In association with Centrum

Knees Up And Ditch The Newspaper – How Bowel Experts Poo

What do the experts do to keep their bowels healthy? We asked, and their answers are... enlightening.

We all know there are things we can do to keep our bowels moving-and-grooving – and getting plenty of fibre is often top of that list. But did you know there are different types of fibre, and you can increase and decrease your intake to alter the consistency of your poo?

That’s just one of the life lessons gastroenterologists swear by. And in the spirit of ‘sharing is caring’, they’ve told us plenty of other ways they keep their bowel health in check in the hope it’ll encourage us to think about our own habits.

The issue is important, of course. Constipation cost the NHS £162m in 2017-18, with people sweeping long-term battles of being bunged up under the rug. The report last year revealed that £71m was caused by unplanned, avoidable emergency admissions and £91m was spent on prescription laxatives.

In the same year, 71,430 people in England were admitted to hospital with constipation – that’s equivalent to 196 people a day – with women accounting for about 60% of admissions.

So, what can we learn from bowel experts about how to stay regular?

Don’t avoid the urge to poo

If Dr Benjamin Disney, consultant gastroenterologist at University Hospitals Coventry and Warwickshire NHS Trust, suddenly needs the loo, he’ll go straight away. “It’s important to have a regular routine and not avoid the urge,” he says.

Ignoring the urge to go for a poo could lead to impairment of the defecation reflex, he told HuffPost UK. This basically means the strength of the urge to go to the toilet could lessen, making it harder to know when you need a poo in future. This, in turn, can lead to constipation.

Knees up, hips down

For Professor Anton Emmanuel, consultant neurogastroenterologist and director of the GI Physiology Unit at University College London Hospital, getting into an appropriate position on the toilet is key to having successful bowel movements. It’s all about the angles, apparently.

When you sit on the toilet with your knees below your hips, your puborectalis muscle (the muscle responsible for continence) relaxes only partially. It’s basically like trying to push a poo through a partially-open (back) door. But in a squatting posture or knees raised position, the muscle relaxes completely.

Try resting your feet on a low stool, box or phone book while going to the toilet. “It’s quite important that your knees are above your hips,” says Prof Emmanuel.

Don’t take a newspaper in with you

Prof Emmanuel won’t read the newspaper when he goes for a poo. He’ll go into the bathroom, do his business, then leave. “Settling into a leisurely session is not the right way of going about things,” he says.

“Don’t spend ages trying to coax something to happen because that’s not a good way, just leave and then go back when the urge comes back.”

This is predominantly to avoid complications when you get older, because opening your bowel for a long time could result in issues with continence and even prolapses later in life.

Get moving

Lack of exercise is one of the most common causes of constipation, which is why Dr Kevin Monahan, consultant gastroenterologist at St Mark’s Hospital in London and medical advisor for Bowel Cancer UK, is a big believer in keeping fit.

An active lifestyle helps keep his bowel healthy and ensures he stays regular. “I cycle 10km morning and evening instead of driving to work, sometimes running the route so I can vary my day,” he says, adding that he deliberately avoids busy roads, pollution and traffic-related danger.

Exercise is independently associated with lower bowel cancer risk, but you don’t have to do it on your commute, he adds: “Having two periods of walking every week, where you are not rushing for a train, also makes a difference.”

Hydrate, hydrate, hydrate

For Dr Disney, staying well-hydrated throughout the day is important to ensure he can poo easily. Drinking plenty of water softens your stools, making them easier to pass, and – bonus – can also prevent unwanted snacking throughout the day.

Make changes to your diet

Dr Monahan cites his diet as a key factor to keeping his bowel healthy – especially as certain foods have been linked to a higher bowel cancer risk. Plus, a healthy diet is key in preventing constipation.

“I start my day with porridge or homemade muesli, and during the day I try to avoid heavily processed foods,” he says. “It’s ok to eat red or processed meat, but on an average week it’s best to have this twice per week only.” A study last year found even moderate amounts of ham, bacon and red meat could increase the risk of bowel cancer.

Most nights, Dr Monahan will eat fish or chicken, and sometimes vegetarian main meals. “The key [to having a healthy bowel] is to have a healthy balanced diet containing all key food groups, not to restrict food unnecessarily, and to do what fits in with our lifestyle.”

If you need to overhaul your diet, do so gradually, as a complete overhaul of your diet or daily routine can actually contribute to constipation.

Get a handle on fibre

Prof Emmanuel is a firm believer in paying attention to what ends up in the toilet bowl. If it’s too soft or too hard, he will amend his fibre intake accordingly. “We need a balance of so-called soluble and insoluble [fibre],” he says.

Insoluble fibre can be found in food sources like fruits with skins, uncooked vegetables, nuts, legumes, bran, brown rice and whole-grain flours. “Those fibres are part of what makes your poo bulky,” says Prof Emmanuel. So, they can be helpful when stools are small or sloppy, as they can add substance.

Soluble fibre is found in oats, oat bran, barley, dried beans and peas, and certain fruit and vegetables such as strawberries, potatoes, citrus and prunes. Upping your intake of this type of fibre is generally a good idea if your stools are too hard, as it’ll soften them.

“Rather than saying, ‘Oh I’m taking fibre’, think a little bit more nuanced about what fibre is,” says Prof Emmanuel. “Pay attention to what comes out. If things aren’t the way you like them to be, act accordingly.”

It’s worth noting that some people with diverticular disease or irritable bowel syndrome might find some fibre sources exacerbate symptoms.

Speak to your GP or a pharmacist if you’re struggling with constipation, and visit the NHS website for further information.