A Key Predictor of Well-Being: Healthy Bowel Movements
No one likes to talk about it, but regularity is absolutely imperative to good health. We need to exercise greater transparency and discussion when it comes to paying attention to our stools. When we accept that our bowel movements are key predictors to our well-being and as useful in diagnosing our health as taking our temperature or our blood pressure, they suddenly become much more than an oversight.
A variety of foods and medications affect the normal passage through the intestine, and the passage of fecal material through the colon to the rectum.
"People can tell a measure of their health by their bowel movement," says Ted Loftness, M.D., an internist in Litchfield, Minn. "Nothing is so overrated as sex and so underrated as a good bowel movement."
From your stool you may be able to get clues about your diet, your gastrointestinal health, and even whether your stress, anger, or anxiety levels are too high.
Keeping these areas clean and healthy provides the following benefits:
A lowered risk of developing colorectal cancer, one of the most common types of cancer in industrialized countries.
A lowered risk of experiencing irritable bowel syndrome, chronic constipation, and chronic diarrhea.
A lowered risk of developing hemorrhoids.
Less gas production.
More efficient absorption of water and minerals.
A feeling of lightness, comfort, and well-being in your abdominal region.
How Food Becomes Stool
From the moment food enters your mouth, your body embarks on a campaign to turn it into a soupy mush called chyme. Chewing, saliva, peristalsis (the involuntary contractions of gastrointestinal muscles), bacteria, hydrochloric acid, digestive enzymes, bile, and other secretions all work to give each meal the consistency of split pea soup. While your digestive cells are absorbing sugars, starches, fats, vitamins, minerals, and other nutrients, waste products continue traveling down the line. In the colon, all the leftovers are combined, packed together, and partially dehydrated. What remain--our feces--consist of water, indigestible fiber, undigested food (such as corn and small seeds), sloughed-off dead cells, living and dead bacteria, intestinal secretions, and bile. (The worn-out red blood cells in bile give excrement its distinctive brown color.)
If all goes as it should, you'll end up with a healthy bowel movement. Although digestive idiosyncrasies, variations in intestinal bacteria, and other variables can produce different standards for a healthy stool, in general it should be brown to light brown; formed but not hard; cylindrical, not flattened; fairly bulky and full-bodied, not compacted; somewhat textured but not too messy; and very easy to pass. And it shouldn't smell--much. "You're passing methane and bacterial, degraded foodstuffs, so there's always going to be an odor," says Patrick Donovan, N.D., a naturopath in Seattle. "But it shouldn't be a very strong, pungent odor."
Keep a record for a week to ten days before consulting a health practitioner and record the following:
What does the stool look like?
Are you straining when you defecate?
Do you lose stools either with a little soilage on your underclothes, or is there severe fecal incontinence?
Do you have any pain in the rectum, or any stomach pain? Is this pain related to defecation?
Do you have a history of hemorrhoids or any diseases of the rectum?
Is there ever any blood or mucus in your stool?
How frequently do you take medications or laxatives? Daily? Weekly? And be prepared to give a diet history. All these historical points are important in determining how best to manage the problems you are having, and to decide whether you need any tests to eliminate the possibility of serious bowel disease.
Medications are a serious culprit of bowel problems. Antihypertensive drugs, calcium channel-blockers, and anticonvulsants may present problems. Iron and calcium supplements, both of which may be very important as supplemental nutrients in the elderly, and aluminum containing antacid compounds, including sucralfate, may cause constipation. Also, drugs that are used for the treatment of Parkinson's disease, antidepressants, and antipsychotic medications are all common causes of bowel roadblocks.
Water and Nutrient Absorption
The mucosal lining of your large intestine is lined with tiny pits that open into long, tube-like intestinal glands; these glands are lined with specialized cells that absorb water, and other specialized cells (goblet cells) that release mucous into your large intestine to lubricate your stools and to protect the lining of your large intestine against acidic substances and potentially harmful gases.
The specialized cells that absorb water from your waste materials are responsible for about 10 percent of the water that you absorb from the foods and beverages that you ingest; the remaining 90 percent is absorbed by cells that line your small intestine.
This 10 percent of water absorption in your large intestine amounts to anywhere between a pint and a quart of water, and represents a significant portion of your body's daily intake of water. As water is absorbed from the waste material in your colon, so are some nutrients, mainly minerals like sodium and chloride.
It takes anywhere between three to ten hours for your large intestine to absorb enough water from waste material to turn it into solid or partially solid stools. Your stools consist mainly of water, mucous, fiber, old cells from your intestinal lining, millions of microorganisms, and small amounts of inorganic salts.
When your rectal pouch is distended with enough feces to trigger a contractile reflex, your feces are pushed out through your anus. When you consciously contract your abdominal wall, your diaphragm moves downward and helps open up muscles that line your anal sphincter.
