Next to sex, few bodily functions are as private as pooping. For example, you’ve no doubt driven past a guy who pulled over to take a leak, but we’re betting the only guy you’ve seen squatting on the shoulder was changing his tyre.
No, defaecation is best executed with stealth. Enter bathroom (or stall), lock door, keep sounds to a minimum and then employ toilet paper and air freshener to eliminate any trace of what transpired. It’s almost as if you’ve committed a crime. Actually, you have: destruction of evidence.
In your rush to flush, you lose a unique opportunity to assess your health. From colour to consistency, logs on the bottom of the bowl are like tea leaves waiting to be read, potentially predicting such conditions as Crohn’s disease, irritable bowel syndrome, colon cancer or a bowel obstruction. If this all sounds (and looks) like a load of crap, it’s time you were schooled in stool.
Regularity Is a Virtue
You might wonder whether your bathroom habits are normal. Well, here’s what science has to say: Japanese researchers have concluded that the average healthy guy takes a seat about once a day. But the key here is “average”. The truth is, when it comes to frequency, there is no such thing as an ideal number for number two. Everyone’s colon moves at a slightly different pace – and that means it’s normal and healthy to go anywhere from three times a day to three times a week, says gastroenterologist Dr Richard J. Saad, an assistant professor of medicine at the University of Michigan.
The time to worry is when your colonic clock suddenly switches from a decades-long schedule of three times a week to three times a day, says Saad. “Don’t ignore any sudden change in bowel movements, in terms of their frequency or their form.”
Ah yes, the shape of your turd. Saad’s research suggests that the healthiest logs resemble smooth sausage links. “Sometimes it can be a little bit on the firmer side – where it’s shaped like a sausage and has a few cracks on the surface – all the way to soft, semi-formed blobs,” he says. But anything harder or softer than that can be a sign that something’s wrong. While deviations in form (or frequency) could be a symptom of something as simple as constipation, they could also indicate a more serious problem, such as irritable bowel syndrome, Crohn’s disease, a bowel obstruction or maybe even colon or stomach cancer, says Dr T. Lee Baumann, a medical consultant and the author of Clearing the Air: Art of the Bowel Movement.
Improve your grade Peer into the porcelain. Is what you see on the firmer side? Has it been days between trips when it used to be hours? Then consider drinking an extra glass of water with every meal. According to new research in the American Journal of Gastroenterology, fluid intake is the biggest predictor of constipation. People who consume less water are more likely to suffer constipation than those who drink more. Adding more insoluble fibre to your diet helps too, says Baumann. Your body can’t digest this type of roughage, so it passes through your gut and softens your stool. In fact, a UK study found that adding at least 3.5 grams of wheat bran, a type of insoluble fibre, to your daily diet can improve constipation and other aspects of digestion in just two weeks. Try good ole Kellogg’s All-Bran Flakes, which has 4.5 grams of insoluble fibre in half a serving.
Now, if you have the opposite problem – you’re producing blobs instead of bratwurst or going more often than ever – increase your soluble fibre intake instead. Add more oats, lentils, almonds and root vegetables to your diet or use a soluble fibre supplement. “Soluble fibre absorbs water and becomes gel-like as it travels through your system,” says Baumann. The result: firmer and less frequent faeces.
And if these dietary adjustments don’t make a difference? Make an appointment with your GP, asap. This is especially true if what you see in the toilet looks like thin ribbons or pencil-sized strands – a possible sign of a bowel obstruction or even colon cancer.
Lots of Things Can Give You the Runs
Anything from food to pharmaceuticals can trigger hormonal responses and nerve reflexes that activate your bowels. And making a beeline to the bathroom after consuming a particular food may be a sign of an allergy or sensitivity.
“The food goes into your gut and causes an allergic response and inflammation,” says Dr Michael B. Stierstorfer, a clinical associate professor of dermatology at the University of Pennsylvania. “The inflammation disrupts motility in your gut, and when your gut’s not passing things through like it should, you experience symptoms.” Acute stress can also trigger repeated trips to the toilet.
Improve your grade Uncover undiagnosed food allergies: in a study, Stierstorfer found that applying patch tests of foods and food ingredients to people’s skin helped them detect hidden food allergies that were causing bowel problems. Try the same thing at home – if your fingers get red and itchy after handling a food for a prolonged period of time, avoid eating it for a week to see if you feel better, says Stierstorfer.
Of the drugs that may stimulate your system, the biggest culprits are antibiotics, non-steroidal anti-inflammatory pain relievers, magnesium-containing antacids and proton pump inhibitors for heartburn. If you suspect one of these is leading you to the loo, talk to your doctor about adjusting your dose or medication. If untamed tension is to blame, study up on mindfulness-based stress reduction techniques and put them into practise.
