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HOW OFTEN SHOULD I MOVE MY BOWELS?

by Konstantin Monastyrsky

According to the dominant medical advice, moving your bowels as little as once every three days is considered normal, while, in fact, a frequency this low indicates severe fecal impaction, stool transit disorders, and chronic constipation — the conditions that commonly precede enlarged hemorrhoids, diverticular disease, polyposis, and colorectal cancer.

Transcript:

According to the medical doctors, once every three days is okay, but on the fourth day you are considered constipated.

This is, obviously, incorrect, because according to every single primer on human physiology and functional digestive disorders, ideally you should move bowels after each major meal, but not less than once a day.

If you fail to do so, you are affected by a condition called “latent” constipation. Because it is invisible, it predisposes you to all major colorectal disorders, from enlarged hemorrhoids to colorectal cancer.

How do you determine if you are affected by “latent” constipation instead of mere “irregularity”:

— You do not move bowels at least every day;

— Your stools don‘t match type 5 or 6 on the Bristol Stool Form scale;

— Your stool weight per bowel movement exceeds 150 grams.

— You have to strain, even very slightly, to complete a bowel movement;

— You already have enlarged hemorrhoids, or any other colorectal disorder;

— You are affected by bloating, flatulence, or abdominal cramps;

— You are experiencing cramping related to Premenstrual Syndrome.

— You are taking fiber supplements or laxatives, or rely on laxogenic food, such as Activia yogurt, fiber-fortified cereals, oatmeal, or juices from prunes, beets, and aloe.

Any of the above symptoms point to latent constipation that may eventually turn into inflammatory bowel disease and colorectal cancer.

To learn more about the normal physiology of bowel movements and how to restore regularity, please visit this page. It also addresses stool frequency in infants, toddlers, grown children, adults, and seniors.

Good luck!

 

Recommendations

To give you a better perspective on my brief overview of bowel movements in the video, let me briefly explain how a bowel movement works, so you‘ll understand my answer in the proper context rather than just take my word for it:

The natural, un-stimulated bowel movement is always preceded by an involuntary urge sensation. Although the sensation itself is unconscious, by the time we have grown out of ‘pampers,‘ we have learnt well to suppress it consciously.

The sequence of events preceding the urge to move the bowels begins with the gastrocolic reflex — a complex serious of unconscious events, usually in response to eating solid food or drinking fluids, particularly on an empty stomach.

The gastrocolic reflex stimulates a mass peristaltic movement inside the large intestine, which propulses formed stools toward the rectum.

Once stools enter the rectum, it contracts to propel them toward the anal nerve plexus, and that stimuli is what sends you flying to the bathroom to actually move your bowels by consciously relaxing the anal canal.

In healthy children and adults, moving the bowels is supposed to be a completely unnoticeable, effort-free and pain-free act. Ideally, moving the bowels is just as effortless as urination, and it should never leave a sensation of incomplete emptying.

Anything other than what I have just described indicates some problem related to stool morphology, colorectal disorders, or both.

In people with colorectal disorders moving the bowels may be compromised by weak peristalsis, anorectal nerve damage, a stretched out colon and rectum, and/or some other problem that slows down motility — the term for propulsion of stools through the colon.

Poor stool morphology means that the stools are either too large, or too hard, or both. Hard stools are often small though, and are just as difficult to eliminate. This kind of stool requires straining, from moderate to intense, and invariably damages the anal canal.

So, my answer to this question — how often should you move bowels — applies to healthy people with no or minimal anorectal, nerve damage and normal stools, who reliably sense the urge to move their bowels, and complete the act without straining or any noticeable discomfort.

If this describes you, technically you should move your bowels after each major meal, particularly the meals that contain plenty of dietary fat, because the act of eating fat stimulates intestinal motility more than any other factor. Here is how this not so well-known fact of human physiology is described in a major textbook for medical students:

“Motility is influenced by the energy content and composition of the meal, but not by its volume or pH. Energy-rich meals with a high fat content increase motility; carbohydrates and proteins have no effect. (R.F. Schmidt, G. Thews. Colonic Motility. Human Physiology, 2nd edition. 29.7:730.)

Thus, ideally, teens, young adults, and middle-aged healthy people should move their bowels at least twice a day, usually after breakfast or lunch, and after dinner. Meals that contain dietary fat benefit the process.

But, again, any food intake, even drinking a glass of water slowly, stimulates the gastrocolic reflex and initiates the complex choreography of a bowel movement. It may not, however, be strong enough to interrupt your daily routine.

As people get older, this frequency may decrease because of adverse changes in stool composition, loss of muscle tone, medication, stretching out of the colon and rectum, diminished nerve sensitivity, and/or other age, diet, habit, and health-related factors.

Is a lesser frequency okay? Yes, it is acceptable, as long as stools remain small, soft, and light, type 4 or 5 on the Bristol Stool Form scale that I described while answering the question What exactly are normal stools?

But this is rarely what happens to anyone who moves their bowels less than daily, because the stool left in the colon for longer stretches of time tend to dry out, impact, and harden up very quickly.

Thus, if you don‘t move your bowels at least once daily, and your stools are larger and denser than type 4 or 5 on the Bristol Stool Form scale, you need to normalize them, increase the frequency of your bowel movements, and keep it up to prevent further problems following my recommendations here: No Downsize, Just Upside-down. It will guide you to all other relevant sources of information about constipation treatment and avoidance.

Good luck in and out of the bathroom!