Your guide to bowel health

About the bowel: The bowel is the lower part of the digestive system and connects your stomach to your anus. It's the passage through which waste materials (faeces) are passed out of the body and the last chance for our bodies to absorb any remaining nutrients or water from the waste product.

• Small intestine/small bowel – takes up nutrients still left in the digested food
• Colon – takes up water as digested food passes through
• Rectum – stores waste material until it is ready to be passed out

The rectum and colon comprise the large intestine and together are 1.5 metres long. The small intestine is 6 metres long but called 'small' because it is narrower.

What's normal?

Gastroenterologist Dr David Devonshire, Southern Health, says there's no set rule on the right number of times to 'go' – anything from several times a day to several times a week can be normal, as bowel habits can vary between individuals. "It's a sudden change in bowel habits that can signal a problem."

Stool texture is more important than frequency. Stools should be soft, sausage-shaped and easy to pass. It should only take a minute or so to empty your bowel. If it takes longer than this, you may be experiencing constipation.

Stools are almost always brown in colour due to the bile needed for digestion. Some pigments in foods (such as beetroot) can affect the colour of stools and some foods cannot be broken down by our guts and will be excreted whole (such as corn). If your stool is very dark/black or very light grey, and this is a change from your normal stool colour, you should see a health professional as this can be a sign that something is not right.

It's normal for stools to smell. Odour is caused by the trillions of bacteria in your digestive system that enhance metabolic and digestive processes. So you can take some consolation in the fact that smelly poo means a healthy gut!

What's not normal?

Blood

Blood smears on toilet paper are usually caused by haemorrhoids or anal fissures. It may be a sign that you are constipated and are straining too hard. Visible blood in the stool itself is a symptom of internal bleeding. See your health professional immediately. 

Incontinence

Poor bowel control or faecal incontinence affects one in 20 people. People with faecal incontinence may experience accidental leaking from the bowel, passing wind when they don't mean to, or they may notice their underwear is stained. Although poor bowel control is more common in older people, it's not something that we have to 'put up with' as a natural part of ageing. It is important to see your health professional as the symptoms will not go away on their own, and may in fact worsen over time. Your health professional can determine the cause of the incontinence and prescribe effective treatments or therapy to improve bowel control.  

Constipation

According to the Gastroenterology Society of Australia, constipation is one of the most common medical complaints, with one in five middle-aged women experiencing constipation.

People say they are constipated when they are not passing stools as frequently or as easily as usual. When a person is constipated, their stools are usually hard, dry and painful to pass and they may also experience bloating and cramping in the abdomen.

Constipation can be caused by changes in routine (shift work, travel), insufficient water or fibre in the diet, lack of regular exercise, some medications, pregnancy or old age.

Many people 'put up' with constipation because they are too embarrassed to seek help. In most cases, constipation can be prevented by simple lifestyle changes such as eating food high in soluble fibre, increasing physical activity, and allowing adequate time for a bowel motion so you don't rush or strain. In some cases, laxatives may be needed to treat constipation. See your health professional further for advice.

Diarrhoea

Diarrhoea is loose, watery, or frequent bowel motions, often accompanied by painful cramps, general weakness and needing to go to the toilet urgently. Other symptoms include nausea, vomiting and fever.

Diarrhoea occurs when the intestinal lining fails to absorb water from food waste. This often happens when there is an infection in the digestive system such as gastroenteritis or food poisoning. The intestinal lining becomes inflamed and irritated, making it difficult for water to be absorbed, resulting in unformed, watery bowel motions. Other possible causes are parasites, drinking contaminated water, stress or food intolerance.

Most cases of diarrhoea will only last a couple of days. It is important to prevent dehydration by drinking lightly sugared drinks such as diluted fruit juice. Avoid tea, coffee, milk, soft drink and alcohol and foods high in fat, sugar or fibre. Practice good hygiene habits to avoid passing on the infection to other people. If the diarrhoea persists for more than 2-3 days or is accompanied by severe pain, blood in the stools or high fever, see your health professional immediately.

