By Dr. Mercola
Bowel movements are probably low on most people's list of topics they like to discuss, but it's an important one nonetheless. Not only can your poop tell you a lot about your health, how you go can have a significant impact too. Your position can affect the ease with which you eliminate, and doing it wrong may increase your risk of bowel and pelvic problems, including constipation, hemorrhoids, and more. As it turns out, virtually everyone living in Western societies is doing it wrong... Most of you reading this probably sit to evacuate your bowel, but this requires you to strain, which has some unwanted biological effects, including a temporary disruption in cardiac flow. Your body is actually designed to eliminate by squatting, which is the topic of the featured article in The Guardian.1
Sitting on a modern toilet places your knees at a 90-degree angle to your abdomen, which actually hinders elimination by pinching off your anal canal, as illustrated in the image below. Squatting, on the other hand, places your knees closer to your torso, and this position changes the spatial relationships of your intestinal organs and musculature, relaxing and straightening your rectum. As a result, you maximize the efficiency of elimination. Importantly, this prevents fecal stagnation and the accumulation of toxins in your intestinal tract that can fester and contribute to bowel problems and a variety of discomforts. In fact, non-Westernized societies, in which people squat rather than sit, do not have the high prevalence of bowel disease seen in developed nations; in some cultures with traditional lifestyles, these diseases are virtually unknown.
Devices That Enable You to Squat Easier
As the benefits of squatting have become better known, a number of devices have emerged, designed to help you assume the proper position. One simple device is a foot stool2 that allows you to get into a more natural squat position without renovating your entire bathroom and converting to a hole in the ground, which is what you'll find in some non-Western countries. It's an inexpensive way to improve your potty posture, and since you're still sitting on your toilet, virtually anyone can benefit from it, as squatting without support can be a challenge for most who didn't grow up squatting on a daily basis. It's definitely a workout for your thighs! If you have trouble with bowel movements, I highly recommend giving the squat position a try. There's compelling evidence suggesting the Western toilet is at least in part responsible not only for constipation and hemorrhoids, but also more severe health problems like inflammatory bowel disease (IBD), appendicitis, and even heart attacks—caused by the disruption of blood flow and straining.
Consider a Bidet
Another helpful tool is a bidet. While it doesn't help with elimination, it's a practical and affordable alternative to toilet paper. Bidets are the norm in many European countries, where you'll find one in virtually every bathroom. A bidet is refreshing in a way toilet paper will never be, is gentler and less irritating than wiping with paper, and reduces hand contamination. Whenever I travel it is one of the items that I miss most from my home. The bidets quickly pay for themselves with the money saved on toilet paper, especially if you just wipe yourself dry with a small reusable hand towel. More importantly, a bidet will clean your bottom far more effectively than simply using dry toilet paper. They are easy to install, as no plumber is required. My favorite bidet can be found in my online store.
The Importance of Regularity
Staying "regular" is important for optimal health, as it not only removes waste from your body; it also affects how you feel. Whether your bowel movements come too frequently or not often enough, it can make you uncomfortable, bloated, or even interfere with your body's ability to absorb nutrients from your diet. That said, what's normal for one may not be normal for another. When we talk about regularity, what we're really talking about is what's regular for you. Anything from three bowel movements per day to three per week is considered to be within the normal range, with many agreeing that once a day is ideal. More important than frequency is the ease with which you move your bowels. Moving your bowels should take no more effort than urinating or passing gas. If you have to push or strain, it's an indication that something's off. A sudden change in your bowel habits (for the worse) might signal a problem. Factors that can affect regularity include your diet, travel, medications, hormonal fluctuations, sleep patterns, exercise, illness, surgery, childbirth, and stress, just to name a few.3
Why Keeping an Eye on Your Stool Is a Good Idea
Your stool is about 75 percent water. The rest is a fetid combination of fiber, live and dead bacteria, miscellaneous cells, and mucus.4 The characteristics of your stool will tell you a good deal about the state of your digestive tract.
