Bowel health can be uncomfortable to discuss. Americans call it “number two” for a good reason. But your bowel health provides a good indication of your overall health. And developing and keeping a regular bowel health routine is essential for staying well.
For some people, improper bathroom habits can develop in childhood and follow us into adulthood. These habits can include:
- Avoiding bowel movements (ignoring the urge to “go”).
- Hovering over the toilet.
- Not allowing enough time to empty the colon.
Adults may develop bowel issues as a result of sickness, sensitivities, microbiome changes, pain, or diseases such as:
- Irritable bowel syndrome.
- Crohn's disease.
- Diverticulitis.
If you ignore bowel changes, irregularity, or discomfort with bowel movements, you could be ignoring — and not addressing — larger health issues.
So what is normal for bowel habits? Having bowel movements that occur anywhere from three times per day to three times per week is considered normal. With this in mind, here are tips to ensure that your bowel habits are healthy.
1. Don't delay the urge to “go.”
If you have a phobia of public restrooms and try to avoid them, you are not alone. But waiting to “go” 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. As the body learns to accommodate an overly large amount of stool, it also can begin delaying your urge to go, further contributing to an enlarged rectum. The rectum was never meant to be a long-term storage area.
Instructions: Go when you get the urge. Wake early to begin a bowel movement routine before you leave home if you’re not comfortable going elsewhere. No matter where you decide to “go,” 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 passing stool. This allows the muscle to relax around the colon, opening the space up so you can easily pass stool without straining. Your feet should be elevated so that your hips are bent at an angle above 90 degrees and up to 135 degrees for best relaxation of the pelvic floor.
Instructions: 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) for relaxation. Try gently tightening the abdomen as you let the pelvic floor relax to void. If you still feel the need to strain, don’t hold your breath. Rather, gently purse your lips and slowly exhale like you are blowing up a balloon. This will help you to avoid excessive and unhelpful straining. There are products for sale that help you achieve the proper position.
3. Spend time wisely.
Avoid sitting for too long on the toilet. Spending more than 10-15 minutes per bowel movement attempt is not recommended. Instead of sitting and straining, you can prompt pelvic floor relaxation by getting up, walking around, changing positions, or doing a deep squat (if your body allows). Then try again. You can also try the abdominal massage technique below to stimulate the colon.
Instructions: Do not sit and strain the stool out. It is important to avoid overstraining pelvic ligaments and muscles; this can lead to pelvic organ prolapse. Sitting and straining also can cause perineal descent, a condition in which the perineum (area between the anus and genitals) is overstretched and lower than normal.
4. Try abdominal massage.
If you are experiencing constipation, a light to moderate abdominal massage can help to promote bowel movement. You can do this daily as a home program for bowel health.
Instructions: 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 five 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 ascending colon to the lower right rib cage. Continue to massage the transverse colon by moving your hand across the abdomen from 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 three to five times. A good abdominal massage will usually take about 10 minutes.
Having difficulty achieving a healthy bowel routine? If the simple tips above do not help improve or regulate your bowel health, a pelvic floor physical therapist who specializes in pelvic health of the bladder and bowel is a great resource to help you achieve optimal bowel health. They can work with you to help resolve constipation or diarrhea issues.
Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can see a physical therapist directly for evaluation and treatment without a physician’s referral.* To find a physical therapist in your area, visit Find a PT.
*A referral may still be required by your insurance policy, corporate policies, or state practice laws (some states limit the type of treatment or number of visits without a referral).
