Constipated? Peristalsis and Bowel Routines: How Can They Help Your Gut Health?
Bowel habits are an important part of our overall health, but constipation, straining, and difficulty emptying the bowels are common concerns. Understanding how your digestive system works and establishing a consistent bowel routine may help support more comfortable bowel movements.
What Is Peristalsis?
Peristalsis refers to the coordinated, wave-like contractions of muscles within the digestive tract that help move its contents along. In the large intestine, muscular contractions help move stool (poo) towards the rectum, where it can be stored before a bowel movement.
When stool enters the rectum, it stretches and sends a message to the brain which the brain understands as a good time to go to the toilet. When you are sitting down on the toilet, the muscles of the pelvic floor and anal sphincters must then coordinate and relax appropriately to allow stool to pass.
Constipation can occur for several reasons, including slow movement through the colon, hard stools, or difficulty coordinating the muscles involved in defecation. This means that constipation is not always simply a matter of needing more fibre or stronger bowel contractions. [1,2]
What Is a Bowel Routine?
A bowel routine is a set of regular habits designed to support comfortable and effective bowel emptying. Rather than forcing a bowel movement, the aim is to work with your body's natural digestive reflexes and toileting signals.
A bowel routine may include:
Choosing a consistent time: Consider sitting on the toilet after breakfast or another meal. Eating stimulates the gastrocolic reflex, which increases activity in the colon and can encourage a bowel movement.
Responding to your body's signals: Listen to the urge, wait for it to build and avoid ignoring it when it is strong.
Optimising your toilet position: Place your feet on a small footstool so your knees are higher than your hips, lean slightly forwards, and keep your abdomen relaxed.
Breathing and relaxing: Breathe gently rather than holding your breath and straining forcefully. Allow your pelvic floor muscles to relax as you empty your bowels.
Supporting healthy stool consistency: Adequate fluid intake, appropriate dietary fibre, and regular physical activity can help support bowel function. Individual needs vary, particularly for people with specific medical conditions.
These strategies form part of conservative constipation management and may be particularly useful when incorporated into a consistent daily routine. [1,2]
How Can a Bowel Routine Help?
A bowel routine can help you recognise your body's natural patterns, take advantage of digestive reflexes after meals, and establish more comfortable toileting habits.
For some people, these strategies can help reduce straining and improve bowel regularity. However, a routine alone may not resolve constipation when there is an underlying problem with bowel movement, medication effects, or pelvic floor coordination.
It is also important to remember that having a bowel movement every day is not essential for everyone. Comfort, stool consistency, ease of emptying, and your usual bowel pattern are important considerations.
The pelvic floor muscles need to relax and coordinate with the abdominal muscles to allow stool to pass. In some people with constipation, these muscles do not relax adequately or contract inappropriately during attempted defecation. This is known as a defecatory disorder or, in some cases, dyssynergic defecation. [1,2]
A pelvic floor physiotherapist can help assess your symptoms and identify whether pelvic floor function may be contributing to your difficulty emptying your bowels.
Treatment may include education about bowel habits, toileting posture, breathing and relaxation techniques, and pelvic floor coordination training. For people with confirmed pelvic floor dysfunction, specialised biofeedback therapy has demonstrated benefits in clinical trials and can help retrain the muscles involved in defecation. [1,3]
If you regularly experience constipation, excessive straining, or a feeling that you cannot fully empty your bowels, you don't have to manage it alone. Book an appointment now.
References
Bharucha AE, Pemberton JH, Locke GR. American Gastroenterological Association technical review on constipation. Gastroenterology. 2013;144(1):218–238. Read the peer-reviewed article
Skardoon GR, Khera AJ, Emmanuel AV, Burgell RE. Review article: dyssynergic defaecation and biofeedback therapy in the pathophysiology and management of functional constipation. Alimentary Pharmacology & Therapeutics. 2017;46(4):410–423. Find the article on PubMed
Chiarioni G, Salandini L, Whitehead WE. Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation. Gastroenterology. 2005;129(1):86–97. Read the study
