In One End, Out the Other

We usually pay plenty of attention to what goes into our bodies, but what comes out the other end is another story. It’s often flushed away without so much as a glance. And it’s no wonder: bringing up toilet topics in conversation can be decidedly unpopular.

Take a good look

Yet monitoring what’s left in the loo could be one of the best things we do for our own health. In order to know when a potentially important change in health has occurred, we should be able to describe what personally constitutes a typical bowel movement.

First things first: what are you looking at when you peer into the bowl? Stool is composed of roughly 75 percent water and 25 percent solids. The solid component includes bacteria, indigestible food matter, fats, inorganic substances (for example, minerals), and protein.

Although bacteria are only a part of the total package, they give stool its main characteristics: the brown colour occurs when bacteria act on bilirubin (a byproduct of the liver breaking down old red blood cells), while the infamous odour comes from chemicals produced as the bacteria do their digestive work.

We spoke to Dr. Robert Enns, Vancouver gastroenterologist and VP of Clinical Affairs for the Canadian Association of Gastroenterology, to answer some of your most important questions about bowel health.

What does a normal bowel movement look like?

“There’s likely no such thing as a ‘normal’ bowel movement. Everybody has different types of bowel movements, different shapes, different sizes, and, in fact, different frequencies,” says Enns. Despite this huge range, he says, it is possible to characterize a relatively good bowel movement: “[One] relatively formed, relatively soft, and passes with relative ease.”

What foods affect bowel movements?

Enns says fibre is the number one dietary factor that affects stool texture. Most often when doctors advise patients to increase fibre intake, they are talking about insoluble fibre, which can have a bulking effect and keep things moving through the gastrointestinal tract.

Certain nonabsorbable sugars, such as xylitol, can also affect bowel movements. “The reason they’re used as diet sugars is they’re [largely] not absorbed,” Enns says. “They give you the same taste, but they may stay in the gastrointestinal tract. In fact, some nonabsorbable sugars will give you diarrhea because they stimulate
the bowel.”

Likewise, products containing caffeine are bowel stimulants that may have a laxative effect. Coffee, tea, and chocolate all fall into this category.

On the other hand, a high-protein diet tends to increase constipation. Thus, says Enns, the “meat and potatoes diet” is less than optimal for bowel health.

Why is it important to drink enough water?

The fact that stool is 75 percent water is a clue to its importance in good digestive health. “If you don’t drink enough liquid, and you get volume-depleted or dehydrated, you’ll tend to absorb more water from the colon,” says Enns. “Your bowel movement will be harder, and you’ll have a tendency toward constipation.”

Are organic foods better for the bowel?

Enns says that many patients report a big difference when they exclusively eat organic foods. However, he says, the jury is still out on whether the organic quality of the foods is what truly helps people stay regular. “When people [start] organic food products they usually change their diet as well,” he says. He and his colleagues look forward to seeing more good scientific studies on the topic.

What else can influence bowel movements?

Because of the prominence of bacteria in stool, anything that changes bacterial balance can change the quality of bowel movements. “Antibiotics kill bacteria, and probiotics add bacteria,” says Enns. “So obviously those types of things affect the bowel.”

He also points to two lifestyle factors that influence bowel movements: exercise and stress. Exercise stimulates the bowel and, like caffeine, can have a laxative effect. Stress, on the other hand, can tip the balance toward either diarrhea or constipation.

Stress commonly creates a feeling of urgency and a looser bowel movement. “However, there are people who get constipated with stress, too,” says Enns. “Having a bowel movement involves a certain amount of relaxation of the muscles in the rectal region … That’s where stress in some people gives them a lot of difficulty with the passage of a bowel movement.”

How serious is constipation?

Just because someone is getting a lot of reading done on the toilet doesn’t necessarily mean he or she is constipated. “Constipation is usually an infrequency of bowel movements, accompanied by symptoms,” says Enns. “Those symptoms are typically abdominal bloating, distension, cramps, and pain with defecation or the passage of stool.

“Constipation certainly can be serious, depending on the cause and the duration of time that it’s been going on for,” he says. “New-onset constipation is a sign that the change in bowel movements, or the constipation, [may] caused by something, such as a tumour or a blockage.” Constipation can also signal other conditions, such as thyroid problems and high calcium in the bloodstream, so may require further investigation.

Who can benefit from taking probiotics?

“Probiotics in some people may certainly help them become more regular. The most common probiotic people use is in the form of yogurt. So a lot of people find that if they have their regular dietary supplement of that probiotic, it helps them in many ways.”

Enns says, however, that we don’t yet have a large body of research to help make recommendations. “Each probiotic is slightly different and the question is, if one probiotic has been studied for one condition, does that mean that all other probiotics will work, or not work, as well? That’s very difficult to know.”

Some of Enn’s patients have reported relief from excessive gas and bloating after supplementing with probiotic pills. He notes that they may be particularly useful for patients taking specific antibiotics and those who travel frequently.

How much fibre?

Check the fibre breakdown of the foods you eat to be sure you’re getting enough fibre in your daily diet.

Best foods for best bowels

These two categories of foods can promote good bowel health.