Haemorrhoids with IBS
Are you always on the toilet? Maybe your frequent bowel movements are starting to worry you, or you’re just sick of going back and forth to the toilet so often. You might be worried about a fast transit time, and all that effort you put into eating healthily going to waste. In this episode of the Inside Knowledge podcast, I’ll explain the types of things that could cause frequent bowel movements. And some of the things that you can do about it. I’ve worked with clients who’ve been going to the toilet as often as 11 or 12 times a day, and we’ve managed to normalise that through diet and lifestyle. So it is possible to reduce the amount of times you’re going.
What are frequent bowel movements?
Frequent bowel movements, we’re talking about when you’re going to the toilet a lot more than normal. So first of all I’m going to start off by talking about what is normal, but then also we’ll go through a couple of things like issues, why it’s not good to have so many frequent bowel movements. But also what some of the causes might be.
And then we’ll talk a little bit about what you can do about that. Just thinking about what is normal, the typical bowel movements that we don’t worry about is one to three times a day. That is kind of an ideal way, although up to three times a week is also considered normal for people who are veering on the constipated side.
Even if you’re not going every day, it’s considered normal, but I wouldn’t call it ideal if you’re only going a couple of times a week. But in terms of today’s topic, talking about going frequently, up to three times a day is 100 percent normal, nothing to worry about.
And that is where I wanted to start because a lot of people feel that that is too much and actually it could just be a byproduct of your diet.
Diets affecting frequent pooing
So when we think about what the poo is, what it’s made up of, a lot of it is waste from our food. Things that cannot be digested, that our body no longer needs. It’s moving it along, getting it out again. If you think about the types of things that aren’t digested, that are left there, one of the main elements that will not be broken down properly is fibre.
It’s not massively well digested by the human body, which is why we rely on our gut bacteria, to do some of that job for us. But if you are eating a diet that is very, very high in fibre with lots of vegetables, fruits, whole grains, you may well have a lot more waste products than somebody else. Sometimes it is just a simple equation that you are eating a lot of fibrous foods and that is creating a lot of waste product and it is nothing to worry about.
Why frequent pooing can be an issue
Where people get a little bit confused, I think, as well is where you’ve got IBS. If you’re listening to this podcast, I’m assuming you have because this is the podcast for people with IBS, Let’s think about, like, what some of the additional problems are.
It could be that you’ve got haemorrhoids. So see the last episode that I just did on haemorrhoids. Because every time you go to the toilet, that is going to be exacerbating them. Seeing blood on the paper and seeing blood maybe in the toilet is worrying. It doesn’t feel good to see your own blood, does it?
But also it can be incredibly sore. And so having to wipe multiple times a day can also be quite sore. I’ve worked with people who’ve been having a poo almost every hour and going a lot throughout the day. And that can be down to uncontrolled IBS diarrhoea type. People who have diarrhoea predominance type.
IBS will frequently go to the toilet and some of it could be very mushy.
Do you actually have diarrhoea or loose stools?
So this is another distinction that I want to make. The difference between having diarrhoea and having very frequent bowel movements. Because when you’re passing very, very loose stools, and if you take a look at the Bristol stool chart, you will see that number 7 at the bottom of the chart is watery diarrhoea, often with a lot of urgency, really explosive.
Now this would indicate normally, a short term acute infection. So obviously some people who have IBS-D will have more frequent episodes of these diarrhoea attacks. If you’re constantly going to the toilet with that watery loose diarrhoea, that is something that needs investigating and you should be going back to your doctor repeatedly to try and find solutions for that. Because when you’re losing that much liquid, there’s a real chance of dehydration, loss of electrolytes.
And also your transit time is going to be so fast that you’re not absorbing your food properly. So we might get a stomach upset, maybe you caught a little bug and you get diarrhoea for a couple of days, like that’s nothing necessarily to worry about, you just need to stay rehydrated, keep yourself rested and recover from this infection.
A stomach bug
So that’s completely separate. So what we’re talking about here is frequent bowel movements that are ongoing. That’s not an acute case of diarrhoea, with urgency and that sort of thing. Also the other things to watch out for would be if you have a fever alongside an acute diarrhoea episode, if you have a lot of blood in your stool, or if you’re also vomiting or feeling incredibly sick, like that could probably indicate that you have got some sort of bug.