Your rectum is lined with three horizontal folds, called your rectal valves; these valves are what prevent stools from passing through your anal sphincter when you pass gas.
If you choose not to release stools when you experience the urge to do so, your reflex contractions may stop, in which case you likely won't have a significant bowel movement until the next mass peristalsis occurs.
Diarrhea and Constipation Explained
When waste material travels through your digestive tract too quickly for sufficient water absorption to occur, your stools will be runny and more frequent than normal.
Three main causes of diarrhea are:
Food intolerances (like lactose intolerance)
In the first two cases listed above, it makes sense that your body would want things to move quickly through your system; your body doesn't want to spend time digesting foods that it can't properly extract nutrients from or that are laced with disease-causing microbes.
Stress can cause transit time to shorten by messing with your enteric nervous system; please recall that your enteric nervous system controls the reflex contractions that mark "haustral churning." Your enteric nervous system is a part of your autonomic nervous system, and your autonomic nervous system regulates your physiological responses to emotional and physical stress.
When waste material travels through your colon more slowly than it should, enough water is extracted from your waste material to cause your stools to become uncomfortably hard.
Five main causes of constipation are:
Eating sporadically, or eating meals that are too small to elicit mass peristalsis.
Not going when you feel an urge to go.
Lack of a healthy intestinal lining that is capable of producing enough mucous to properly lubricate your stools (vitamin A deficiency is a potential cause of this situation).
Insufficient intake of water, water-rich foods, and/or fiber-rich foods.
Experts disagree on two other stool characteristics: the number of pieces and their buoyancy. Each bowel movement preferably should be in one piece, about the shape and size of a banana and tapered at the end, according to Melanie Ferreira, a nutritionist and instructor at the Natural Gourmet Institute for Food and Health in New York City. Others, however, object. "Stools don't have to be well-formed logs," Donovan says. "They can disperse in the toilet water; they can break down."
As for "floating versus sinking," one school argues that stools should float. Ferreira says buoyancy is a sign that the body has absorbed the minerals in the food and that these nutrients are not contained in the waste. Another camp believes healthy bowel movements should touch bottom because of their bulk and fiber content. Loftness is not impressed with either argument: "Most stools will sink," he says. "Whether it floats or sinks really doesn't seem to make any difference."
For a list of specific characteristics that may point to health problems, see our chart below.
If Your Stool Looks...
It Could Mean...
Bleeding in your upper digestive
tract. The black color comes from
digested blood cells.
VERY DARK BROWN
You drank red wine last night or
have too much salt or not enough
vegetables in your diet.
GLOWING RED OR MAGENTA
You've eaten a lot of reddish foods
such as beets.
You're consuming too much sugar, or
too many fruits and vegetables with
not enough grains or salt.
PALE OR CLAY-COLORED
Minimal amounts of bile are being
excreted, perhaps because of problems
with the gallbladder or liver.
BLOODY OR MUCUS-COVERED
Hemorrhoids, an overgrowth of certain
bacteria in your gastrointestinal
tract, colitis (inflammation of the
colon), Crohn's disease (also known as
inflammatory bowel disease), or colon
cancer. Red blood usually means the
ailment is located near the end of
your digestive tract, whereas black
blood signals partially digested blood
coming from an ailment higher up the
tract. Seek medical advice promptly.
PENCIL-THIN AND RIBBONLIKE
A polyp or growth in your colon that
narrows the passage for stool.
LARGE AND FLOATING, WITH GREASY FILM ON TOILET WATER
Malabsorption--your digestive system
isn't getting the full nutritional use
LOOSE AND WATERY, SOMETIMES
WITH UNDIGESTED FOODSTUFFS
Diarrhea. Possible causes are food ,poisoning lactose intolerance,
antibiotics, antacids, dietary
changes, travel, anxiety, stress,
inflammatory bowel disease, or
irritable bowel syndrome.
SMALL, HARD, ROUND PELLETS
Constipation--even if you're
defecating frequently. Possible causes
are eating too much dry food,
including protein, and not enough
vegetables and raw foods; laxative
abuse; worries; or irritable bowel
ALTERNATING BOUTS OF DIARRHEA AND CONSTIPATION
Irritable bowel syndrome. This chronic
condition can be aggravated by red
meat, spices, sugar, alcohol, lack of
fiber, allergy-causing foods,
irregular hours, and chaotic
An imbalance of intestinal bacteria or
eating too much animal protein, which
can putrefy in your digestive tract.
Steps You Can Take To Have Healthy Bowel Movements
Regular bowel movements may contribute to more than better physical health. "The act of digestion and elimination can be seen as a metaphor for our ability to absorb what is useful from our experiences and eliminate what is unnecessary, harmful, or holds us back.