What you see in the toilet can give you clues about how your gastrointestinal tract is functioning and even signal serious disease processes that could be occurring, like infections, digestive problems, and even cancer. The color, odor, shape, size, and even the sound it makes when it hits the water and whether it's a "sinker" or a "floater" are all relevant information. The Bristol Stool Chart, originally published in the Scandinavian Journal of Gastroenterology in 1997, describes the kind of variety you may find in your toilet. Ideally, your stool should approximate Types 3, 4 or 5. Type 4 is generally considered "the Holy Grail".5 Ideally, you would also spend very little time on the toilet—once seated, elimination should be quick and effortless. The harder and lumpier your stools, the longer the feces have remained in your colon, suggesting your elimination is slower than ideal. For a more detailed discussion about the different types of stools, see GutSense.org.6 Your feces can also reveal something about your diet, and/or indicate a food sensitivity. Fiber, for example, is important for optimal bowel function as it adds bulk to your stool, and acts like glue to keep your stool from falling apart. If your stool is on the softer side and lacking in bulk, you may need more fiber in your diet. But it could also be related to lactose intolerance, artificial sweeteners (sorbitol and Splenda), or a reaction to fructose or gluten. As for what's healthy and what's not, the following table will help you determine what's what, and when seeing a doctor may be advisable. If you have a change in stools accompanied by abdominal pain, be sure to report it to your physician.
Medium to light brown
Stool that is hard to pass, painful, or requires straining
Smooth and soft, formed into one long shape and not a bunch of pieces
Hard lumps and pieces, or mushy and watery, or even pasty and difficult to clean off
About one to two inches in diameter and up to 18 inches long
Narrow, pencil-like, or ribbon-like stools: can indicate a bowel obstruction or tumor—or worst case, colon cancer; narrow stools on an infrequent basis are not so concerning, but if they persist, definitely warrant a call to your physician7
S-shaped, which comes from the shape of your lower intestine8
Black, tarry stools or bright red stools may indicate bleeding in the GI tract; black stools can also come from certain medications, supplements or consuming black licorice; if you have black, tarry stools, it's best to be evaluated by your healthcare provider
Quiet and gentle dive into the water... it should fall into the bowl with the slightest little "whoosh" sound—not a loud, wet cannonball splash that leaves your bottom in need of a shower
White, pale, or gray stools may indicate a lack of bile, which may suggest a serious problem (hepatitis, cirrhosis, pancreatic disorders, or possibly a blocked bile duct), so this warrants a call to your physician; antacids may also produce white stool
Natural smell, not repulsive (I'm not saying it will smell good)
Yellow stools may indicate giardia infection, a gallbladder problem, or a condition known as Gilbert's syndrome—if you see this, call your doctor
Presence of undigested food (more of a concern if accompanied by diarrhea, weight loss, or other changes in bowel) habits
Increased mucus in stool: This can be associated with inflammatory bowel disease like Crohn's disease, or ulcerative colitis, or even colon cancer, especially if accompanied by blood or abdominal pain
How to Improve Your Bowel Movements
Most gastrointestinal problems can be prevented or resolved by making simple changes to your diet and lifestyle, such as the following:
- To reverse constipation or diarrhea, remove all sources of gluten from your diet (the most common sources are wheat, barley, rye, spelt, and other grains)
- Eat a diet that includes whole foods, rich in fresh, organic vegetables and fruits that provide good nutrients and fiber
- Avoid artificial sweeteners, excess sugar (especially fructose), chemical additives, MSG, excessive amounts of caffeine, and processed foods as they are all detrimental to your gastrointestinal (and immune) function
- Boost your intestinal flora by adding traditionally fermented foods to your diet. Consider adding a high quality, broad-spectrum probiotic supplement if you suspect you're not getting enough beneficial bacteria from your diet alone
- Increase your fiber intake, most of which should come from vegetables, not grains. Good options include sunflower sprouts, psyllium, and freshly ground organic flax seed. Aim for about 30-35 grams of fiber per day
- Make sure you stay well-hydrated with fresh, pure water
- Get plenty of exercise daily
- Avoid drugs such as pain killers (especially codeine), antidepressants, and antibiotics, all of which can cause a variety of GI disruptions. If you have to take a course of antibiotics, be sure to reseed your gut flora with probiotics
- Consider squatting instead of sitting to move your bowels; squatting straightens your rectum, relaxes your puborectalis muscle and encourages the complete emptying of your bowel without straining, and has been scientifically shown to relieve constipation and hemorrhoids