Also if you cannot control your bowel movements and you’re getting incontinent and having accidents, like that would be again something to go back to the doctor with and make sure you get some sort of other investigations. Maybe they want to do a stool test to look for parasites or bacterial infections.
Also, they would look for hidden blood. That’s the FIT test. This is looking for blood that is not visible to the eye, which can also indicate small amounts of bleeding inside the gut. So really important that you get those kind of things properly checked out. Today, I’m not focusing on that sort of diarrhoea.
How to manage frequent pooing
I’m just talking about people who go to the toilet a lot, and it doesn’t necessarily need to be that bad, urgent type 7 all the time. It’s just that you’re going frequently, maybe 4 or 5 times a day. That’s very common with a lot of people who I start to work with.
So now we know that going more than 3 times a day is considered frequent bowel movements and you know, based on the people I see, often 5 times a day is kind of average for someone who is experiencing this.
When do you poo?
Also, you might think about when these extra bowel movements are happening. A lot of people go first thing in the morning when they wake up . This can be as your body gets going. Maybe you have a glass of water. Maybe you have a cup of tea or coffee first thing. Sometimes people will get up and immediately they need a wee and they go to the toilet and they might have a poo as well That can be completely normal.
Then you might have your breakfast and your gastrocolic reflex kicks in. This is when your body is trying to make room for more food coming in by releasing some more food out. Kickstarting this pulsing movement through your gut, moving the muscles to contract and pulse the food along, push it through.
Okay, often after eating a meal you will need to go to the toilet. In babies this gastrocolic reflex is very strong and I can remember from my girls when they were younger actually the babies like pooing in the high chair as they’re eating because as soon as they start eating some more room is made.
The gastrocolic reflex
When we think about that gastrocolic reflex being very strong maybe you need to go to the toilet after every meal. We know that unless it is that watery loose diarrhoea it’s very unlikely to be the last thing that you’ve just eaten that is actually coming out into the toilet.
Remember that food sits in your stomach for somewhere between 30 minutes and two hours. It is not that food passing through you and coming out into the toilet straight away But it could kickstart the process.
Now, if that happens, there could be multiple reasons why your gastrocolic reflex is so strong. But some of the most obvious answers would be down to the nervous system, thinking about your stress or anxiety levels and your gut brain connection. So the vagus nerve that is supporting the connection between your feelings, emotions and your mood, and your digestion.
Supporting your nervous system
There are some things you can do to manipulate that to calm it and soothe it. It involves things like going to bed early, making sure you’re getting some sleep, doing some exercise, some deep breathing. I have got lots of support on that in episode two about how to do mindful eating is also really helpful.
And also controlling your IBS with your mind, which is episode four. That is a very good basic level introduction to the vagus nerve and things that you can do to help support it. So far we’ve covered, reasons why you might be getting these extra bowel movements.
Is it because you, are eating a very high fibre diet? Is it because as soon as you eat, you are encouraging the motion and you are kick starting that gastrocolic reflux? Is it because you have got an acute infection? So those are the three things I’ve covered so far.
Gut stimulants causing frequent bowel movements
Other things that can stimulate, frequent bowel movements would be high levels of coffee or alcohol.
Coffee is definitely a gut stimulant and for a lot of people it can be pretty much instant that you just have a couple of sips of coffee and then you immediately need the toilet. Again, that is not the caffeine or even the coffee working on your colon or rectum to expel the poo, but it’s more down to do with a hormone connection.
We think potentially down to something called chlorogenic acid in the coffee that is like working on your hormones to kick start that nervous system action.
Alcohol will also stimulate frequent bowel movements because your body is kind of trying to expel it and trying to get it out And that’s a little bit the same if you have an infection your body is trying to wash that through and get rid of it . Another key thing, of course, we want to talk about food. Are there some specific foods that you’re eating frequently that could be triggering frequent bowel movements?
High FODMAP foods causing frequent poos
If you think about the low FODMAP diet for IBS, the foods that we’re cutting out during the low FODMAP diet are typically foods that draw in water. That is going to give you more bowel movements because you’ve got more content in your small intestine and the large intestine, and the water is drawing in and then making it looser, so you’re going to need to go more often.
