This subject is a little sensitive for most people but it is so critical that we must all get over our squeamishness and deal with it head on if we are ever to be totally healthy.  Congruent with the mantra of ‘Turning consensus on its head’, we are doing that again here as we address this subject.  Just like Professor Tim Noakes took the section on Carbohydrate Loading in his world famous book ‘The Lore of Running’ and tore out the pages, Konstantin Monastyrsky has exposed the real truth in the field of gut and bowel health with his book, ‘Fiber Menace’.  Konstantin earned a pharmacy degree in the Ukraine before immigrating to the US where he is now also a certified nutritional consultant and an expert in forensic nutrition.  His website, Gut Sense, goes into great detail debunking all the myths surrounding constipation and fibre.  I have endeavoured to assimilate the core of this information into the lesson below such that it provides most people with enough of an insight into the issues and ways to address their problems and then, for those who want to go into more detail, they can spend more time on his website, and even get his book.  This is a very long lesson, but it is critical that you get through it and make sure you read the section on ‘Recovery’ at the end.

If you go to your doctor, or read about constipation or bowel problems almost anywhere, you will most likely be advised to eat more fibre, drink more water and exercise more.  The bottom line is that this is totally wrong and just leads to more intense constipation and a bunch of the pretty gruesome consequences.

DEBUNKING THE MYTHS

Drinking more water does not produce soft and moist stools because this water never reaches the large intestine of a healthy person.  In fact, death from water intoxication would happen before this water reaches the bowels.  Water gets absorbed in the small intestine long before it reaches the large intestine.  In the case were it doesn’t, you get hit with diarrhea.  This only happens when inflammation, soluble fibre, or laxatives cause intestinal malabsorption.

Next, the large intestine excretes about 100-150 ml of water a day along with normal stools. That’s around six-nine tablespoons of water.  The difference in water content between hard, formed, grayish stools (that’s as bad as it gets) and normal stool is less than 15 ml — a tablespoon’s worth.  Obviously, you don’t need to drink two liters of water to make up for one tablespoon.

Finally, the large intestine recovers sodium chloride — table salt in plain English — back from stools.  Salt is needed body-wide to keep blood adequately salty, to prevent edema, to avoid dehydration, to make sweat, and to synthesize hydrochloric acid for gastric digestion.  If you don’t consume enough salt, stools get dehydrated even faster thanks to the intense recovery of this precious sodium chloride from the large intestine.

It’s worth noting that regular table salt is also the primary source of dietary iodine in the American diet.  Iodine is required for a healthy thyroid function.  Hypothyroidism happens to be one of the major causes of persistent, chronic constipation.

Incidentally, a low-salt diet lowers blood pressure not because salt causes it (salt consumed in moderation absolutely doesn’t, the idea that it does is another big lie waiting to get debunked), but because, at least initially, sodium deficiency causes dehydration.  In turn, this reduces the volume of blood.  Less blood in the system = less blood pressure.  That’s a no-brainer.  Later on, the low thyroid function kicks in and slows down the metabolism.  Slow metabolism, in turn, reduces heart output and muscle tone.  Along with hypotension (low blood pressure), these are the top reasons behind chronic fatigue in general, and “colon fatigue” (a.k.a. lazy gut) in our particular case.

If there is a connection between water consumption and constipation, it’s actually the complete opposite: the more water you consume, the drier the stool gets, because the excess water consumption causes the depletion of potassium with excess urination.  Potassium happens to be the key mineral responsible for water retention in the stools.  And, by the way, all that calcium and magnesium that your heart, teeth, joints, and bones are craving 24/7 gets peed away as well.  The more you drink, the faster…….  Prof Tim Noakes wrote a book called Waterlogged which talks about the dangers of over-hydration for endurance athletes, but the same principles apply to everyone else.  We should not be forcing water down our throats.  The most healthy approach for most people is to ‘drink to thirst’.

The erroneous concept that regular exercise stimulates intestinal activity came from correctly noting that fit and healthy people complain of constipation less often than sedentary types.  But that concomitance (more exercise — less constipation) is an outcome of good health habits, not exercise.  If there were a connection, constipation simply wouldn’t exist among athletes, laborers, gym-goers, and beach jocks and bunnies.  But of course, that isn’t remotely the case.  This doesn’t mean that you shouldn’t exercise.  You absolutely should for all the other benefits it gives you.

Dietary Fibre from fruits, vegetables, grains, bran, and laxatives is the PRIMARY cause of chronic, persistent constipation and related colorectal disorders.  For those who are familiar with the large intestine’s anatomy, it isn’t difficult to comprehend why fibre’s most heralded asset — its ability to bulk up stools — is complete nonsense. The fibre’s journey inside the large intestine begins not by going down, but by going up, up, and up the ascending colon. And the weightier it is, the longer it takes, because the peristaltic propulsion inside the colon isn’t strong enough to move up very heavy ‘loads’.  The by-products of fibre’s bacterial fermentation (short chain fatty acids, ethanol, and lactic acid) destroy bacteria for the same reason acids and alcohols are routinely used to sterilize surgical instruments—they burst bacterial membranes on contact.  And that’s how fibre addiction develops: as the fermentation destroys bacteria, you need more and more fibre to form stools.  If you suddenly drop all fibre, and no longer have many bacteria left, constipation sets in as soon as the large intestine clears itself of the remaining bulk.

