When push comes to shove, bowel function has a big impact on our health and emotions – yet we're usually reluctant to talk about it.
Not so Australian colorectal surgeon Dr Michael Levitt, who offers practical advice and debunks common myths in The Bowel Book.
Every day, billions of bowels are in action "for a few desperate seconds, or any number of interminable lonely minutes,” Levitt says.
Yet our discomfort with the subject means an increasing number of people wind up in the surgeon's office with bowel complaints that would best be treated elsewhere, Levitt says.
“The problem with bowel complaints is they aren’t life-threatening… They are awkward, troublesome and sometimes infuriating, and it can be difficult to get practical useful information to help.”
The idea that every one of us should be going every day?
A myth based on the largely male narrative of 'taking care of business', Levitt says.
“How easily we go and how empty we are when leave the toilet is much more important.
“The empty bowel is the happy bowel.”
The ideal bowel movement is “prompt, effortless, brief and complete" but excretion is not for everyone an effortless operation.
“People can wake up in the morning and be anxious from an early stage about whether they’re going to have their bowels open or what they’ll have to do to get their bowels to work. Will it be time-consuming, strenuous, painful, frustrating and infuriating?”
“Bowel dysfunction is much more likely to be a cause of stress and distress, than stress and distress is likely to be a cause of bowel dysfunction.”
Levitt says many people have a sluggish bowel, but the problem is more prevalent among women.
“It tends to become apparent in their teenage years and inevitably slows and deteriorates over time.”
Levitt has three golden rules for a happy bowel:
- Go to the toilet only when you’re busting: “Getting to the toilet with what I call the irresistible urge is fundamental to having a bowel action that will commence promptly and with no straining.”
- Don’t take in any reading material or devices
- Keep in mind the ideal motion is “firm and formed”
Levitt’s preferred treatment for a sluggish bowel is behavioural retraining and laxative treatment.
"For individuals habitually reaching the toilet in advance of the forceful urge", he uses a simple behavioural retraining programme called the 3 Ds.
Defer – If you’re not busting, back off.
Distinguish – between urges that are the real thing and false alarms.
Desist – If you get to the toilet and nothing happens, leave.
“The Eleventh Commandment is never sit on the toilet to have your bowels open until the urge that takes you there is strong and true.
“Imagine a sign on the inside of door: 'If you’ve been here for 30 seconds and nothing’s happened you shouldn’t have been here in the first place'.”