It’s harder to hold that in when it’s loose. But also, it’s creating more content because of the additional fluid balance. So, FODMAP intolerance is a possible other cause of frequent bowel movements. If you need to hear more about the low FODMAP diet, then go back and listen to episodes 17 and 18, where I start from the beginning and explain exactly what that is and how to do it.
But essentially, You’re cutting out or removing portions of highly fermentable foods that have got this kind of action. One of the things that you might do is to start implementing the low FODMAP diet process, which will help you identify if there are any food triggers. Now, some of my clients, in fact, A fair number of them will go through this process and not find any particular intolerance.
People are sometimes a little bit disappointed with this, but just taking them all out, giving yourself a break and then slowly reintroducing them can actually give a really good, rest and reset time, and then that Well, just allow your digestion to regulate, and then you can start bringing the foods back in.
If you start seeing more frequent bowel movements, for example, then that would be an indication that potentially it is diet related. So that’s like a little summary of some of the things that could cause frequent bowel movements. And so you might want to ask yourself, Do I get this straight after a meal?
Hormones can affect bowel frequency
Do I get this all month? If you are a woman, maybe your period week is the time when you get more frequent bowel movements and you feel like you’re going more often. This can definitely be the case and if you’re in perimenopause, that is more challenging because you may not know where you are in your cycle.
So you may have certain weeks and you think maybe you might be due on but you’re not quite sure. That can be really challenging, so that’s why tracking your period and tracking your symptoms is so helpful. I have got a guide for tracking your IBS, which you can also write in your menstrual cycle along the bottom.
And you can download that from the show notes or from episode 6, which is all about tracking your diet. Because the reasons why you’re getting frequent bowel movements could be very varied, there is no prescription that I can give that says, yes, do this and you will reduce your bowel movements.
There isn’t really a set pattern that will definitely work, but some of the things that I have noticed that do help include Changing your diet, managing your stress and also sitting on the toilet or the way that you go to the toilet. So let’s break those down a little bit more.
Fibre to slow down a fast transit time
One of the benefits of eating more soluble fibre is that it helps to draw the water in and provide more bulk. When we’ve got loose and frequent stools, what we want to do is try and firm them up a little bit. So that they’re less loose.
So something like soluble fibre can help. This can be found in oats and also in root vegetables are very good. Things like carrots and sweet potato very helpful as well as just like upping your fruits and vegetable content. However, If you’re someone who’s already eating like 10 portions of fruit and veg in a day, then the last thing you want to do is increase your fibre content.
Maybe you need to reduce your fibre content a little bit to notice if that has any bearing on the frequency that you need to go to the toilet. If you are feeling like you need to go all the time and you’re just not actually being able to empty properly, and that is why you’re getting frequent bowel movements because there’s always, it’s almost like it’s stuck there even though it’s soft, there could be a couple of reasons for this scenario.
So one would be that the mix of fibres that you’re getting isn’t quite right, so maybe you do need to increase your fibre in order to create more bulk, more of a firm stool that will then be harder to pass and in a way like not come out every time you go and sit on the toilet.
Sitting comfortably on the toilet
The other thing is how you’re sitting on the toilet does have some impact. Where you are not raising up your knees higher than your hips, you may find that the muscles are just not coordinating properly in order to let the stool out. So you’re not actually allowing yourself to go as easily as you could, which means some of it might be stuck up there.
You want to make sure you get a little step and put it near the toilet. When you go and sit on it, you put your your feet on the step and that will raise your knees up a little bit and you can lean forward bring your elbows towards your knees And then that is putting your body into a similar position to squatting which is physiologically how humans should be going to the toilet. Of course, we like our toilets. They’re more comfortable and all but it’s not necessarily the best physiological position To let out the poo.
So, what you can do is to try and recreate that by sitting down, using a little step to help you get a better action on the toilet.
Calming the gut-brain connection
Now, the other thing is, if you are getting frequent bowel movements, and you think maybe it’s connected to how you’re feeling, to your stress levels, if you’re, uh, big worrier, someone who’s always got a very busy mind, you find it hard to switch off, even if you don’t feel particularly stressed, you’re just someone who is always on the go, you really can’t sit still, you very rarely relax or have an afternoon just lounging around. That could indicate that there may be this disconnect between your brain and your gut, or not even a disconnect, it’s like you’re constantly on high alert. That can put your body into a slight state of fight or flight, which means your body is always trying to get rid of any built up waste, because you may have to face threat to your life. Obviously you don’t, it’s just things like you’ve got another email from your boss and oh, your car’s broken down and extra things that cause us daily stress. So very rarely are we put in a position where actually our life is under threat, but we can feel like that really a lot.