Don’t Ignore a Pain in the Butt
Some parts of your body, such as your heart, can develop problems without symptoms. Your butt is another story – when something’s wrong, you’ll know it every time you take the throne. “Your anus and lower part of the anal canal are among the most sensitive places in your body,” says Saad, “because they have to sense gas, liquids and solids and choose when they can pass and when they can’t.”
Improve your grade An itching, stinging or burning feeling could mean that you ate too many chilli poppers last night. But when spicy foods aren’t to blame, the most likely cause is haemorrhoids: swollen veins in your anus or rectum. The veins can become inflamed from constipation, straining on the john or sitting for too long during the day, says Saad. Follow the advice in Lesson 1 and soothe the inflammation with haemorrhoidal suppositories. Suppositories are better than creams, Saad says, because your anal canal extends into your body, and it’s, er, hard to reach in there with cream.
If you’re still wincing after five days, drag your ass to your doctor and ask for a topical anaesthetic-containing formulation to take the edge off those razorblades it feels like you’re passing. And don’t procrastinate: you could also have a tear in the lining of your anal canal, caused by straining or passing hard stool. Or your pain could signal Crohn’s disease. This autoimmune disorder can spur the formation of small tracts in your colon or rectum that extend through the skin near your anus, causing pain and bleeding.
You Can Have Any Colour Bowel Movement, as Long as it’s Brown
While slight variations in the hue of your poo are fine, any colour in the spectrum other than brown should give you pause. Best-case scenario: it really was just something you ate. Beetroot, spinach, rhubarb and foods that contain artificial colours can all make the bowl look like a child’s art project. Unfortunately, it’s not always easy to predict what colour will come out. “After foods mix with digestive enzymes in stomach acid and bile, food colouration can change drastically,” says Baumann. If you can’t link what you’re seeing to a recent meal, it may be a medication, such as indigestion remedies, antacids or one of several antibiotics. The worst-case scenario? You could have ulcerative colitis, Crohn’s disease or even colon cancer, says Saad.
Improve your grade The two colours you never want to see in the toilet or on the paper are black and red. Both can indicate blood. First try to rule out food, medications and haemorrhoids while watching closely for a recurrence over the next several weeks. “If it happens more than once and is combined with any other symptoms, such as rectal pain or a change in frequency, see your doctor immediately,” Saad says. Start with your GP, who can refer you to a gastroenterologist if needed. You should also see a doctor about your bowel movements if the colour is very light, almost white. This could indicate an obstruction in your bile duct, which can cause a life-threatening infection or chronic liver disease.
You’re Probably Doing it All Wrong
The modern toilet is so simple to use that even a cat can be taught to jump up and take a dump. And yet for all our Homo sapiens smarts, most folks assume the wrong position. In a Japanese study, people who squatted to defaecate with their knees towards their chest actually straightened their rectal canal and cleared its contents better – with less straining – than those who kept their feet planted flat on the floor. That’s important if you tend to strain while sitting on the bowl, since putting too much effort into your evacuations can increase your risk of haemorrhoids, diverticulosis and even stroke. “The main manoeuvre involved in defaecation is called the Valsalva manoeuvre, where you press your abdomen down to your bowels and close your windpipe,” says Baumann. “If the pressure is too great, it can cause strokes and brain haemorrhages.”
Improve your grade Even though the knees-up position might be the optimal way to defaecate, it’s probably going to feel awkward. That’s why if you aren’t having any problems with frequency, consistency or straining, you can go ahead and keep your legs down. Otherwise, try pulling up your knees. (You can also keep a 10-centimetre step or box in your bathroom and place your feet on it during toilet time.) If you still need to strain for a few seconds to finish the job, make sure to take frequent, shallow breaths to reduce pressure on your windpipe, says Baumann.
Don’t Delay the Inevitable
Unless you’re already wearing adult nappies, you sometimes have no other option but to ignore the urge. And while it might seem that all you’re doing is clenching your cheeks and distracting your mind from the sensation, there’s more going on inside your body than you realise. “If you hold back a bowel movement, your rectum returns the contents to your sigmoid colon,” says Baumann. “Once that happens, your colon reactivates the process of extracting fluid from its contents and your stool will harden.” That means when you finally do go, you may need to strain, which can increase your risk of haemorrhoids, anal tears and diverticulosis.
Improve your grade When nature calls, try not to put it on hold any longer than you absolutely have to. “Don’t make it a habit to ignore the urge to have a bowel movement, as this can lead to defaecation problems over time,” says Saad. Once you find a place to unburden your bowels, get comfortable and practise patience. (May we suggest taking a copy of Men’s Health into the stall with you?) It can take several minutes for gravity and nerve reflexes to pull your colon’s contents back down into your rectum and out, says Baumann. Some things are too important to rush.
By Julie Stewart