When your bowels work properly, it’s easy to take them for granted. When they play up, however, bowel function – or lack of it has a major impact on your quality of life. As a doctor, I’ve noticed that patients fall into two distinct categories – those who have elevated stool gazing to a fine art, and those who go out of their way not to examine the fruits of their bowel’s labours. But the nature and consistency of our motions can reveal a lot about our digestive health as it indicates how rapidly food passes through the gut.
A team of gastroenterologists from Bristol therefore devised a stool classification scale in 1997, which defines 7 different types of bowel motion. (See the chart at the bottom of the page)
Types 1 & 2 are abnormally loose (ie constipation) and result from a slow bowel transit time. These seem to be linked with an increased risk of gallstones. Types 3 & 4 are described as “perfectly normal bowel motions.” Type 5 is poorly formed, soft and verging on abnormal. Types 6 & 7 are abnormally loose (ie diarrhoea). Types 1,6 and 7 are considered abnormal and suggest a current bowel problem or increased risk of developing one in the future.
Since the Bristol Stool Scale, more guidelines have been released in an attempt to make sense of functional digestive problems. The most recent are based on new understandings of the way the gut works, and the way it responds to stress and alterations in bacterial balance. These guidelines offer doctors a way to help diagnose some bowel problems according to their symptoms, without necessarily having to refer patients for invasive tests.
Bowel problems are not something you should diagnose yourself, however, as an examination is also important to rule out more serious bowel disorders. Always seek medical advice if you notice a change in bowel habit, recurrent abdominal pain, or see blood or slime in your motions.
Probiotic Bowel Bacteria
Your bowels contain around 11 trillion bacteria – more than the total number of human cells in your body. Together, these bacteria weigh around 1.5kg. Bowel bacteria play an important role in intestinal health. They ferment fibre and bulk up the stools to make defecation easier. In fact, every 1g in dietary fibre you consume increases the weight of your motions by around 5g – mostly due to an increased weight of bacteria.
Ideally, at least 70% of bowel bacteria should be ‘probiotic’ which, by definition, provide definable health benefits. Only 30% should be other types of bacteria, such as E.coli, which tend to produce gas and can, in some circumstances, produce harmful toxins.
Probiotic bacteria, such as Lactobacilli and Bifidobacter, secrete beneficial substances which discourage less acid tolerant bacteria, which are anti-inflammatory and act as a fuel for intestinal lining cells, natural antibiotics and nutrients which we can absorb and use.
Although we think of our intestines as being inside our body, substances in our gut lumen actually remain outside our body unless they are absorbed across the intestinal wall. Our gut is therefore an important first line of defence against infection, and contains one of the largest concentrations of immune cells. The gut-associated lymphoid tissue continually samples bowel contents and helps to prime our immune system against infection, while promoting tolerance to normal food components. Probiotic bacteria play an important role in this process, helping to boost our immunity and protecting against atopic conditions such as eczema and asthma.
Maintaining a beneficial bacterial balance
Because our bowel empties regularly, probiotic bacteria are readily lost from the body along with their less desirable relatives. Replenishment comes from those adhering to the gut wall, and from the vermiform appendix – a blind pouch which acts as a reservoir of bacteria. When we are under stress, follow a poor diet or take antibiotics, however, our numbers of probiotic bacteria dwindle. This can lead to an imbalance known as dysbiosis. Lack of probiotic bacteria increases the risk of a number of digestive problems, including abnormal fermentation, bloating, diarrhoea, constipation and spasmodic pain – symptoms compatible with irritable bowel syndrome.
To maintain a healthy balance of probiotic bacteria in your intestines, aim to replenish them regularly – ideally on a daily basis – in the form of a probiotic supplement.
Prebiotics (eg fructooligosaccharides) also help to promote the growth and survival of probiotic bacteria by providing them with a food source that they can ferment.
Psyllium
Many people do not eat the recommended minimum of 18g fibre per day, and a fibre supplement can help to maintain bowel regularity. Psyllium seed and husks (also known as ispaghula) is a highly effective, natural and gentle fibre source. Its effectiveness is due to its mucilage content, which swells to between and 8 and 14 times its original volume when mixed with water. In the intestines, psyllium forms a laxative bulk that acts rather like a sponge, gently scrubbing the bowel clean as well as absorbing toxins and excess fats. It is particularly helpful for people who cannot tolerate other forms of fibre such as bran. Always consume with plenty of water.
Peppermint
Peppermint, a traditional remedy for indigestion and bowel spasm, is among the most effective treatments for treating irritable bowel syndrome. A meta-analysis exploring the effectiveness of fibre, antispasmodics and peppermint oil found the number of people that would have to be treated to prevent one person from experiencing persistent symptoms was six for ispaghula husk (psyllium), five for prescribed antispasmodic treatments, but only two and a half for peppermint oil, making it the most effective therapy.
Conclusion
Don’t take your bowels for granted. Spend a bit more time gazing at what you produce, eat more fibre (fruit, vegetables, wholegrains plus, if necessary, fibre supplements), consume probiotic products regularly, and if you do develop persistent symptoms don’t be embarrassed to seek medical advice. If you are diagnosed with irritable bowel syndrome, and antispasmodic therapies are not as helpful as you would wish, you may find peppermint oil is more effective.
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