Let's face it. Whilst we'll happily chat away about our aches and pains with friends, most of us don't talk about bowel movements, even with our nearest and dearest. But this tendency to avoid the subject - even with our doctor - can lead to the worsening of existing health problems, and continuance of discomfort that might otherwise have been relieved.
So - brace yourself - it's time to talk about the brown stuff.
What is normal?
It's common to think that having a bowel movement once a day is normal, but the truth is that many of us poo more or less frequently than this. Whether you're going two or three times a day or two or three times a week, as long as you aren't suffering any pain or discomfort and haven't noticed a significant alteration in your bowel movements, then there's no reason to be concerned.
Dr Adam Haycock, consultant gastroenterologist at The London Clinic, explains: "An average 'normal' healthy bowel movement would be a formed stool between three times a day and once every three days. However, what is normal for a specific individual may be different from this and frequency and consistency can vary from day to day."
In fact, contrary to popular belief, aiming to pass a so-called 'perfect' stool each day is not necessary: "There is no such thing as an optimal stool. The idea of increasing your stool frequency to one a day or changing the consistency is not desirable. Only about a third of people have that particular pattern," explains Dr Anton Emmanuel, consultant gastroenterologist at University College Hospital in London.
The ouch factor
Whilst passing harder stools is not necessarily a problem health-wise, you may wish to soften your poo to ensure a more comfortable passage.
"The best way of softening your stools is to take a moderate amount of fibre in your diet. This works out at approximately 25 g of fibre for a woman, 35 g for a man. A portion of legumes would have about 4-5 g, brown bread 3-5 g, and cereal about 5-10 g, depending on the cereal. This should get you to a softer stool," advises Emmanuel.
In fact, whilst many of us believe that improving our hydration will help to create a softer stool, it is fibre rather than liquid that will make a change. "Liquid intake doesn't make much difference. Once you're drinking a litre and a quarter a day that's as much as your bowel needs - any extra is not going to stay in your bowel."
In addition, to keep everything in working order, it's important to keep our body moving. "A bit of gentle exercise - about 30 minutes of walking a day - should keep the bowel moving," explains Emmanuel.
Knowing what's normal
Whilst it isn't a pretty sight, most of us will have glanced in the bowl after a movement from time to time. And it's a good idea to develop an awareness of the usual size, shape and colour of your poo. "A normal bowel movement can range from small, marble-like stools to something almost resembling a cow-pat," explains Emmanuel. "The important thing is knowing what’s normal for you and being aware of any changes in frequency or appearance."
When to seek advice
If you experience a dramatic change in bowel habit or the appearance of your poo, it's important to get yourself checked out, even if you feel well.
"Concerns should be raised if the bowel habit changes significantly from what is 'normal' for an individual, particularly if the frequency increases and the stool becomes looser, if there is blood visible on wiping or mixed in with the stool, or if it is associated with abdominal pain or weight loss," says Haycock.
Whilst seeing blood in our stool can be alarming it is not necessarily a sign of colon or rectal cancer - although it's important to discuss your symptoms with your GP. Conditions such as inflammatory bowel disease, small growths known as colonic polyps and even piles (haemorrhoids) may cause blood in the stool.
However, any unexplained change in the appearance or frequency of your bowel movement may indicate a problem even if your poo appears to be in the normal range. "Unless there's an obvious reason for a change, such as a change in diet or medication, you should contact your GP after about a week," advises Emmanuel. "Even if you feel your faeces looks healthy, it's about what's normal for you."
At your appointment
Some may find visiting the GP to talk about bowel movements a little nerve-wracking - and wonder what examinations might take place. According to GP, Dr Toni Hazell, tests carried out will depend on "lots of variables such as the initial symptom, the patient's age and associated symptoms. For example, diarrhoea and rectal bleeding in a 60-year-old who is losing weight would lead to an urgent referral for colonoscopy. However, constipation in a young person with no worrying features might not require any tests," she explains.
The doctor may carry out a range of different procedures, including blood tests and rectal examination, and may ask you for a stool sample. Tests may be done for conditions such as: "anaemia, coeliac disease, thyroid function and signs of inflammation."
If you are referred to hospital, this might result in a colonoscopy or CT colonography to look at the bowel in detail.
Don't feel embarrassed
Most of us feel a little awkward when speaking about our bowel movements, but it's important to put your health first.
"Don't be embarrassed - we've seen and heard it all before," advises Hazell. "There are few things more tragic than a late presentation of a cancer that could have been curable, but the person didn't come because they are embarrassed."
What do my symptoms suggest?
If you experience a change in your bowel movement, it may indicate an underlying problem.
Looser, more frequent poo
Loose stools or diarrhoea may indicate a stomach bug or food poisoning and will probably ease off after a few days. But longer term, this could be a sign of inflammatory bowel disease, overactive thyroid or bowel cancer. So do see your GP if you're concerned.
Thin, narrow poo
Thin, narrow poo could be a sign of IBS. However, although unlikely, consistently passing a thinner poo could be a sign of obstruction or narrowing of the bowel which may be caused by cancer.
Foul smelling, floating poo
Bright red blood in your poo
Passing bright red blood can indicate many different conditions, including piles, anal fissure (a small tear in the anus), inflammatory bowel disease or bowel cancer. Always check with your doctor if you're seeing blood in your poo.
Black, tar-like poo
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