Understanding Typical Bowel Function

Author: Joh-Ann Gouws

Physiotherapist with a special interest in pelvic health and function

I often hear people say: “This is normal for me” or “I know I should be having a bowel movement every day, but… (insert whatever reason you can think of here)” and we often have to talk about what is actually considered typical bowel behaviour. Bowel function can vary greatly between individuals and a great amount of variance can all be considered “normal”. Understanding some basics of typical bowel function in someone who is healthy, can help you measure your own bowel function and know when it’s time to seek medical advice and what specific changes or symptoms to mention to your healthcare provider.

For a quick FREE printable overview and questionnaire that you can use, see the BOWEL NORMALS resource available here Free resources | Pelvic Therapy (thepelvictherapist.wixsite.com).

How often should we have Bowel Movements?

Although there is a common belief that everyone should have a daily bowel motion, this doesn’t seem to be the one size fits all solution for all. It is considered normal to fall between the range of 3x per week to 3x per day.

This means that going about every second day, if that is typical for you, is completely acceptable. For some people it can also be considered normal to go up to three times a day, often this will occur following bigger meals. And in these cases, where it is what their bowel typically does, it will be considered normal.

What is important to remember is that YOUR bowels will likely follow the same routine and changes that are not related to nutritional factors or an acute tummy bug, should be monitored and potentially investigated. Of course you shouldn't see your doctor every time you have a different pattern, but if there are major consistent changes that interferes with your life or has you worried, please do not just think that it will normalize without intervening.

What should your poo Consistency and Appearance be?

Most healthcare providers will use the Bristol stool chart (see below) to ask you about your poo consistency, so before you flush, have a quick look in the bowl.

In healthy individuals, stool consistency is expected to be Type 3 or 4 most of the time. These type of stools are formed well and firm enough to let you know that they are ready to be passed when they arrive in the right area, but soft enough to pass easily.

Anything firmer, is often an indication that the poo doesn't have enough moisture left in the stool matter. This can be due to a variety of reasons which could be as simple as not having enough fluids from hydration or it could be related to more complex problems like food intolerances, amongst other reasons.

Poos that are very watery or runny or consistently softer than a type 4 can be problematic too. These are much harder to hold onto if you have weakness in the muscles and in cases not liked to a tummy bug, again could be cause for concern.

Stool colour will usually be a medium brown colour but might change due to changes in your diet. The most common diet related changes we see would be a deep purple from beetroot or green when you have eaten a lot of spinach. If the colour changes to pale or black, however, it can often be related to more serious health issues. Any blood or mucous present in your stool should also be mentioned to your doctor.

How should a bowel motion pass?

Poos should not be painful to pass, you should not have to strain to get a poo out and if you do need to push, it should be to initiate the bowel motion only as your rectum muscles should do the actual job of getting the poo out.

In other words, sitting and pushing until you are red in the face is not only ineffective, but can also be harmful. Straining this way repetitively, over a time period can lead to a range of pelvic health problems like pelvic organ prolapse (see more information here Pelvic Organ Prolapse in a nutshell), haemorrhoids, tears around the area and incomplete emptying which can lead to stretching out your back passage.

What else is considered typical bowel behaviour?

When a formed poo arrives inside your anus, you should get a signal telling you that it is time to go. When this signal happens, don’t ignore it too long and delay going, as this will only cause the poo to become harder and more difficult to pass. You should have control over when you can go in case it is not a convenient time.

You should be able to hold the poo inside until you get to the toilet without any poo leaking out. After passing the poo, you should feel empty until the next time a formed poo arrives.

It is normal to have some gas, but you should be able to control the release of gas. You should also be able to recognize the difference between gas and a poo that is waiting to exit. Any excessive gas or consistent bloating, however, could indicate digestive problems. If you are concerned about the amount of gas you produce or your ability to control gas, it is worth talking to your healthcare provider about this, even if it feels like a minor or embarrassing topic to discuss.

Factors affecting Bowel Function.

Certain medical problems could affect your bowel health, but it can also be influenced by lifestyle factors that is often modifiable.

Diet and hydration is important in providing the bulk of poos and water you need for correct poo consistency. As mentioned, changes in your diet could also change the colour of your poo, but this will correct once the food has made its way out of your body.

Physical activity is important to help your intestines move and is a very important part of managing constipation. If you talk to any runner doing long distances, they can tell you stories about their bowels and running, however, running is not the only exercises that is helpful for managing bowel health. Doing physical activity that you enjoy is the most important thing when choosing exercise.

Stress and gut health can influence the bacteria available to aid digestion. It is therefore important to equip yourself with stress management tools.

Some medications can also change your poo consistency and lead to diarrhoea or constipation, so be sure to check any known side-effects when starting new medications. Also be sure to report these concerns if they last.

If your bowel health and function fall outside of these typical values, consistently changes or new changes persists beyond a couple of days, it is a good idea to seek medical advice. It can be hard to talk about these issues because it is a function that we do not like discussing and find difficult to ask for help with, but just know that healthcare providers are there to help you address all of the concerns that impact your life, we have most likely heard the same or similar problem mentioned before.

Although bowel function can vary between individuals, a person’s own bowel function should be relatively consistent. By paying attention to your own body’s signals and ensuring that you follow a healthy lifestyle, you can help maintain typical bowel function. If you know what your normal signals and functions are, you can also easily identify when your bowel function is abnormal and when to seek medical advice.