Some of us are ‘daily like clockwork’ people, while others can go for days without action. If you don’t poo daily, are you OK? Or is this a reason to take laxatives?
[Image source: iStockPhoto | james Anderson]
Hands up if you’ve got an elderly relative who loves to talk about their bowel habits at family gatherings. Chances are one thing you’ll hear is that it’s vital you poo daily, along with an enthusiastic lecture on the benefits of prunes and enemas. But is it okay if you don’t poo every day?
Plenty of us think we need to have a bowel motion every day to avoid becoming constipated.
Chronic constipation, or passing small, hard poo, infrequently, and with some straining, is believed to be one of the most common medical complaints of modern society, with up to 20 per cent of the population affected.
It is typically caused by factors including a poor diet, dehydration, or certain medications with some health practitioners suggesting psychological factors may also be involved.
While you may think you need to have a bowel motion daily because this is what’s ‘normal’, research has shown bowel behavior is a much more varied phenomena than once thought. A study in the journal Gut showed most people have irregular bowel habits and in fact, less than half of us routinely poo daily.
Despite this, some of us panic when we haven’t done a number two for a day or so and we’ll begin to eat prunes or dose up on over-the-counter laxatives.
Laxatives, in one form or another, have been used for health purposes for more than 2,000 years and for much of that time, misuse or abuse has occurred. These days this over overuse is especially common among the elderly who were brought up in an era where a daily motion was considered vital to good health.
“In the ’50s and ’60s, mums and dads used to put kids on potties first thing in the morning and tell them they couldn’t go out to play until they’d done a poo,” says Brisbane-based colorectal surgeon Dr Andrew Bell.
“It’s just not natural. If there’s nothing there to poo, you’re not going to pass anything.”
Bell feels no-one should experience constipation in the presence of a good diet and regular exercise, adding that regular laxative use should be avoided.
But this view is not shared by the president of the Gut Foundation, gastroenterologist Professor Terry Bolin, who concedes there is division among the medical community about the treatment of constipation.
“It’s quite common for some doctors to think like this,” he says. But constipation is “a very real phenomenon.”
Women and especially young women are more likely than men to become constipated and develop associated symptoms of bloating and abdominal pain, he says.
While there’s clearly disagreement about exactly when laxatives should be used to treat constipation, if you’re a laxative user continuing with the habit purely because of a belief you need to poo every day, you can relax because this isn’t the case.
A belief daily bowel movements are necessary for good health isn’t always entirely harmless.
It can lead some middle-aged or older people who begin using laxatives when constipated to continue to overuse them, researchers from the University of Dakota said in a 2010 review article in the journal Drugs.
Such individuals form one of four key groups who misuse or abuse laxatives a habit that can be associated with medical problems including changes to electrolytes (vital chemicals in the body) and the level of acidity or alkalinity of body fluids. These problems can affect the kidneys and cardiovascular systems and may become life threatening.
The three other groups they identified who misuse or abuse laxatives are:
- Those with an eating disorder such as anorexia or bulimia nervosa
- Athletes or others involved in sports with set weight limits.
- Those who use laxatives to trigger diarrhoea to suggest they have a genuine physical illness when they do not
If you really are constipated, both Professor Bolin and Dr Bell agree that a high-fibre diet can assist in combating the problem.
Bolin believes eating a breakfast cereal is vital, “processed or something more natural, it doesn’t matter”, he says. He also says grains as well as fruit and vegetables should be a vital part of your diet.
Bell suggests learning to love chia seeds and says each tablespoon of chia provides six grams of dietary fibre. We need 25 to 30 grams per day and with our Western diet, we usually get only about half that. So a little chia may be just what the doctor ordered to get your bowels back in shape.
Laxative love affair
As a child in the 1940s, 77-year-old Eileen and her brothers received weekly enemas from their mother, together with a tablespoon of fig syrup.
Eileen, who admits she is “obsessed”, feels her bowel cancer surgery 30 years ago has built on the bowel fixation she acquired from her mother in her childhood. She now begins to worry if she has not had a poo in three days, fearing her cancer will recur.
“I’m trying to keep my bowel clear all the time. I don’t want anything building up in my bowel because I feel there is a potential for going bad,” she says.
Her laxative regimen begins with prune juice and if this doesn’t work, she “starts obsessing” and gets out what she call “the ammunition”: over-the-counter constipation remedies.
“They all work about the same. If my routine changes I go on holidays for example or I eat different foods or am not using my own toilet, I go longer and longer without anything happening and then I resort to the enema.
If she is desperate, she will supplement her arsenal with what she calls “drano” Epsom Salts which she keeps in her pantry.
The whole ritual of triggering a bowel evacuation is not something she finds distasteful; “I’m rather fond of it. In fact, I love it,” she says with glee.