And so, you want to try and work then on calming down your nervous system. And you can do that through deep breathing like diaphragmatic breathing and you can listen to my episode on breathing for IBS, episode 48. that’s got some different breathing techniques how to slow down how to improve your vagal nerve tone, which will help you, feel calmer and also just soothe that connection so that you’re not constantly on high alert.
Supplements for frequent stools
The other thing you might be interested in is using something like psyllium husk. Now, psyllium husk is a fibre. Some of it is soluble and some of it is insoluble. And most people think about it like a laxative or something to take when you have constipation predominant symptoms. But actually, it has been shown to regulate bowel movements in people who have diarrhoea as well, so you may find that something that is helpful, particularly if you’re struggling to increase your fibre intake through fruits and vegetables. Now, I always try and recommend food first, but where sometimes we do need to supplement, this is something that is very well tested and well researched and generally is pretty safe, so most people do not find they get negative effects with it.
Some people do find they get a little bit more bloated. So, Always start with a really low dose, low and slow, start small. And see how you get on.
The final thing I want to mention is a beneficial yeast called Saccharomyces boulardii which has been shown to reduce frequent bowel movements so it’s been tested quite a lot in children who have antibiotic caused diarrhoea and they have done Tests showing that people have less bowel movements.
So there’s like a couple of studies. I’ll link to a few in the notes for this episode, but for example a group of Pakistani children who had drunk some water that had a bacteria in it, um, and against a control group, the people who took the Saccharomyces boulardii every day for six days had 50 percent less bowel movements compared to the people who didn’t have the Saccharomyces pallidii, the control group. Those children were having more than three bowel movements a day, whereas the group were having around one and a half.
So that just shows it can slow down your transit time. Now that’s not to say it’s like taking Imodium. It’s not for an acute condition, but over the long term, the way that it maybe works is can resist pathogenic microbes and it kind of takes up space, it pads out the gut. It can also help the gut barrier, which fights off other microbes that might want to get in.
It’s a very good support for your overall gut health. It isn’t suitable for everybody, particularly if you’re immunocompromised, you shouldn’t take this, and in some cases it might not work for you. But it’s something that you might want to discuss either with your doctor, your nutritionist for example.
The other way that it maybe it works, and we don’t really have enough data on it, but that there’s a theory that Saccharomyces boulardii will affect the way serotonin is affecting your gut motility.
Some people who have IBS-D, who have frequent bowel movements, have a higher rate of serotonin expression in the gut, and serotonin generally speeds up your gut transit time. If we are to reduce excessive serotonin in the gut, maybe that will slow down the gut motility as well.
So that’s another mechanism by which Saccharomyces boulardii may help people who have frequent bowel movements. It is something that I use with people who have more frequent bowel movements quite a lot and can see some quite good results. with it. It’s kind of like, you can think about it like a probiotic.
It’s a beneficial yeast, so it is of fungal nature, but it’s not the same as candida, or it’s not the same as baker’s yeast, which is live. It’s different, but it’s a beneficial yeast. To round out this episode, the kind of things that can cause frequent bowel movements could be a very high fibre diet, Could be down to a FODMAP or other food intolerance that is speeding food through your transit time.
It could be that you’ve got anxiety and ongoing stress. Could be down to high levels of coffee, alcohol or any medication. Actually, I didn’t even mention that but sometimes that can cause fast transit time. So the things you want to think about is when do you get this?
Is it after meals? Is it all month or is it just around your period? Have you changed your diet recently? These are all questions that will give you clues if you’re working on your own to try and resolve your IBS. Then you can start to think about those things. Do use my tracker as well to see what changes you can make that can change the frequency of your bowel movements.
Your next steps
If you need help with your IBS and working this stuff out, that is what I can do for you. I’m a registered nutritional therapist and I work with people all over the world, so I’d love to hear from you if you feel like you want help with your digestion. You can just click on the link in my show notes and set up a call and we can talk about what you’re looking for help with and how I may be able to support you.
Thank you for listening to this episode of the Inside Knowledge podcast. Better digestion for everyone.
