Bowel Dysfunction

The purpose of the digestive system is to break down the food we consume, absorb liquid and nutrients, and then expel the waste products. Food enters the gastrointestinal tract starting at the mouth and travels through the esophagus, stomach, and intestines, then fills the rectum and exits the anus as stool or bowel movement (BM). The lower half of the GI tract is referred to as the bowel. The brain sends and receives messages through the spinal cord which aid in digestion and tell the body when it is time to empty the bowel.

Process of a bowel movement (BM)

1. When the bowel is full of stool, it stretches and pushes on the area nerves. This sends a sensory message from the bowel to the sacral nerves and then up through the spinal cord.
2. When this sensory message reaches the spinal cord, the message splits. Part of it stimulates the bowel reflex which causes the muscles of the bowel to squeeze.
3. The other part of the message travels up the spinal cord to the brain with the “urge” to have a bowel movement (BM).
4. As soon as the person decides it is the right time to have a BM, a message is sent back down the spinal cord, through the sacral nerves, and out to the external sphincter muscle of the anus.
5. This message tells the sphincter muscle to open up and let the stool out. If it is not a good time to have a BM, the message tells the sphincter muscle to stay closed and not let stool out.

• Constipation: Having hard stool (Bristol Stool Type I) or no bowel movement for three days or more in a row. This is a type of emptying dysfunction because the bowel is unable to move and get rid of the stool. Constipation can lead to a tight or bloated abdomen, loss of appetite, hemorrhoids, and rectal bleeding. If you have not had a bowel movement in four days, notify your provider. Constipation can lead to fecal impaction or bowel obstruction.
• Fecal urgency: Developing a strong, unexpected need to have a bowel movement. This is a type of storage dysfunction because the bowel does not completely identify the need to have a bowel movement. Urgency can occur if you have an incomplete bowel program, eat or drink a trigger food, have a change in medication or do not have the right stool consistency. Urgency can lead to fecal incontinence because anal sphincters do not remain closed while you are getting to the restroom.
• Fecal incontinence: An unplanned bowel movement or bowel accident. This is a type of storage dysfunction because the bowel cannot hold in stool until the appropriate time. Incontinence can occur if you have an incomplete bowel program, eat or drink a trigger food, have a change in medication, or do not have the right stool consistency.

Three keys to healthy and happy bowels

1. Maintain a bathroom routine
2. Eat enough fiber balanced with water
3. Maintain activity

The key to a successful bowel routine is stool consistency. When the stool is the right consistency, you are able to effectively empty your bowels without other bowel symptoms. Stool is made up of the digested food you eat and water. The ideal stool consistency is achieved by a bathroom schedule, eating enough fiber balanced with enough water, and maintaining activity.

The Bristol Stool Chart categorizes seven types of stool based on firmness. This tool helps patients identify their stool consistency and communicate with healthcare providers about their bowel health. The ideal stool consistency is between a Bristol Stool type 2 and type 4. By reviewing your current bowel consistency, you can determine if you need to make lifestyle adjustments to reduce the risk of bowel dysfunction.

Each person’s method to evacuate the bowel may be different; however, the success is dependent on the stool consistency. Hard stool is harder for the bowel to move and can lead to constipation, incontinence, and rectal bleeding. On the other hand, soft stool can lead to incomplete bowel movement and fecal incontinence. It is also important to identify your triggers for constipation and/or incontinence and the tools to maintain bowel regularity. Until your bowel routine is established, keep a record to help identify any positive or negative trends. Include the frequency of bowel movements, Bristol stool number, and any bowel accidents.

Bowel routine schedule

The body works best on a routine. Bowel schedules programs are routines to train the bowel to effectively empty at the right time without accidents.

• Schedule time in the morning or evening every day or every other day. Try for 30 minutes after a meal while your body is digesting food. Your body has a natural reflex during digestion to increase bowel motility and promote bowel emptying. Try drinking 1 – 2 cups of hot liquid such as coffee or tea 30 minutes before your scheduled bathroom time.
• Allow 10 minutes in the sitting position for the bowel program. Positioning does help. Mimic the squatting position to activate your natural bowel reflex. While sitting on the toilet, prop your feet up on a stool to position your knees higher than the hips.
• Visualize or lightly palpate the left lower abdomen to promote stool movement.
• Relax, read a magazine, light a candle, play music, etc. Stress decreases digestion and limits bowel activity.
• Stick to your scheduled even if you do not have a bowel movement.
• Keep a packed bag in the car with a change of clothes, bowel program supplies, cleaning wipes, and waste bag for emergencies.

Hydration

Dehydration is the most common cause of constipation. Water works with fiber to make up your stool consistency. The recommended amount of non-caffeinated fluids water is eight 8-ounce glasses per day unless instructed otherwise by your doctor. Slowly increase the amount of water you drink a day while recording the frequency of bowel movements, Bristol stool number, and any bowel accidents to help identify trends. It may take several weeks to see the benefit of adding water to your diet with better stool consistency and more effective bowel movements.

Fiber

Fiber is in all plant-based food. It improves digestion and the movement of stool through the bowel. Fiber must have water to work. It pulls the water into the bowel to regulate and soften stool. It is just as important to stay hydrated as it is to eat fiber-rich foods.

There are two types of fiber: soluble and insoluble fiber.

• Soluble fiber breaks down during digestion. It absorbs water to form a gel-like consistency to allow for softer stool and regulate digestion. Soluble fiber is typically found in:
  • Legumes, such as dried peas and beans
  • Oats, rye, and barley
  • Some fruits, especially apples, bananas and berries
  • Some vegetables, such as potatoes, yams, broccoli, and carrots
  • Psyllium seed and other commercial fiber supplements
• Insoluble fiber is roughage because it does not break down during digestion. This allows it to add bulk to stool which helps it move through the GI tract and establish regularity. Insoluble fiber is typically found in:
  • Whole grain foods: whole wheat bread, brown and wild rice, and whole wheat pasta
  • Bran
  • Nuts and seeds
  • Vegetables, especially those with skins or peels
  • Fruits, especially those with skins or peels

The recommended amount of fiber to eat per day is 25 – 30 grams. Add fiber slowly to your diet. Aim for a mix of insoluble and soluble fiber in your daily diet. Try to include at least one fiber-containing food with each meal. Remember that fiber must have water to work, so hydrate.

Activity

Regular activity improves digestion. It increases blood flow, water absorption, and muscle contractions throughout your bowel to break down food and move stool. Activity ranges from walking, changing positions, massage, a range of motion activities, and stretching.

Avoiding surprises

Activities that can trigger bowel changes include:

• Not staying on your bowel schedule
• Not completely emptying the bowel
• Change in medications for pain, muscle spasms, or urinary symptoms

The foods listed below may result in GI upset and may lead to an involuntary bowel movements. Be cautious with these foods until you know how your body tolerates them.

• Fried or greasy/high fat food
• Spicy foods
• Caffeinated drinks
• Alcohol
• Lactose

Treatments for bowel relief can include manual evacuation and rectal suppositories. Learn more about bowel care techniques.