This one bathroom habit is especially bad for gut health
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“[Doing this] on a regular basis puts patients at risk of chronic constipation and eventual loss of coordination of the muscles that should relax when defecating.” — Irene Sonu, MD, clinical associate professor of medicine in gastroenterology and hepatology at Stanford
Find more of your peers' perspectives and insights below.
Is your patient guilty of “holding it in”?
They should know that delaying bowel movements isn’t the best idea.
Here's why
“Holding in bowel movements on a regular basis puts patients at risk of chronic constipation and eventual loss of coordination of the muscles that should relax when defecating. This condition is known as pelvic floor dysfunction and can lead to chronic difficulty defecating, resulting in constipation,” Irene Sonu, MD, a clinical associate professor of medicine in gastroenterology and hepatology at Stanford, tells MDLinx.
The ability to delay or “hold in” a bowel movement is indicative of an intact anal sphincter, which helps prevent fecal incontinence.
Related: Can your poop patterns predict how long you'll live?“We have a reflex called the sampling reflex, which is via the highly specialized nerves and tissues of the internal anal sphincter, which detect liquid, solid, or gas. If these tissues detect gas, we can let it pass. If they detect liquid or solid and a bathroom is not available, it is important that we are able to delay urge by closing our sphincters until we can get to a bathroom,” says Lucia Miller, a board-certified physical therapist with the Stanford Pelvic Health Center.
Sending mixed signals
While occasionally holding in or delaying a bowel movement may be necessary at times, it shouldn’t be a habit.
“Delaying a bowel movement or ignoring fecal urge, while sometimes necessary, is to be avoided. It gives a mixed signal to our nervous system and our pelvic floor muscles. When our body gives us the message of fecal urge, it would be ideal to obey it immediately by sitting on a toilet, leaning our pelvis forward, relaxing, and breathing deeply, and allowing the bowels to contract involuntarily as they are designed to do,” Miller says.
"If we ignore or delay that urge, we may have difficulty voiding later, especially if the stool becomes dry and hard, or desiccated, and that can contribute to painful evacuation, hemorrhoids, straining behavior, and even fissures or splits in the rectal wall," Miller continues.
Follow the 'rule of three'
While there is no one-size-fits-all rule when it comes to how regularly a person should have a bowel movement, many experts go by the rule of three.
“I use three and three. If they have three bowel movements within a day, probably that is relatively high. Some people have once a day, some people have three times a day. That's not excessive. When we come to five times a day and more, that is significantly higher than normal. So that is the frequency per day,” Ronald Hsu, MD, a gastroenterologist at UC Davis, tells MDLinx.
“But the other three is, if you have three bowel movements in a week like every other day, it's probably still an acceptable norm. But if there's bowel movement once in 4 days, that is excessively longer than what we want to see.”