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Bowel health — what's normal, what's not?

Monday, October 30, 2006
Isn't it funny, we all go to the toilet, but we don't like to talk about it, particularly number twos.

Our mission is to find out what goes on in the smallest room in the house — what's normal? Once a day, once a week, or something else ...?

And how can you tell when something's going wrong? What's the best way to treat those problems when they show up?

Our reporter Dr Andrew Rochford is going to answer all those questions. It's a dirty job, but it's an important one.

Stool school question one: how often should we go to the toilet?

One of the most common questions about bowel habits is "how often should I go?" Most would say "once a day". But it's not that simple.

It's quite a journey from meal time to splash down, as our bodies absorb from our food, the nutrients we need to live.

As part of the digestion process, the food we eat travels through our small intestine. Funnily enough, that's long, about five metres long. But that length alone isn't enough to absorb all the nutrients we need from our food. So on the inside of the muscular tube, which makes up our small intestine, are hundreds of thousands of finger-like projections called villi. Now if anyone ever felt the urge to lay those villi out flat you'd end up with a surface about the size of a tennis court.

All of this is to make sure everything that should be absorbed will be and the rest passes out as waste.

But the big question is, how often should that happen?

"Well, there are a lot of myths about how often you should go to the toilet and some people are quite fixated on the need to go every day. But that's neither necessary nor statistically correct," says gastroenterologist, Dr Katie Ellard.

"The issue is how comfortable you feel. If you go once a week and you feel perfectly comfortable and don't have to strain, that's absolutely fine. And if you go four times a day and you're quite comfortable, that's also fine.

Bottom line? Less than once a week, things might need help moving along — but everyone's different.

So regular is not as regular as you might have thought. But, we all know the system gets thrown out of whack from time to time. One day you're constipated, the next you're house bound with diarrhoea.

Stool school question two: what is diarrhoea?

So it's perfectly normal to visit the john as often as four times a day, or as little as once a week. But when a dodgy curry hits the staff canteen you face the dreaded diarrhoea.

"Diarrhoea is really when the motion is watery and explosive, as well as frequent," says Dr Ellard.

When your leftover food reaches your colon, it's mixed with large amounts of water. Under normal circumstances, the colon absorbs most of that water, leaving the semi-solid stool. But when you have diarrhoea, the colon doesn't absorb properly, and you end up with loose, watery poo. It's mostly caused by tummy bugs, parasites, viruses and bad bacteria.

"The most common one we all know is an acute passing viral gastroenteritis. That'll give you frequency of going to the toilet, cramping, urgency, sometimes even accidents," says gastroenterologist, Dr Thomas Borody.

So what's the best way to treat the runs? Dr Katie Ellard's seen a lot of tummy troubles in her time. Her advice? Let nature run its course.

"It's often best just to bide your time, make sure your hydration's okay, and if people just rest their gut by just having fluids — they might need to have something like Gastrolite, which can put the salts and the fluid back into their body that they're losing — they'll spontaneously get better," she says.

With your fluids topped up, your immune system can get on with the job of dealing with whatever caused the diarrhoea in the first place.

So, normally, it's a case of putting up with diarrhoea until it's had a chance to work its way out of your system. But if the problem persists or there are other warning signs, seek medical advice.

Stool school question three: what is constipation?

"Constipation is when you go to the toilet infrequently, perhaps less than three times a week and you have to strain to go. It's not an easy thing to pass the motion," says Dr Ellard. What happens when you're constipated is, instead of maintaining a, moist, slippery stool, the colon absorbs too much water, leaving the stool hard, lumpy and stuck! And the longer it's stuck, the more painful your predicament.

Time to resort to a laxative. And according to Dr Thomas Borody at the Centre for Digestive Diseases, your first port of call should be good old prunes!

"Prunes are a useful therapy because they contain chemicals that stimulate the bowel to produce loose motions. If we look at yogurt, no amount of acidophilus or bifida bacteria is going to reverse constipation. But, in some patients, it does make them go. So, being a non-drug therapy, I would recommend it," says Dr Borody.

Others say water does the trick, but it doesn't.

"Drinking water is good in its own way, but it does not give you a softer motion. It's excreted in urine and no matter how much you drink, it still goes down in urine by and large," Dr Borody says.

And a word of warning for older people: straining too long can trigger a sudden drop in blood pressure, leading to fainting or heart attack. A disproportionately high number of older men, die on the toilet.

The lesson from all of this? Don't strain too hard. It's just not worth it. Instead, try and stay regular.

Stool school question four: how can we stay regular?

When it comes to going for number twos, we should all look for the Goldilocks outcome — not too often, not too seldom, but just right. But what's the best way to be regular?

Dr Katie Ellard's top five tips

  • "It really helps to have breakfast." Most experts agree that a daily dose of dietary fibre, from unprocessed cereals, helps keep your poo in good shape.

  • "You should eat fruit and vegetables every day." Fruit and vegetables are a major source of fibre.

  • "You should drink six to eight glasses of fluid a day." Plenty of water, plus herbal and normal teas, all help ensure your poo enjoys a smooth passage!

  • "Exercise is a great help." For reasons medical science doesn't yet understand, a vigorous walking motion helps propel your other sort of motion on its one metre journey along your large intestine.

  • "You also need to take time to go to the toilet." A relaxed routine gives your system permission to get its job done effortlessly.

"It doesn't really matter if you go to the toilet at eight o'clock in the morning or eight o'clock in the evening. It doesn't have to be everyday, you just have to find a regime and routine that's comfortable for you," says Dr Ellard.

Stool school question five: how should your poo look?

They say our eyes are a window to our soul, but our poo offers a pretty good glimpse into what's happening inside too.

Changes in consistency, or colour, shouldn't be ignored. Sometimes the reason is fairly simple, sometimes it can be more serious.

"In gastroenterology we divide people into people who look and people who don't. I would urge everyone in Australia to look," says Dr Ellard.

Now, some of what you see in the toilet bowel you shouldn't worry about.

Corn almost always goes straight through.

"It's because we don't have cellulose to break down enzymes and that's the main reason why we don't graze and eat grass or eat timber," says Dr Borody.

A tinge of beetroot red shouldn't alarm you either: "It will go through with the pigment unchanged," he says.

But there's one red tinge you should never ignore. Blood red can mean big trouble.

"Bowel cancer's very common. One in 18 men and one in 26 Australian women develop bowel cancer. And one of the cardinal signs of people developing bowel cancer is blood in the motion. If you see it, you must get it checked out. It's never normal," says Dr Ellard.

Stool school question four: how can we stay regular?

So here's what we've learned in stool school:

  • Keep regular.
  • Make sure you're not straining.
  • If you're constipated, chow down on the prunes.
  • If you do get diarrhoea, remember "time" is the best healer.
  • Above all, don't be afraid to look for trouble in the toilet bowl!

There you have it — our top five of number twos.

There's no hard and fast rule about how often we should go, or what it should look like when we do, but you do need to be vigilant about any changes that occur from what's normal for you. Most importantly, it's natural, we all do it and there's no shame in talking about it — especially to your doctor.

Fast facts

  • While we're on the subject of toilets, bowel cancer kills about 90 Australians every week. But there's a new initiative designed to help cut that number … the sooner you discover bowel cancer, the better your chances of beating it. The government is phasing in a new home test to help with early detection — it's aimed at older Australians, and if you're interested, call 1800 118 868 to find out if you're eligible.


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