Other conditions

Some abnormal bowel habits may be symptoms of gastrointestinal conditions such as irritable bowel syndrome, inflammatory bowel disease or food allergies or intolerances. "Not all changes in bowel habit indicate disease," says David. "However a persistent change in bowel pattern, especially blood in the stool if you're over 40 years of age, needs prompt review by your doctor. This may need further assessment by stool testing, blood counts, scans or colonoscopy."

Tips for good bowel health

• Eat a healthy diet including foods high in fibre, e.g. wholegrains, fruits and vegetables.
• Drink plenty of water.
• Get enough exercise.
• Allow enough time on the toilet so that you don't need to rush or strain.
• The best position for emptying your bowels is leaning forward, with a straight back, forearms on your thighs and feet slightly raised if possible (you may find a footstool helpful). Try not to strain or hold your breath.
• Be aware of your bowel habits so that you notice when something changes.
• Maintain a healthy weight and don't smoke. Obesity and smoking are associated with an increase risk of bowel cancer.
• If you are over the age of 50, talk to your health professional about appropriate screening tests for bowel cancer.

Bowel Cancer

What is it?

Bowel cancer, also known as colorectal cancer, is a malignant growth inside the lining of the large bowel. Most bowel cancers start out as polyps, which look like small spots on the bowel lining or like cherries on stalks, protruding from the wall of the bowel.

Australians have a high incidence of bowel cancer. "One person dies on our roads every six hours, one person dies of breast cancer every four hours, but one person dies from bowel cancer every two hours," says David. "Screening with a stool test for small amounts of occult blood has been shown to reduce bowel cancer death rates by 30 per cent. A colonoscopy test may reduce the rate by 70 per cent or more, thus potentially preventing thousands of deaths each year.

Symptoms

The most common symptoms of bowel cancer are:

• Blood or mucus in the stool
• Unexplained change in bowel habits (e.g. diarrhoea, constipation, incomplete emptying of bowel)
• Discomfort in abdomen (such as pain, cramps, bloating, fullness)
• Thinner than usual bowel motions
• Unexplained weight loss
• Fatigue and weakness

If you experience these symptoms, see your health professional.

Who is at risk?

The exact cause of bowel cancer is unknown. However certain factors increase your risk.

• Ageing – bowel cancer commonly affects people over the age of 50.
• Family history – although 75 per cent of people who develop bowel cancer have no family history, you are at increased risk if any of your family members have a history of bowel cancer at a young age, especially close relatives (e.g. parents, siblings or children).
• Genetic factors – some genetic conditions increase your chance of developing bowel cancer.
• Personal medical history – people who have had cancer of the colon, rectum, endometrium, ovary or breast, or who have a history of polyps, ulcerative colitis or Crohn's disease are at greater risk of developing bowel cancer.

If you fall into any of these categories, see your health professional for advice about bowel cancer screening.

Bowel Cancer Screening

Ninety per cent of bowel cancers are treatable if caught early. Unfortunately, most bowel cancers show no symptoms in the early stages so many people do not realise that something is wrong until it's too late.

The National Bowel Cancer Screening Program offers free screening tests to all Australians aged 50, 55 or 65. This test involves collecting tiny samples from two bowel motions using a home testing kit. The samples are then posted to a laboratory where a faecal occult blood test (FOBT) is used to detect microscopic amounts of blood that might indicate early stage bowel cancer.

Treatment

Treatment depends on the stage of the bowel cancer. The affected area of the bowel will often be removed surgically. A stoma (shunt that funnels waste out of the bowel and into an external bag) may be needed while the bowel heals and in some cases, permanently. Chemotherapy or radiotherapy is also used post-surgery in the majority of cases. Sometimes, the bowel cancer will progress to other parts of the body and a cure is not possible. Even in these situations, using a range of therapies, the cancer can often be managed for quite a long time.

Further resources

Gastroenterology Society of Australia

www.gesa.org.au

Better Health Channel

www.betterhealth.vic.gov.au

Bowel Cancer Australia

www.bowelcanceraustralia.org

National Bowel Cancer Screening Program

www.cancerscreening.gov.au  or call the information line on 1800 118 868

Gut Foundation

www.gut.nsw.edu.au

Content updated November 2010