right rib cage. Continue horizontally across the abdomen right to left, above the belly button. Finish downward again to stimulate movement toward the rectum. You may want to finish with colon strokes up the ascending colon, across the transverse colon right to left, then down the descending colon again 3 to 5 times. A good abdominal massage will usually take about 10 minutes.
A pelvic floor physical therapist who specializes in pelvic health of the bladder and bowel is a great resource to achieve optimal bowel health. If the simple tips above do not help improve or regulate your bowel health, seek a physical therapist who specializes in this area to help resolve constipation or diarrhea issues.
Resources
Sakakibara R, Tsunoyama K, Hosoi H, et al. Influence of body position on defecation in humans. Low Urin Tract Symptoms. 2010;2(1):16–21. Article Summary in PubMed.
Sloots K, Bartlett L, Ho YH. Treatment of postsurgery bowel dysfunction: biofeedback therapy. J Wound Ostomy Continence Nurs. 2009;36(6):651–658. Article Summary in PubMed.
Wen J, Wang Q, Zhang X. Normal voiding pattern and bladder dysfunction in infants and children. Life Sci J. 2007;4(4):1–9. [Article summary not available.]
Harrington KL, Herskovits EM. Managing a patient’s constipation with physical therapy. Phys Ther. 2006;86(11):1511–1519. Article Summary in PubMed.
Lin HC. Small intestinal bacterial overgrowth: a framework for understanding irritable bowel syndrome. JAMA. 2004;292(7):852–858. Free Article.
Sikirov D. Comparison of straining during defecation in three positions: results and implications for human health. Dig Dis Sci. 2003;48(7)1201–1205. Article Summary in PubMed.
