What's regular, anyway? bowel-health basics

When it comes to bowel habits, many people have misconceptions about what's normal. Some overuse laxatives because they believe toxins will accumulate in their body if they don't have a daily bowel movement. Others live with the bloating and discomfort of constipation.

The fact is that what's normal varies from person to person. They may go three times per day or three times per week. But without any strict standards for comparison, how do you know whether you're regular? The first step is to clear up any confusion about what's healthy and what's not.

When the system runs smoothly

Your digestive system is vital to your health. It processes the food you take in, absorbing the nutrients and energy your body needs and eliminating the waste that you don't need. Under normal circumstances, food travels from your mouth, down the esophagus to the stomach, and through the small intestine, where essential nutrients are absorbed. Then, whatever is not used moves to the colon, also known as the large intestine or bowel. This is the stage of the process that is most directly related to your regularity.

As the solid food waste passes through it, your colon gradually soaks up the remaining water in the waste and shapes it into stool. In the colon, gentle wavelike muscle contractions known as peristalsis slowly push stool downward toward the rectum, and stronger contractions then signal the urge to have a bowel movement. If you respond to these signals by passing soft, solid stools without cramps, pain, or strain, you should consider yourself regular, even if you don't have the prototypical one bowel movement a day.

When things slow down

The digestive system is fairly sensitive, so don't be alarmed if, from time to time, things start to move more slowly than usual. Occasional bouts of constipation are quite common.

In most cases, a lifestyle factor rather than an underlying health problem disrupts the body's normal rhythm and slows the movement of stool through the colon. This causes more water to be absorbed from the stool than would normally occur, and as a result, stools become drier and harder, making them more difficult to pass out of the body.

So what can you do to avoid an uncomfortable backup? Try to establish—and stick to—regular routines for meals, sleep, and bathroom breaks. And if you have to go to the bathroom—then, go. One of the biggest contributors to constipation is ignoring this urge, either because you're too busy or you're not comfortable moving your bowels when away from home. Lack of fiber in the diet and a change in dietary habits are other common causes of intermittent constipation.

How to keep things moving

Gradually increasing your dietary fiber and fluid intake should be your first line of treatment. The extra fiber will help keep things moving because fiber absorbs water and swells in the bowel, creating bulkier stools, which stimulate the contractions in the bowel that push stool along. If dietary measures alone aren't sufficient, nutritional supplementation, over-the-counter laxatives, and bulk-forming fiber supplements are also effective forms of self-treatment.

5 rules for regularity

1. Listen to your body. When you feel a bowel movement coming on, go to the bathroom as soon as you can. This may require overcoming any aversion you may have to using bathrooms outside your home.
2. Get your fill of fiber. Increase the amount of dietary fiber in your meals by adding whole-grain breads and cereals, raw vegetables, and fruit. Aim for at least 25 grams of fiber per day, and minimize your intake of low-fiber foods, such as meat, cheese, refined sugar, pastries, candy, and anything made with white flour.
3. Stay hydrated. Don't let yourself get thirsty. Drink plenty of water or other noncaffeinated, nonalcoholic fluids.
4. Don't skip meals. Eating stimulates the reflex that causes waste to move forward in the bowel. Missing meals decreases this movement.
5. Keep your body moving. Moderate physical exercise, such as walking or swimming, at least four times a week can help maintain regularity.

There are also several food-based folk remedies that may help relieve occasional constipation. You may consider trying:

• Apples or apple juice
• Carrots or carrot juice
• Rhubarb
• Persimmons
• Hot tea with 1 tablespoon of honey or molasses
• Hot broth
• 1 tablespoon of olive oil in the morning and evening
• Spinach juice
• Sunflower seeds
• Pitted dates soaked in hot water

When things stay slow

If self-treatment doesn't help to normalize your bowel habits, or if your well-established pattern suddenly changes without any explanation, see a physician or other healthcare provider (HCP). Extended bouts of constipation may be a symptom of another disease or condition. And chronic constipation may lead to hemorrhoids, diverticular disease, yeast/Candida infection, bowel obstruction, enlarged prostate, fatigue, irritability, mild depression, and decreased libido.

If you're not sure whether your patterns constitute constipation, answer these questions.

During the past year, have you:

1. Strained during more than 25 percent of bowel movements (BMs)?
2. Had lumpy or hard stools for more than 25 percent of BMs?
3. Felt as if the BM was incomplete more than 25 percent of the time?
4. Felt a sensation of anorectal blockage/obstruction for more than 25 percent of BMs?
5. Used manual maneuvers to facilitate BMs (e.g., digital evacuation)?
6. Had fewer than three BMs per week?

If you answered Yes to two or more questions, make an appointment with your HCP to find out if you have a condition more serious than constipation alone. Make note of the following factors to discuss with your doctor:

• Medications and supplements you take regularly
• Your diet; include fiber and fluid intake, dairy and meat consumption, and any recent changes
• Other conditions (pregnancy, diabetes) that may affect constipation
• Urge to move bowels (present or not)
• Sharp pain or bleeding when passing stool
• Other symptoms (dry skin, weight gain or loss, fatigue/lack of energy, sensitivity to cold), which may be clues to the cause of your constipation

Stay regular in your own way

Remember, what's normal for one person may not be normal for another. Your digestive system is unique and behaves according to your body makeup, daily habits, and lifestyle, so rather than focusing on a particular number, focus on what's regular for you most of the time.