The three basics required for healthy bowel movements (and a healthy digestive system) are fiber, fluids, and exercise. If your stool doesn't fit the profile of a healthy bowel movement, the following steps can make it better.
Eat substantial meals; don't nibble on small amounts throughout the day.
Each time you eat a substantial meal, you stimulate stretch receptors in your stomach that are responsible for triggering normal and mass peristaltic waves throughout your small and large intestines. These natural contractile waves promote regular movement of waste material through your colon and rectum.
Also, eating substantial meals allows significant boluses (roundish masses) of waste materials to travel together through your colon, turn into well formed stools, and get eliminated from your body in an efficient manner.
Don't suppress the desire to go.
If you regularly suppress the urge to have a bowel movement, waste materials spend more time than is optimal in your colon, causing excessive dehydration of these materials and formation of hard stools.
One of the most common gastrointestinal complaints is hard feces and infrequent and difficult elimination --better known as constipation. If chronic, it may contribute to autoimmune diseases and colon or breast cancer. The longer stool stays in the colon, the more one reabsorbs some of the metabolic products [such as estrogen] that have been excreted in the bile.
Avoid anal intercourse if possible.
Your anus is designed to be an exit, and your anal sphincter is not naturally inclined to comfortably allow external objects to enter your rectal pouch. Your anal sphincter is designed to stretch to allow passing of stools when your rectal pouch accumulates enough waste materials to illicit contraction of its walls.
Repeated anal intercourse can lead to a loss in anal sphincter tone, which may lead to incontinence issues, if not now, then in the future.
Repeated anal intercourse can also lead to regular injury of the mucosal lining in your rectal pouch, anal canal, and in some cases, the distal region of your sigmoid colon. Repeated injury and healing of these areas may increase your risk of developing polyps, which can increase your risk of developing colorectal cancer.
Ensure adequate intake of water and/or water-rich foods.
Water helps to move waste materials along, and is absorbed throughout the entire length of your colon. Insufficient water intake can cause stools to form far before waste materials reach your rectal pouch, which can cause constipation.
This doesn't necessarily mean that you need to drink several glasses of water per day. If you eat plenty of water-rich plant foods, then you can rely on your sense of thirst to dictate how much water to drink. For more guidance on this issue, please view:
Fiber adds bulk to the boluses of waste material that travel through your large intestine, and this bulk is essential to your colon's ability to turn waste materials into well formed stools.
A diet that is rich in vegetables, fruits, legumes, and whole grains ensures high fiber intake. Regularly eat foods that are known to stimulate the flow of digestive enzymes, including brown rice; pungent foods such as garlic, ginger, and onions; and daikon radish.
Eat Fermented Foods
Eat fermented foods such as miso (fermented organic soybean paste), high-quality organic kefir, and pickles to replenish the beneficial bacteria in your gut.
Ensure optimal vitamin D status.
Optimal vitamin D status significantly lowers your risk of developing all types of cancer, including colorectal cancer.
All of your cells, including those of your large intestine and nervous system, require a constant influx of undamaged fatty acids and cholesterol to remain fully functional. If you don't ensure adequate intake of healthy fats, your nervous system and the smooth muscles that surround your digestive passageway - both of which are responsible for creating peristaltic waves throughout your digestive tract - may deteriorate in function.
Also, intake of healthy fats is necessary for optimal absorption of fat-soluble vitamin A, which is critical to building and maintaining the mucosal lining of your colon.
Healthy foods that are rich in healthy fats include: avocados, organic eggs, olives, extra-virgin olive oil, coconut oil, coconuts, raw nuts, raw seeds, and cold-water fish.
Build and maintain a population of friendly bacteria in your digestive tract.
Large populations of friendly bacteria can keep your digestive tract clean and healthy by:
Promoting optimal digestion, thereby preventing build-up of toxic waste materials.
Taking up space and resources, thereby helping to prevent infection by harmful bacteria, fungi, and parasites.
Pay attention to your food while you eat. Turn off the television. Don't read or listen to the radio. Look at the food, the aroma, the color. That creates a kind of relationship between you and the food. It will improve your digestion.
If you're daring, consider this: Squat on the rim of the toilet in your bare or stocking feet while you eliminate. "Squatting straightens the recto-anal angle and opens it more fully so elimination is much easier," says yoga practitioner Richard Ravizza, Ph.D., a psychology professor at Pennsylvania State University in Scranton. "You could think of it as straightening a partially kinked garden hose."
The quality of your bowel movements are more important than any other factor, including frequency. Good lifestyle habits including clean, unprocessed foods as well as exercise will ensure that healthy bowel movements are generated by good overall health.
Karen Foster is a holistic nutritionist, avid blogger, with five kids and an active lifestyle that keeps her in pursuit of the healthiest path towards a life of balance.