Pooping: it’s not exactly our go to topic of conversation (unless of course you happen to be a pelvic health provider!). But bowel health has tremendous impacts on our overall health and our pelvic health in particular. Keeping our bowel routines healthy can help with our mental wellbeing, gut health, physical abilities… pretty much everything! Constipation on the other hand can lead to pain, prolapse, urinary leakage, bowel leakage… nothing fun, that’s for sure. To put it simply, pooping is important! Unfortunately, constipation is on the rise. In the US, an estimated 10-15% of all persons struggle with chronic constipation and constipation can affect persons of all ages and genders.
While constipation is a common and serious problem affecting our wellbeing, conversations surrounding constipation often remain inadequate to put it mildly. Knowing where to begin in resolving constipation and keeping bowels regular going forward can feel confusing and overwhelming. To get started, it’s important to know what constipation actually looks like and how to identify your own constipation.
One tool that can be very helpful in classifying and talking about your own bowel movements is the Bristol Stool Scale. It is a visual classification system we use to understand what kind of bowel movements a person is having and to track symptoms accurately. Bristol 4 is what we are aiming for – perfect, soft, formed bowel movements.
Another tool healthcare providers use is a criteria system called “Rome IV” to diagnose and guide treatment strategies of various gut-related issues (as I’ve mentioned in earlier posts, we LOVE categorizing!). The Rome IV criteria for chronic constipation breaks things down into four subtypes: (a) functional constipation, (b) irritable bowel syndrome with constipation (IBS-C), (c) opioid-induced constipation, and (d) functional defecation disorders. While there is substantial overlap in management and treatment of each subtype, it is critical to know which group your constipation falls into in order to fully address the underlying concerns and make sure we keep symptoms at bay long term.
We will go over each subtype in detail in later posts, but for today, let’s start with the first and broadest listed: functional constipation. Functional constipation is the form of constipation we typically picture when we mention constipation in the first place. You are experiencing functional constipation if you do NOT have an IBS diagnosis or use opioids but DO experience two or more of the following symptoms:
a) Straining during more than 25% of times passing bowel movements
b) Lumpy or hard bowel movements (Bristol Stool Scale of 1-2) more than 25% of the time
c) Sensation of not emptying fully more than 25% of the time
d) Sensation of bowel movements or bulging in the anus or rectum more than 25% of the time
e) Having to use your hands to either remove bowel movement or support your pelvic floor when you go
f) Fewer than 3 spontaneous bowel movements (i.e. not stimulated by something like laxatives or a suppository) per week
An important take away here is that you can poop frequently and still be constipated. Healthcare providers can sometimes make the mistake of not catching constipation during your visits because saying you go daily (or 2, or 3, or 4… times per day!) can make it sound like all is well. In reality, bowel movements are not being cleared out regularly. Therefore it’s important to be your own advocate if you think there may be a chance you are constipated. The sooner we can begin addressing these concerns the easier it is to resolve and get back on a good pooping routine.