What is one thing we all have in common? What brings us all together? We all poop! How much do you know about your bowel movements? What does it mean when your stool is a different color, shape, texture? What leads to constipation or diarrhea? How can we have a healthy bowel movement and how often should we have a bowel movement?
I am writing this blog in two parts to help you have a better understanding of the mysterious #2, because pooping is an integral part of our daily life and can tell us a lot about our health.
Lets start from the beginning, how food travels from entry to exit:
1. ORAL CAVITY & ESOPHAGUS Digestion begins in the mouth, as saliva helps break down starches. The esophagus is the portal to which the contents travel to our stomach. No digestion occurs here, but “heart burn” can occur when there is backflow from the stomach up into the esophagus through the cardiac orifice seen above.
2. STOMACH Now that the food has made it to the stomach, acids break down proteins. Food spends approximately 2-4 hours here before traveling to the small intestine through the pyloric sphincter
3. SMALL INTESTINE In the small intestine, over the course of 4-6 hours, our body continues to break down starches and proteins and tackle a new molecular compound called carbohydrates. Juices secreted from the pancreas and liver help break down starches, fats and proteins.
4. LARGE INTESTINE What’s next? You guessed it, the large intestine, which absorbs 1000- 1500 mL per day, leaving 100-150 mL along as hardened feces to the rectum. Digestive contents spend the longest time here, approximately 24-72 hours. It travels through the ileocecal valve up the right side of the abdomen through the ascending colon, across the transverse colon and down the left side into the descending colon.
5. RECTUM Using strong peristaltic waves, our bodies push stool into the rectum. That’s when we have our first urge to defecate. We have stretch receptors which tell our bodies to relax an involuntary muscle called the internal anal sphincter while we close our external anal sphincter (EAS) to keep feces from coming out until we are ready.When we sit on the toilet, our EAS relaxes along with our puborectalis muscle. This relaxation combined with a gentle increase in intra-abdominal pressure pushes fecal matter out. Placing our knees higher than our hips, via a squatty potty or stool, helps relax the puborectalis muscle even more, allowing from easier elimination as shown below. The external anal sphincter (EAS) changes its tone based on what it senses. If it senses liquid, such as diarrhea, the EAS increases its tone. If it senses, gas, it allows that to be selectively released. If it senses solid stool, our body can override our urge to defecate until we are at a toilet, so we can hold it in when necessary.
When we sit on the toilet, our EAS relaxes along with our puborectalis muscle which surrounds the rectum tightly at rest creating the "anorectal angle". When the puborectalis relaxes it allows the rectum to have easier passage. This combined with a gentle increase in intra-abdominal pressure pushes fecal matter out. Placing our knees higher than our hips, via a squatty potty or stool, helps relax the puborectalis muscle even more, allowing easier elimination.
GOOD DEFECATION TECHNIQUE
A healthy bowel movement (BM) should not involve straining or pushing. The action of defecation is a part of the parasympathetic nervous system, which helps the body soften and relax. The first step to a good BM is making sure you are in a comfortable, safe place. Have you ever noticed it’s easier "to go" at home versus in an unfamiliar place?
If we lose our ability to properly relax with a bowel movement we may start to strain with defecation, which over time is injurious to our body.
Here are some quick, easy tips for a healthy BM.
- Sit with your knees above your hips, feet resting on a child's step stool or "Squatty Potty"
- Place both hands on your abdomen, or, if you have jaw tension, support your head in your hands
- Draw up or contract your pelvic floor muscles as though you are trying to hold back gas
- Relax your pelvic floor muscles as though you are trying to release gas
- Note how the stomach muscles relax and bulge forward
- Relax the pelvic floor muscles and think of widening the rectal opening
- Imagining your body is a tube of toothpaste, pushing from the top down, brace and breathe out
- You can use certain sounds such as “grrr” and “shhh” to help gently increase intra-abdominal pressure to pass stool
If you feel like you are unable to perform an easy BM even with taking fiber, drinking water, or are spending too much time in the bathroom, straining often, or experience frequent constipation and bloating, consult a pelvic floor physical therapist. We'll assess if restricted pelvic floor, abdominal muscles are hindering your function. We perform gentle manual therapies to restricted muscles/fascia of both internal and external pelvic areas, visceral mobilization to help the organs move optimally and "do their thing", use biofeedback to retrain the pelvic floor muscles so they don't contract when they are supposed to relax, teach breathing techniques and other home exercises.
Stay Tuned for "Pooping 101 - Part 2"!