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This leaflet is to give advice and information to maintain healthy bowels and avoid constipation.
Bowel opening is part of a normal healthy regime; however ‘normal’ opening can vary between 3-4x/day to every 3 days. We need to encourage bowel opening to be healthy, regular, ‘pain & strain’ free in order to reduce the likelihood of damaging other anatomical structures. This can be aided by correct fluid intake, good diet with regular eating, exercise and good toileting position.
There are many, more complex reasons why we develop poor bowel opening habits, but if we address the simple lifestyle factors first this can often ease problems on a day to day level.
Complex problems include for example: presence of anal fissures causing pain, pregnancy, eating disorders, pain medication, history of sexual abuse or psychological issues due to causes such as stress or bereavement.
We advise consumption of 8-10 drinks/day which equals approximately 1.5-2litres of fluid, avoiding caffeine and fizzy drinks where possible. This can help maintain a soft stool which is easy to pass.
By maintaining a good eating regime, eating meals regularly with a good balance of fibre, carbohydrate, fats and sugar – stool can be easier to pass and a more regular emptying pattern can be achieved. Sticking to soluble fibre in fruits and vegetables (e.g. prunes, figs, kiwi and liquorice) is often more advisable than insoluble fibre in cereals which can lead to more discomfort and bloating. People with eating disorders and a very irregular eating pattern often struggle with emptying their bowels. By thinking about strategies to change this irregularity, bowel opening can become more normalised.
People living a very sedentary life – for example, driving to work to sit behind a computer all day, often have difficulty with constipation. Adding a short walk to your commute, lunchtime or daily routine can often promote bowel action.
If you are using medication that encourages constipation discuss the possibility of these side-effects with your pharmacist. If really necessary, try a fibre supplement (Fybogel), mini-enema or suppository to alleviate problems in the short-term. Ideally these products should be used to aid the body into a normal regular routine, rather than long-term use to manage an ongoing problem.
Long term use of laxatives is not advised for most patients, except for those:
• who have only very occasional episodes of constipation.
• who need laxatives to counteract a short-term constipating medication.
• who need to avoid straining (e.g. angina sufferers).
• who are in hospital.
• who are undergoing a radiological or surgical procedure.
• who are severely or terminally ill.
• who have an anal condition which needs soft stools for the healing period.
If used over long periods, laxatives tend to become less effective therefore requiring a higher dose of the medication. It also takes the bowel longer to return to its normal function after long term use.
Toilet habit and positioning
Getting into a routine of going to empty your bowels can in itself help to trigger a normal regular pattern. Bowel activity is often stimulated by eating, therefore by going to sit quietly on a toilet – somewhere you feel comfortable 10 minutes after a meal- can promote bowel opening. Do not sit and strain, just get yourself into a position of comfort as described overleaf and wait. If the bowel does not evacuate, carry on with your day and try again at the same time the following day. It may be normal for you not to open your bowels on a daily basis.
The optimum position for the anatomy of the bowel is to be:
• Slightly leaning forward – supporting your elbows/forearms on your thigh.
• Having your feet supported on a raised step/support so maintaining a hip angle of less than a right angle.
• Relaxing your pelvic floor by ‘bracing or doming’ your abdomen Using the hand/pad of tissue to support the perineum (the area in front of your anus) may also help with bowel emptying.