Have you ever noticed how new parents are always talking about the toilet habits of their little ones, often describing their bowel movements to the smallest of details? We’ve all heard about the super explosive poos that always seem to happen at the worst possible time, which are kind of funny when you’re not the one who has to clean it up. But getting an adult to talk about their own bowel movements… now that’s a taboo topic.
Now I’ll be the first to admit that this isn’t a prime topic for dinner conversation. There is definitely a time and place for it. But what concerns me is that many people are reluctant to mention their bowel movements to health professionals, even when they think there is a problem.
Unfortunately, we’ve been raised to believe that what happens behind the closed bathroom door should stay there, to be flushed away and never spoke of again. But bowel movements are a normal part of living, an essential part of our physiology that has to happen for us to remain healthy.
Don’t get me wrong here though. I do understand the reluctance. It’s taken me a long time to become comfortable discussing my bowel habits with health professionals. In the early years of my irritable bowel syndrome (IBS), back in my teens, it was a struggle to get me to discuss any of my symptoms with my doctor because it always seemed too gross.
But continuing to hide behind this taboo does nothing to help people who have IBS.
In fact, the real problem is that many people who have IBS don’t understand how bad their symptoms are because they don’t speak about them, or because they don’t know what is considered normal and what isn’t.
That’s why we need to open the toilet door on bowel movements and have a frank discussion about the shitty side of IBS. (Yes I went there!) And since it’s IBS Awareness Month, now seems to be the perfect time to do it.
What is a ‘normal’ bowel movement?
The first step to knowing whether your bowel movements are normal is to understand how they are described. The medical profession does this using the Bristol Stool Chart. Types 1 and 2 represent constipation. Types 6 and 7 represent diarrhoea. Types 3-5 represent a healthy bowel movement.
Bowel movements do change from day to day because they’re affected by many things. For instance, how much fibre you eat (as well as the types of fibre), how much fluid you drink, your overall health, and the presence of illness. Since you’re unlikely to eat, drink and live in exactly the same way from day to day, your bowel movements will change too. And if they occasionally shift outside of types 3-5, that’s normally not a major concern.
However, if you’re consistently passing types 1 or 2, this means that you’re experiencing ongoing constipation. On the flip side, if you’re consistently passing types 6 or 7, you’re experiencing ongoing diarrhoea. Both of these situations are undesirable and should be discussed with your doctor, but by themselves don’t necessarily indicate a diagnosis of IBS.
What are bowel movements like in someone with IBS?
Unfortunately there’s no absolute answer to this question since bowel movements in IBS are highly variable. If you were to talk about your bowel habits to another IBS sufferer, odds are that your pattern wouldn’t be the same as theirs. However, there are four common patterns of bowel movements in IBS sufferers that can be categorised as follows:
- IBS with constipation, which is characterised by bowel movements that are hard or lumpy (types 1 or 2). To fit this pattern, constipation needs to occur at least 25% of the time, while loose or watery stools (types 6 or 7) occur less than 25% of the time.
- IBS with diarrhoea, which is characterised by bowel movements that are loose (mushy) or watery (types 6 or 7). To fit this pattern, diarrhoea needs to occur at least 25% of the time, while hard or lumpy stools (types 1 or 2) occur less than 25% of the time.
- Mixed IBS, which is characterised by the switching of bowel movements between hard or lumpy stools and loose or watery stools. To fit this pattern, both types of bowel movements need to occur at least 25% of the time.
- Unsubtyped IBS, which doesn’t have a distinct pattern and so includes bowel habits that don’t fit another pattern.
Please note that IBS is not diagnosed solely on stool patterns. A diagnosis of IBS also requires the presence of recurrent abdominal pain or discomfort, a change in the frequency and/or appearance of the stool, and often involves relief of discomfort following the passing of a stool. This means it’s possible to have persistent constipation or diarrhoea but not have IBS. Be sure to consult your doctor if you’re concerned about your bowel habits and don’t attempt to self-diagnose.
What do these stool patterns in IBS mean?
Humans like to classify things in the belief that it will assist with a diagnosis or treatment strategy, but aside from knowing when to prescribe someone with laxatives or anti-diarrhoeal medication, the IBS stool pattern classifications don’t have a huge amount of use. This is because people can change between the subtypes, either as their IBS naturally morphs into a different form over time, as they alter their treatment strategies, or as they learn to control their own IBS triggers.
Where these patterns of bowel movements do come in handy is helping to recognise when something has changed. When you know which pattern of bowel movements you normally experience, you can tell if something new is affecting your IBS. This is particularly helpful when trialling a potential management strategy, such as the low FODMAP diet, so you can see if it’s improving your symptoms.
Is there a way to improve the bowel patterns of IBS?
Traditionally we’ve been told that the best way to have normal bowel habits is to eat more fibre. That’s because dietary fibre bulks out the stool, making it larger and a more consistent shape. Drinking enough water is also important because the fibre in the stool absorbs water to make it soft enough to pass. In theory, this strategy should prevent constipation by increasing the bulk of the stool, and it should minimise diarrhoea by giving the stool more structure.
That’s the theory, but the reality is a bit different.
In people with IBS, some fibres irritate the gut, altering the fluid balance in the bowels and thus the form of the stool. So increasing these irritating fibres can make IBS symptoms worse. But that doesn’t mean that someone with IBS should avoid all types of fibre. Instead, they need to know which fibres to avoid and which fibres to include.
One of the ways that the low FODMAP diet can help to stabilise the gastrointestinal symptoms of IBS sufferers is to remove certain irritating dietary fibres that are high in FODMAPs. The catch though is that dietary fibre is essential for gut health, so it’s important to ensure that enough fibre is still consumed on a low FODMAP diet. It is quite a balancing act, but it’s something that a qualified nutrition professional can assist you with.
Monitoring your bowel movements to help manage your IBS
Now that you know the different types of bowel movements, and what is considered normal, you can track your own bowel movements to help you understand your symptoms better. One of the best ways to do this is with an IBS Symptom Tracker, where you track your symptoms on a daily basis for a week or two. You can then share this information with your doctor to get a more accurate diagnosis. And when you start making changes to improve your IBS, you can use the symptom tracker to see if your bowel habits are improving.