The bossiest, most demanding part of our pelvis is our "back passage" (our anorectal function, BMs or pooping). If your bowels aren't emptying well (full, complete and satisfying daily BMs), then your bladder, your pelvic organ support, your intimate function and your general sense of wellbeing won't be thriving either. "Back Passage First" is a rule in pelvic physiotherapy. Once you learn and/or relearn wonderful bowel release, your other pelvic issues may be addressed with ease.
What is normal for your BMs? The rule is that you enjoy a full, complete and satisfying BM at least every 2nd or in rare people, every 3rd day or as frequent as 2 - 3x per day for some people. There should always be a sense of full evacuation of your stool, not a sense of "there's still some left behind". There should be ease in release, not pushing, forcing, breath-holding or grunting. There should be ample time to get to the toilet, not making a mad dash to get there in time. There should be a clean exit with tidy wiping with ease, no skid marks in your undies or loss of stool without you being aware. There should be no straining or pushing or pain. And it should end with a sense of satisfaction of a job well done! What should a normal bowel movement be? Perhaps surprisingly, we talk about this a lot and the smart folks in Bristol, England developed the Bristol Stool Chart. It's a handy guide to give both you and your health care providers a simple way to talk the same language about our bowel function. The scale goes from 1 to 7. Numbers 1 and 2 describe hard lumps, either separate or together…..think deer droppings and indicate a level of constipation. 3 and 4 are sausage-y like shapes, sometimes dry and cracked or smooth and snake-like. If your bowel movements look like 3 and 4, that's great as long as they're the width of a sausage, not a pencil. That indicates other issues. 5 is soft and blobby with clear edges and indicates a lack of fibre in your diet. 6 is the beginning of diarrhea, soft and blobby but with ragged, frayed edges. 7 describes full-on diarrhea….loose, watery, liquid poop with nothing solid visible. Understanding and getting familiar with the Bristol Stool Chart can help you describe to your health care providers what's going on inside you. It's not normal to have blood or mucous. Blood can appear from a hemorrhoid and enthusiastic wiping or can be an indicator that there are more challenging problems. Mucous shouldn't be in our digestive tract and suggests that your body is fighting an infection. You need to see your doc, either way. Your BMs should be brown, with no undigested food visible, not chalky or blackish or have a truly foul or different-from-normal odour. We're not talking smelling like roses, but healthy BMs don't smell awful! Stop and have a gander…..this is digested food that's done its job for you, feeding you and giving you nutrition, energy for your life and yumminess….be grateful and pay attention. Your BMs give you cues about your health. Your toileting habits matter. Firstly, it's important to understand the gastrocolic reflex. This is the nudge that you receive (thanks to your lower esophageal sphincter chatting with your lower colon) when you start your day with a warm, caffeinated drink. As you swallow, your colon gets the message, "Empty out yesterday's food…..today's is coming!" Paying attention at that moment will help you establish beautiful bowel habits. Go to the loo. Spend some relaxed time, not rushing, calmly breathing into your belly, with your knees slightly higher than your hips on support, massaging your tummy and enjoying effortless bowel release. It takes opening of the pelvic floor to accomplish this, so calm, unrushed presence is really helpful. Don't wipe right away. Take a few more breaths to be sure that you're done. Toileting habits will be in our next "chat". Bladders and bowels ask different things of us on the toilet, so clarity around the messages you receive and your response is important. Happy BMs!
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