Constipation - it’s not just the little poos that matter.

Many people associate ‘constipation’ with those firm, little ‘rabbit droppings’ poos that leave you feeling sore and frustrated. However there is more to constipation than the size of your stool, and it’s really how well you are emptying your bowels that matters.

What Is Constipation?

Constipation is defined as any problem with passing stool. Constipation

generally means passing fewer than three stools a week or having a

difficult time passing stool.

Constipation is often typically associated with hard, overly-firm, lumpy or

dry stool, however overly wet/soft stool can also result in incomplete

emptying.

What is needed to do a good poo?

There are two main reflexes involved in our ability to open our bowels.

These reflexes are involuntary, and involve a number of different messages

being sent to/from our brain and our bowels.

1. RAIR (RectoAnal Inhibitory Reflex)

When your rectum is full, with either stool or gas or both, it greats a

stretch of the tissues. This stretch triggers a reflex that causes the

internal anal sphincter to relax while the external anal sphincter

briefly contracts. This allows a small amount of material to enter into

your anal canal for “anal sampling”, where your body senses if it is

safe to pass wind or if it;s an occasion where a toilet trip is needed.

This reflex also gives you the opportunity to either acknowledge this

‘call to stool’ and go to the toilet, or send a message back to your

bowels that it isn’t the right time.

2. RACR (RectoAnal Contractile Reflex)

This brief, involuntary contraction of the external anal sphincter

occurs in response to rectal filling or stretching. It allows anal-

sampling to occur without any leakage.

If you receive the urge to stool, and decide that you are in a good position

to get to a toilet, you actively relax your external anal sphincter and pass a

poo.

If you receive the urge to stool in a less than ideal location (hello, the

freezer section at your supermarket), the external anal sphincter contracts

and sends a message back to the bowels. Your internal anal sphincter

stays relaxed for a short period of time and then will slowly close until the

next RAIR.

Don’t Ignore Your Poo!

Why is this relevant? Well, choosing to ignore your body’s message doesn’t

mean the stool goes away - the urge might, but the poo doesn’t.

This means that your rectum remains loaded. And more stool is transported

from your large intestine around to your rectum. And things start to back

up. If you regularly ignore the messages from your body that it’s well and

truly time to empty your bowels, the stool starts to build up to the point it

backs up into your colon.

If your bowels register that things are backing up, it will slow down your gut

transit. This means that your gut motility (or the way your bowels move

waste product from your small intestine, through the large intestine, and to

the rectum) starts to slow, leaving the stool to sit in the large intestines for

longer periods of time.

Why is this a problem?

Your large intestine (large bowel) is designed to reabsorb water from our

stool, turning it into the ideal stool we are all hoping for (think thin, formed

sausage). However the longer the stool stays in the large intestine, the

more water is reabsorbed - and we head towards the rabbit droppings.

Once our stool is hard, firm and lumpy it becomes more difficult to

successfully (and comfortably) do a good poo. This leads to incomplete

emptying, our rectum remaining full, and the cycle continues.

But what about the soft stools?

Our aim when we sit on the toilet is to do a full, complete bowel motion that

leaves our rectum empty and supports normal gut motility and stool transit.

Soft/liquid stool doesn’t do a very good job of coming out in one go, as it

lacks the binding that adequate fibre/hydration is designed to give. This can

result in people straining/bearing down to feel adequately empty, as well as

an amount of the stool staying in the rectum.

When we talk about “stool consistency” we often refer to the Bristol Stool

Scale. This scale ranges from Type 1 (pellets) to Type 7 (diarrhoea). An

ideal poo is either Type 3 or Type 4 - a sausage or snake, either smooth or

with cracks on the surface.

So, what can you do?

Reviewing with a pelvic floor physiotherapist who has training in anorectal

assessment can help to identify any underlying problems, however often

optimising your bowel routine is enough to get on top of constipation.

Simple lifestyle changes can make a huge difference in getting that happy

bowel:

● Honour your call to stool: when you need to go, you need to go. Don’t

put off a poo!

● Eat breakfast: Having something small in the morning, even if you

aren’t a “breakfast person”, helps your bowel to switch on and start

working. This can help to ensure you’ve done a good poo before

leaving the house and starting your day.

● Know your fibre: we need a mix of fibre to help our stools to bind and

achieve that perfect Type 3 - 4 consistency. If you’re not sure, chat to

a dietitian.

● Adequate hydration: drink 1.5-2L of water based liquids per day is ideal for optimal bowel function. This can include water, sparkling water, diluted juice, milk, tea and coffee, as well as high water content foods like watermelon, grapes, lettuce, custard, soup and jelly.

● Chew your food: we all love a smoothie, but we need to chew for our gut to know we’re eating and it needs to get working. Consider adding some texture to your smoothie like soaked chia seeds, dry coconut, cocoa nibs, or granola to ensure you get some crunch.

● Proper poo posture: using a foot stool that supports your whole foot

(toe to heel) and gets your knees higher than your hips helps your

pelvic floor to relax.

● Moo to poo: slow day? Mooing helps to build abdominal pressure

around your bowels without causing strain.

By Eleanor Lambert