Bowel Health in Adults Patient Information Contact Details: Bladder and Bowel Specialist Nurse Service First Floor New Alderley House Macclesfield District General Hospital Victoria Road Macclesfield SK10 3BL Tel: 01625 663337 @EastCheshireNHS Leaflet Ref: 15122 Published: Feb 2019 Review: 31/01/2022 Page 1
This leaflet will give you advice to help improve your bowel function and control. Bowel Function There are many different causes of bowel problems: Constipation Some medications such as antidepressants, pain relief and iron tablets Bowel diseases (such as Crohn's Disease, IBS, Diverticulitis, Coeliac Disease) Neurological disease (e.g. Multiple Sclerosis, Stroke, Parkinson s disease) Diarrhoea Damage or weakness of the muscles around the anus Regular Bowel Routine A regular bowel routine will help to ease your symptoms. The bowel is most active after a meal, but warm drinks such as tea or coffee can also trigger bowel activity. Make good use of this increased bowel activity by trying to have your bowels open when your bowel is most active 15 to 20 minutes after food or drink (such as after breakfast or lunch. Exercise General exercise stimulates the bowel, promoting bowel emptying Anal sphincter exercises Anal sphincter (a ring of muscle around the back passage) exercises can help you to improve your bowel control. When done correctly these exercises can build up and strengthen the muscles to help you to hold both wind (gas) and stool in the rectum (back passage). Leaflet Ref: 15122 Published: Feb 2019 Review: 31/01/2022 Page 2
The correct position for opening your bowels Sitting in the right position on the toilet will make it easier for you to empty your bowel. Sit on the toilet and raise your feet so your knees are higher than your hips. Lean forwards, with a straight back and rest your elbows on your knees. Push out your stomach and pretend you are gently blowing bubbles. Rest and then do this again. Do not sit on the toilet for longer that 10 to 15 minutes and do not strain. Figure 1: Position for opening your bowels Bowel frequency and urgency If you have diarrhoea or urgency ( the sudden feeling of wanting to have your bowels open), you may find the following advice helpful: Avoid caffeine and high fat foods as these stimulate the bowel and can cause it to contract or spasm, which may cause bowel urgency. Avoid foods that contain sorbitol (an artificial sweetener often used in sugar free sweets and chewing gum) Avoid antacids that contain magnesium such as Gaviscon, as these can also cause diarrhoea Leaflet Ref: 15122 Published: Feb 2019 Review: 31/01/2022 Page 3
Dietary advice Sometimes, milk and milk products can cause loose stools. Reduce these types of products. If you think that milk may be a problem, talk to your dietician or doctor. Lactose free milk or soya products may be better. Try eating little and often, rather than 3 larger meals. Cut down on fruits, berries, rhubarb, legumes (lentils & kidney beans), peas, corn, broccoli, spinach and nuts. For some bowel symptoms, you may need to eat less fibre in your diet until the diarrhoea has stopped, then slowly go back to your normal diet. Drinking Caffeinated tea and coffee can stimulate bowel activity for some people and may increase wind and urgency to stool. Try decaffeinated tea and coffee for a week or 2, to see if this makes any difference. Skin Care Frequent bowel motions, diarrhoea or accidental leakage may, from time to time, may cause sore skin around the back passage. Taking good care of this area can help to prevent this problem. There are several reasons why your skin may become sore. It may be due to chemicals in the bacteria of the stool. There are digestive juices and acid present in the bowel, which break down your food so your body can use the nutrients in it. If you have liquid bowel motions, the diarrhoea will still contain these juices and acid, which can cause skin soreness and redness If you have faecal incontinence, the small quantity of juices and acid contained in even a normal stool can damage the skin. If you open your bowels frequently, repeated wiping can cause damage to sensitive skin around your anus If you have incontinence of the bladder and bowel, you will be more likely to get sore as the urine and faeces react together People who are not eating a healthy balanced diet, are not drinking enough, or not taking much exercise, are more prone to skin soreness. People who are generally unwell and are immobile are at increased risk of skin soreness.. Leaflet Ref: 15122 Published: Feb 2019 Review: 31/01/2022 Page 4
Dietary fibre advice There are two types of fibre, soluble and insoluble. Fibre is an extremely important part of a balanced, healthy diet. Its main role is to keep the digestive system healthy, but it has other functions within the body including: - Controlling blood sugar levels - Bringing down cholesterol levels - Improving how the body uses nutrients - Controlling appetite - Preventing bowel disease (IBS, diverticulitis and bowel cancer). Soluble fibre Is soluble in water, causing a softer stool, more bulky and thicker in consistency. It does this by absorbing water in the gut to produce a gel like substance which increases the size of the stool as well as softens it. Foods that contain soluble fibre include Oats barley and rye Fruit Root vegetables such as carrots and potatoes Beans and pulses Ground linseed or ground flaxseed. Insoluble fibre Does not absorb or dissolve in water, but it holds water very effectively like a sponge, increasing stool weight. This increase in stool weight improves the movement of nutrients and waste products through the digestive tract. Foods that contain insoluble fibre include: Whole grains (wholemeal bread) Wheat and bran (cereal) Corn (maize) Nuts and seeds (except golden linseed). Leaflet Ref: 15122 Published: Feb 2019 Review: 31/01/2022 Page 5
How much fibre should I eat? To stay healthy, a balance of both types of fibre should be included in your diet. Depending on your age and gender the recommended daily allowance of fibre is between 24 & 30 grams. It is best to avoid eating more than 35g of fibre per day. You should also drink 8 glasses of water per day. Eating too much fibre in your diet can cause 'explosive' bowel movements. A change from a low fibre diet to a high fibre diet can cause abdominal pain, increased wind and bowel urgency. Fibre can improve stool consistency and regular bowel movements, while also controlling symptoms of bowel frequency and urgency. If you suffer from constipation or diarrhoea, increasing or reducing the amount and type of fibre in your diet may help. If constipation is present, the aim should be to soften the faeces to produce a stool that is easier to pass. Increasing the amount of insoluble fibre (which increases the absorption of fluid in the stool) will help to make it softer and bulkier. If diarrhoea or bowel urgency are present, reducing the amount of fibre in your diet may help. Increasing fibre in your diet Always have breakfast. Start the day with muesli or a high fibre cereal and try to include wholemeal or wholegrain breads. Add nuts/dried fruit to breakfast cereals. Eat more beans. Keep skins on fruit and vegetables when possible. Choose wholegrain bread. Introduce seeds in to your diet. Leaflet Ref: 15122 Published: Feb 2019 Review: 31/01/2022 Page 6
Comments, compliments or complaints We welcome any suggestions you have about the quality of our care and our services. Contact us: Freephone: 0800 1613997 Phone: 01625 661449 Textphone: 01625 663723 Customer Care, Reception, Macclesfield District General Hospital, Victoria Road, SK10 3BL For large print, audio, Braille version or translation, contact Communications and Engagement on 0800 195 4194. East Cheshire NHS Trust operates a smoke-free policy (including e-cigarettes) For advice on stopping smoking please contact the KICKSTART Stop Smoking service on 0800 085 8818. East Cheshire NHS Trust does not tolerate any form of discrimination, harassment, bullying or abuse and is committed to ensuring that patients, staff and the public are treated fairly, with dignity and respect. If you have any comments about how we can improve our services please inform a member of staff in the department or complete a comment card available throughout the hospital. Macclesfield District General Hospital, Victoria Rd, Macclesfield SK10 3BL Leaflet Ref: 15122 Published: Feb 2019 Review: 31/01/2022 Page 7