Improve Your Bowel Habits

 

Train your bowel

 

People who are regular tend to have bowel movement around the same time every day. The goal of bowel training for people with constipation is to establish such regular patterns of bowel elimination.   The best way to do this is to take advantage of the gastrocolic reflex, a natural reflex that stimulates gastrointestinal motility. This stimulus is at its highest in the morning and shortly after a meal. Even if you do not feel an urge, go to the toilet 30-40 minutes after a meal, preferably breakfast. Your attempt to have a bowel movement should take about 5 minutes and not be rushed. If your mornings are too busy, choose a different time - after an afternoon or evening meal.

 

Do not ignore the urge to go

 

If ignored, the natural reflex that initiates the urge to eliminate will become weaker over time. In addition, by remaining in the 

Folden S. L. et al., Practice Guidelines for the Management of Constipation in Adults, 2002
Bowel training for constipation relief

colon for too long, the stool becomes hard and thus difficult to pass.

 

Adjust your position

 

For anatomical reasons, the best position for emptying the bowel is squatting. Studies have shown that squatting minimizes the need for straining and decreases the time needed for successful defecation.   To achieve the squatting position on the toilet seat, lean forward while using a footstool to bring your knees above your hips and closer to your abdomen.

 

Put your muscles to work

 

Abdominal muscles. Strong abdominal muscles can compress the intestines and thereby substantially help in the propulsion of stool. Several clinical studies have demonstrated the value of diaphragmic or abdominal breathing (which engages and strengthens abdominal muscles) in facilitating elimination.

 

Abdominal breathing for constipation relief

Like its name suggests, abdominal breathing entails using your abdomen, rather than your chest, for breathing.   To better understand this breathing technique and how to use it correctly, place one hand on your abdomen and the other hand on your chest. While inhaling and exhaling, the hand on your abdomen should move outward and inward; the hand on your chest should remain still.

To practice abdominal breathing, sit comfortably with your shoulders relaxed. Start by inhaling (expanding your abdomen) slowly and deeply for 6-8 seconds. Hold your breath for 30 seconds (or less, if this feels uncomfortable) and slowly exhale (collapsing the abdomen) for 6-8 seconds, expelling all the air. Pause briefly for 10s, taking 2-3 normal breaths, then repeat

Sikirov, D., Comparison of Straining During Defecation in Three Positions, Results and Implications for Human Health, 2003, Digestive Diseases and Sciences, 48 (7), 1201–1205
Ozturk R and Rao S.S.,  Defecation disorders: An important subgroup of functional constipation, its pathophysiology, evaluation and treatment with biofeedback, Turk J Gastroenterol 2007; 18 (3): 139-149

the exhale/inhale routine. If you feel uncomfortable or start to feel dizzy at any point during the exercise, stop and try it some other time.

Aim to practice this technique three times a day for approximately 15 minutes. Although it may seem unnatural at first, with time and practice, abdominal breathing will become a habit.

Abdominal breathing can be combined with “huffing” (short bursts of expiration) to reduce straining during defecation. Excessive straining is not advised as it leads to the weakening of the pelvic floor muscles.

Pelvic floor muscles. Pelvic floor muscles are the long muscles that support pelvic floor organs: bladder, bowel and (in women) uterus. In a substantial number of cases, constipation occurs as the result of inappropriate contraction (rather than relaxation) of pelvic floor muscles. Biofeedback is a clinical approach that uses various instruments to monitor and correct this behavior. This approach has proven effective in a large number of cases. Discuss with your doctor whether biofeedback is the right choice for you.

 

At home, you can perform exercises that help retrain the pelvic floor muscles to allow easier evacuation.   While keeping your abdominal, thigh and buttocks muscles relaxed, tighten the muscles around your back passage (as if trying to prevent passing gas). Keep the muscles tight for 3 seconds then focus on relaxing them for 30 seconds. Aim for 30 repetitions of this exercise, three times a day. It can be performed anywhere (no one will notice) and in every position, while sitting, standing or laying down.

Harrington K.L. and Haskvitz E.M., Managing a Patient’s Constipation With Physical Therapy PHYS THER. 2006; 86:1511-1519
Zivkovic,V., et al., Diaphragmatic breathing exercises and pelvic floor retraining in children with dysfunctional voiding, Eur. J. Phys. Rehabil. Med., 2012, 48:413-21

Abdominal massage

Several small clinical studies have suggested the usefulness of abdominal massage in relieving constipation.   The massage can improve abdominal relaxation and increase colonic motility. It has no known side effects. Abdominal massage is also easy to learn and perform at home.

Use your fingers (or a tennis ball) to apply moderate clockwise circular pressure along the line of the colon. Start at the right hip, then move upward, cross to the left side underneath the ribs, and go down to the left hip (see the picture). Be careful not to apply intense pressure, as this can compact the stool and lead to the worsening of the problem. Aim for 10 repetitions, each lasting about 1 minute.

Harrington K.L. and Haskvitz E.M., Managing a Patient’s Constipation With Physical Therapy PHYS THER. 2006; 86:1511-1519.
Abdominal massage for constipation relief

To summarize:

Toilet training for improved bowel habits infographic

Last updated: December 6, 2016