My Answer to A Question I Get Asked Frequently

What do my bowel habits have to do with pelvic pain or urinary problems?

In this week’s blog I am going to answer a question I get frequently when I ask people about their bowel frequency, stool consistency, etc.  when they are coming in to see me about urinary issues or pelvic pain.  “Why do you need to know that?”

Well, if you bowels are not working well and you are constipated, the bladder is more likely to leak and you are going to feel stronger senses of urinary urgency and experience urinary frequency.  Why is that? Because stool or feces will be sitting in the sigmoid colon and rectum and that presence will move forward in the pelvis pushing into the bladder.  Also, if your poop is hanging out in the sigmoid colon and rectum the pressure also moves backwards and may irritate the nerves of the lower back and sacrum—increasing pain-pelvic and back pain that doesn’t respond to other forms of treatment.

Another reason why I ask is that constipation is the most common GI complaint resulting in 2.5 million (yes, you read that right) visits to the doctor.  In the US, people spend about $750 million on over-the-counter laxatives every year.  Until I know, without a doubt, people who are seeing me have healthy bowel movements, I assume that they don’t.

What are healthy bowel movements? Like most answers, it depends.  Doctors and other health professionals will tell you if you are pooping at least 3 times per week, you are normal.  I think it may be common to skip a day, but it’s not normal.  I think everyone should aim for at least 1 bowel movement a day.  Some people are normal if they go up to 3x/day.  I find the Bristol Stool Scale useful in determining where some one is on the healthy stool scale.  (For you science nerds it was developed and has been validated to evaluate the effectiveness of treatments for various bowel diseases like IBS.)  Here is a link to the chart that I use in the clinic: https://en.wikipedia.org/wiki/Bristol_stool_scale.

And I ask if you strain when you have a bowel movement.  Women who constantly strain are at increase risk of a hemorrhoids, anal fissures and pelvic organ prolapse.  This risk increases with following menopause because of the loss of skin and tissue elasticity.  So much we didn’t learn about how to poop!!

Another thing to know about constipation and why it’s important to work towards healthy bowel movements is constipation can lead to an increase in belly fat.  Why’s that? Briefly, it has to do with an excess of estrogen in your body.  The liver is processing the estrogen and dumps it into the gut to be eliminated.  If stool sits in the sigmoid colon, the body resorbs the estrogen and the cycle starts all over again with the estrogen going back into your system.  (More on estrogen coming in a later blog!)

It’s frequently during this part of the conversation, that women start to look a little worried or scared because they thought some of this was normal.  Here’s where I get to tell you there are some easy life-style modifications you can make to improve your bowel habits.

1. Drink a warm beverage first thing in the morning.

Some of you believe it’s that first cup of coffee in the morning that gets you going, but research shows it's warm fluid that helps get things moving.

If you choose to drink coffee eliminate the artificial sweetener and creamers both of which have been linked to constipation.

If you drink warm water or tea, add a wedge of lemon to your warm drink.  The lemon may help with ensuring that your stomach juices are optimized for digestion.

2. Sit on the toilet! Lean forward and place your feet on a stool. 

Even if you are able to plant your feet on the floor, your pelvis and hips may be tipped in such a way, that the muscles aren’t able to relax for things to move freely. Grab a stool-maybe the one your kids use to reach the sink- and put it in front of the toilet.  How tall should the stool be—like everything else it depends.  If you have one of the newer, taller toilets you may need a 9” stool.  If you are on the tall side you may only need a 5” stool.  The average height person needs a stool between 5-7” tall.

This position-your knees a little higher than your hips help the muscles relax.

3. Drink plenty of water

How much should you drink? It depends.  Most of us have heard we need 8 glasses of water a day, the equivalent of 64 ounces, or ½ gallon.  Our needs may change depending on where we live, what we do and our age.  The latest research has determined that we should drink ½ of our body weight in fluid ounces daily, and 80% of those ounces should be water.  (I know that’s a lot of math).
Here’s an example:

You weigh 128 pounds

128/2 = 64 fluid ounces

64 x80% + 51.2 ounces of water/day

4. Increase and balance your fiber

Insoluble fiber is the fiber is the fiber from foods like whole wheat products, seeds, fruit and vegetable skins, and brown rice.  They move bulk through the intestines and help maintain an optimal pH which helps prevent microbes from producing cancer substance.
Soluble fiber is the fiber you get from eating fruits and vegetables.  They help bind fatty acids which lowers the total cholesterol and reduces the risk of cardiovascular disease.  It also helps regulate blood sugar.

You should aim for a minimum of 5 cups (!) of fruits and vegetables a day.

5. Take a walk every day 

Lace up your walking shoes and hit the pavement for a 20-minute walk.  Regular exercise keeps everything moving.  It helps decrease your stress level which in turn allows the “rest and digest” part of your nervous system do what it needs to do.  There is also research that supports getting outside decreases our stress hormones.  Invite your partner or a friend and catch up with each other, listen to an audiobook or podcast—but only with one earbud so you can hear what’s going on around you as well.

6. Practice mindful breathing

Sit quietly, with your feet on the floor.  Notice your body--the sensations it experiences, the touch, the connection with the floor or the chair. Relax any areas of tightness or tension. Just breathe.  Feel the natural flow of breath—in, out. You don’t need to do anything to your breath. Not long, not short, just natural. Notice where you feel your breath in your body. It might be in your abdomen. It may be in your chest or throat or in your nostrils. See if you can feel the sensations of breath, one breath at a time. When one breath ends, the next breath begins.  
Now as you do this, you might notice that your mind may start to wander. You may start thinking about other things. If this happens, it is not a problem. It's very natural. Just notice that your mind has wandered. You can say “thinking” or “wandering” in your head softly. And then gently redirect your attention right back to the breathing.

Stay here for 3 to 5 minutes. Notice your breath, in silence. From time to time, you’ll get lost in thought, then return to your breath.  

Once again notice your body, your whole body, seated here. When your done appreciate that you are helping your nervous system reset to rest and digest.

7. Schedule a time to move your bowels

Your bowels are creatures of habit.  They like to have a schedule.  Using the 5 tips above will help you become more regular.  Set a regular time for daily bowel movements. Choose a time that is convenient for you. Keep in mind your daily schedule. The best time for a bowel movement is 20 to 40 minutes after a meal, because eating stimulates bowel activity.

There you have it.  Why your bowel health is important to your overall pelvic health and if you are suffering from constipation, some actionable steps that you can take to help yourself.  Please feel free to reach out with any questions or concerns.  Some of my clients who see me because they complain of constipation call me the bowel whisperer.  It’s one of the highest compliments I’ve been given!  😊