Healthy bowel guide

Information for patients

Welcome
It is normal to open your bowels from between three times
a day to three times a week.
If you need to strain excessively, do not feel completely
empty or have to help the stool out, you may be
constipated or you may be experiencing faecal
incontinence.
There are many causes of constipation. Our busy, modern
lifestyles may be responsible for most cases of constipation
with contributing factors such as not eating enough fibre
or drinking enough water, not getting enough exercise, and
not taking the time to respond to an unmistakable urge to
go to the toilet.
However, emotional and psychological problems can
also contribute to the problem, as can long-term health
conditions; including irritable bowel syndrome, colorectal
cancer, diabetes, Parkinson’s disease, multiple sclerosis, an
under-active thyroid gland and depression.
This leaflet gives you information on how to help keep
your bowel healthy.
What are the symptoms
of constipation? Bristol Stool Chart
• Hard, compacted stools that Type 1
are difficult or painful to pass Separate hard
• Straining during bowel lumps, like nuts
movements (hard to pass)
• No bowel movements in Type 2
three days
Sausage shaped
• Stomach aches that
but lumpy.
are relieved by bowel
movements Type 3
• Leaks of wet, almost Like a sausage
diarrhoea-like stools between but with cracks
regular bowel movements. on its surface
You can use the Bristol Stool
Type 4
Chart opposite to monitor
what you are passing. An ideal Like a
stool is type 3 or 4. sausage or
snake, smooth and soft.
Type 5
Soft blobs with
clear-cut edges
(passed easily).
Type 6
Fluffy pieces
with ragged edges, a mushy stool.
Type 7
Watery,
no solid pieces. Entirely liquid.
People sometimes feel unable to So what can I do?
open their bowels at school or in
their workplaces. Others even feel Step 1: Lifestyle
inhibited in their own homes. Over
It is important to try to make time
the years, their gastrointestinal
for your bowels each day. Most
tract gradually slows down and
bowels respond best to a regular
they become constipated.
habit. About 30 minutes after
A lot of factors can influence your eating is the most likely time for
bowel habits: the bowel to work. This is because
• Some people feel unable to relax of the ‘gastro-colic response’
enough to open their bowels in which means that eating sets
public places, or even at home waves of activity in motion in the
• Women often experience a bowel.
change in their bowel habit due Try not to rush going to the toilet.
to their menstrual cycle If you have a tendency to be
• A change of routine, such as constipated, set aside about ten
being on holiday with a different minutes in the toilet. Preferably
diet and time zone, or a change this should be at a time when
in environment, such as using you are not rushing to do other
sharing facilities, can affect your things. Find a toilet that you feel
bowel habits. comfortable to use and where you
do not feel inhibited by lack of
privacy or time.
Step 2: Medication Step 3: Correct positioning
If you are taking any medicines It is important not to ignore the
(prescribed or bought from feeling that you need to open
the chemist) ask your doctor your bowels. Make sure you have
or chemist if they could be enough time and sit correctly on
contributing to your constipation. the toilet.
If possible, try to remove • Firstly, make sure you are
constipating medications. comfortable on the toilet. It is
most-natural for humans to
squat to pass a stool. You may
find that having your feet on
a footstool, about 20-30cm
(eight to ten inches) high helps
by improving the angle of the
rectum within the pelvis and
making it easier to pass stools.
Keep your feet 1.5 - 2 feet apart.
• Relax and breathe normally. Do
not hold your breath as this will
encourage you to strain.
• Tighten your abdominal muscles.
You should feel them push
forwards and sideways. This is
called the brace.
• Concentrate on relaxing the anus
(back passage) to allow the stool
to pass. Do not push from above
without relaxing the anus below.
Step 4: Fluid intake Step 5: Fibre intake
Try to drink at least 1.5 litres Eating regularly is the best
(six to eight cups) of fluid per stimulant for your bowels.
day, unless advised otherwise Skipping meals, especially
by your doctor as the body may breakfast, can lead to a sluggish or
become dehydrated if it is not irregular bowel habit. Contrary to
replaced. Dehydration can result popular belief a high fibre diet is
in constipation. Try to limit the not always the best diet for people
amount of coffee and alcohol you who suffer from constipation.
drink as this can irritate the bowels Regular meals and an adequate
as well as causing dehydration. fluid intake are more important.
Too much fibre can lead to
an increase in bloating and
discomfort. If you do feel your
diet is short on fibre, try to use
fruit and vegetables (soluble fibre)
rather than cereals (insoluble fibre)
as they are less bloating.
Be careful not to eat excessive
amounts of fibre as this could lead
to loose bowel motions that are
difficult to control. Some foods
can act as natural laxatives in
some people, such as liquorice,
chocolate, prunes, figs and spicy
food.
Step 6: Keep active Other options
Exercise can help to improve bowel If you have tried all the steps in
habits as it helps to stimulate the this leaflet and you are still having
bowel to work regularly but be problems with your bowels, you
careful not to overdo it. If you lead may need to try using laxatives,
a very inactive lifestyle (driving to suppositories or mini-enemas.
work at a desk job) even taking Your nurse can discuss this with
a regular walk at lunchtime can you.
make a difference.
There are specific exercises for Tell us we’re listening!
your sphincter and pelvic floor that Our staff want to know how they
may help to improve both bowel are doing. Tell us what you think
function and control. at: www.cnwl.nhs.uk/feedback
and then we’ll know what we
Exercises have to do.
Anal sphincter exercises focus on
tightening the muscles around the Contact us
anus (back passage). Hillindon and Harrow Adult
The following exercises are Bladder and Bowel Service
beneficial if you are experiencing Tel: 01895 485100
any leakage from the bowel or
finding it difficult to empty the
bowel:
• Tighten the muscles as if you
are trying to stop wind from
escaping
• Hold for the count of five
seconds and relax
• Repeat this ten times, three
times a day.
This document is also available in other languages, large print, Braille, and audio
format upon request. Please email communications.cnwl@nhs.net

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