Bladder and Bowel Health

Bowel Health

It’s a popular children’s book, it’s a sock-puppet sing-along, and its the truth: Everybody Poops. But it’s also the truth that this vital process can get disrupted in a lot of ways, causing distress and discomfort. Read on for more on “normal” function and some very common problems with bowel function.

For starters, let’s discuss the pathway of food through the digestive tract:

  1. Food enters the mouth, is broken down by chewing and starts to digest with saliva.
  2. The food slides down the esophagus into the stomach.
  3. The stomach continues with digestion, holding 1 liter of food/fluid but feeling full at ½ liter. The food can stay in the stomach for up to 2 hours while being digested. Stomach digestion also elicits the gastrocolic reflex about 10-15 minutes after eating, which triggers muscular waves in the intestines to push food through the gastrointestinal system towards rectum.
  4. Food then enters the small intestines, which continues digestion due to pancreas, gall bladder and liver secretions. The digested food takes about 4-6 hours to travel to the large intestines and is still a liquid.
  5. The large intestine (also called the colon) turns liquid food into solid stool by slowly drawing water out. It uses strong, muscular contractions called peristaltic waves to push stool through the large intestines, taking 24-72 hours for food to reach the rectum.
  6. The rectum is the end of the large intestine and gives an urge to defecate by stretching when full.
  7. The pelvic floor muscles tighten to retain stool in the rectum until bowels are full and then relaxes to allow for a bowel movement to occur.


  • Bowel movements are our body’s way of eliminating waste after digesting food.
  • Normal frequency of bowel movements is anywhere from 1 time every other day to 6x per day. Normal bowel color should be brown due to digestive bile but can be green if the food has digested quickly.
  • There is no normal for size or shape of stool.
  • It is normal for bowel movements to have an odor. The odor comes from bacteria that digest the food within the intestines.

This understanding of ideal digestive and bowel function is necessary to begin to understand when our bodies are demonstrating abnormal symptoms. These abnormal symptoms can include fecal incontinence (unwanted loss of stool or gas), constipation (infrequent bowel movements and/or hard stools), diarrhea (loose and watery bowel movements) and rectal pain.

The list of causes for these symptoms is extensive. Below are a few of the most common:

  • Changes in diet or fluid intake
  • Frequent suppression of urge
  • Trauma and scarring- childbirth injury, surgery, radiation
  • Pelvic floor muscle dysfunction- weakness or tightening or the pelvic floor muscles
  • Rectal prolapse- rectum stretches out and protrudes through the anus
  • Rectocele- bulge of the rectum into the vagina
  • Crohn’s disease
  • Ulcerative colitis
  • Fistula- abnormal tunneling in tissue due to infection or swelling
  • Anal fissures- tear in the skin of the anus
  • Spinal cord injuries
  • Hemorrhoids- swollen veins in the anal canal and lower rectum
  • Irritable Bowel syndrome
  • Stress

Fiber, Fluid and Exercise

Keeping a healthy GI tract is the best way to avoid unwanted bowel symptoms and is easier than you would expect.bIt comes down to fiber, fluid and exercise.

Fiber is the part of grains, fruits, and vegetables that cannot be digested by the body. There are 2 types of fiber and they have different effects on our body. Soluble fiber dissolves in water and turns into a gel-like texture in the intestines. This slows digestion and allows for more complete absorption of food. Insoluble fiber does not dissolve in water and adds bulk to the stool. This helps the stool pass more quickly through the large intestines. A comprehensive diet should include both forms of fiber with a total of 20-25g/day. Below are examples of each type of fiber:

Soluble fiber:

  • Rice
  • Oatmeal
  • Oat bran
  • Barley
  • Soy
  • Quinoa
  • Corn meal
  • Carrots
  • Sweet Potatoes
  • Bananas
  • Applesauce
  • Psyllium husk

Insoluble fiber:

  • Bran
  • Whole grains
  • Seeds and nuts
  • Popcorn
  • Granola
  • Legumes
  • Berries
  • Apples
  • Greens (spinach, lettuce, arugula, kale, etc.)
  • Peaches
  • Nectarines
  • Broccoli
  • Cauliflower
  • Celery
  • Onions
  • Dates and Prunes
  • Green beans
  • Peas

Proper fluid intake also keeps our digestive tract healthy. It keeps the stool moving through the intestines quickly and effectively. Traditionally we have been taught to drink 8 glasses of water a day but the truth is that the amount of water needed is highly dependent on each individual person. A good rule of thumb is to drink ½ your body weight in ounces of fluid and ½ of that should be water. Ex: If your weight is 140 lbs, then drink 70oz of fluid total with 35oz being water.

Exercise also helps with moving stool through the intestines and improves the metabolic processes. Click on this link to see a guideline for recommended daily exercise:

If you find that you have bowel symptoms that cannot be controlled by fiber, fluid and exercise alone, you can get help! The first step is talking to your doctor. They will be able to direct you through the proper avenues of treatment. These may include medication, pelvic floor physical therapy, nutritional counseling, and more. For more information here are websites that may be helpful:

And if you are interested in finding a physical therapist specializing in women’s health and pelvic floor dysfunction, the following resources may be helpful:

  • Click on “Find a PT”. Select “Women’s Health” as the specialty area from the drop down menu and search in your area.
  • Click on “Practitioner Directory” to search in your area.

Ruth E. Hensley, PT, DPT Physical Therapist, Marathon Physical Therapy and Sports Medicine