INSOLUBLE FIBRE

The anal canal stands firmly between the bowels and toilet bowl — sometimes too firmly.  The bulked-up stools require straining to expel them because their size may exceed the regular aperture (opening) of the anal canal.  The straining, even if moderate, may cause a gradual enlargement of internal hemorrhoids, which line up along the anal canal.  The enlarged hemorrhoids further constrain an already narrow pathway.  Eventually, the passing of large stools causes pain and anal fissures (as the skin tears).  The pain and bleeding leads to an incomplete emptying of the bowels.

This incomplete emptying causes an inadvertent retention of stools, which, in turn, become impacted (large, hard, and dry), and difficult to expel.  Impacted stools cause constipation, not the other way around.  The term impacted stools is preferred over constipation because, for most people, constipation means poor frequency of stools rather than poor quality.  Thus, from a health perspective, having impacted stools regularly is just as bad as being irregular, or constipated.

Impacted stools and straining cause diverticular disease— the bulging of the intestinal walls from excessive inward and outward pressure from straining and impacted stools.   The bulges (diverticula) may trap stale stools and cause exceptionally painful inflammation. This condition is called diverticulitis, and may require surgery.  Left untreated, it may cause colon perforation and peritonitis.   Few people survive this ordeal.

The large intestine can easily retain 5 to 10 lb. of impacted stools before they become noticeable.  Long-term impaction causes irreversible stretching of the large intestine.  The extreme outcome of this condition is called megacolon.  The walls of an enlarged colon and rectum lack tonus — which is needed to propel large stools and complete defecation.  The lack of tonus causes fecal impaction, essentially an immovable plug.  This fecal impaction requires manual or surgical removal of impacted stools to remove the obstruction and prevent necrosis, perforation, and other complications.

This unpleasant procedure completes the vicious circle of indignities brought upon by that extra helping of fibre eaten a few decades ago.  All along you may still remain perfectly “regular” —  because by now, you are an expert strainer, depend on laxatives, or both.  Unfortunately, all laxatives have serious side effects.  All are habit-forming, and gradually lose punch.   So the victim goes back for more fibre…

And, of course, impacted stools do not “move faster,” either with or without fibre.   The transit time for a normal stool ranges from 24 to 48 hours, depending on how often you move your bowels.  But once the large intestine is filled with impacted stools from end to end, the transit time slows down to several days, if not weeks.  Only the young and very healthy may experience faster colon emptying after adding fibre, because it acts as a laxative and, for a while, stools don’t have a chance to get impacted.  But only for a while.

And don’t expect the myth of “fibre keeps the colon cleaner” to be true, either.  Fibre is fibre — no matter its solubility.  Unless it causes profuse diarrhea, it ferments 24/7 inside the large intestine with all of the usual after-effects: flatulence, bloating, and cramping.  All three result from copious gases, acids, and alcohols produced by bacterial fermentation.

This process isn’t any different from turning grapes into vinegar — except that your colon isn’t a stainless steel tank!  The acids and alcohols produced by fermentation cause inflammation of the intestinal lining, which is just as delicate and sensitive as the lining inside your mouth.  The intestinal inflammation interferes with the absorption of gases back into the bloodstream, and you end up even more bloated, more flatulent, and more miserable.  This, of course, describes the classical symptoms of irritable bowel syndrome, or IBS.

At a certain point, intestinal inflammation stops, not only gases from assimilating, but also fluids — water, bile, chyme, and digestive juices.  Blocked digestive fluids cause diarrhea until the intestines are flushed out clean from all the rot.  That too has a ruinous outcome — the straining to contain diarrhea enlarges hemorrhoids and harms the anal canal all the same as large stools.  Even worse, the exceptionally astringent bile, acidified gastric juices, and flesh-eating proteolytic enzymes inflame unprotected mucosa inside the large intestine and skin around the anus.  That causes hard-to-heal perineal ulcers, fissures, and fistulas.  (Normally, bile, enzymes, and gastric juices get neutralized long before reaching the large intestine.)

After the diarrhea subsides, fibre is commonly recommended to restore “formed” stools.  Not surprisingly, the symptoms of IBS — bloating, flatulence, cramping, and constipation — come back and cause diarrhea again. More fibre again?  More diarrhea?  And again… And again?

If you are totally down on your luck, you may end up getting ulcerative colitis or Crohn’s disease, collectively known as inflammatory bowel disease, or IBD.  In addition to the usual calamities — severe bleeding, colon perforation, anorexia — the IBD raises the risk of colorectal cancer 32 times.  That’s 3,200%.  In this context, gutting out affected intestines may be considered a life-saving surgery.  What would you rather have: an indiscreet colostomy bag or a nice funeral?

Even if you get spared from IBD, you may still — as so many do — develop precancerous polyps, and, to top it all off, colorectal cancer.  Ironically, dietary fibre is recommended as a primary preventive of polyps and cancer too, even though study after study has demonstrated the complete futility of this “hit and never miss” approach.

Interestingly, irritable bowel syndrome, ulcerative colitis, Crohn’s disease, polyps, and colon cancer affect Ashkenazi Jews more than any other ethnic group in the United States.  This aberration is happening because bread and cereals, especially from whole wheat, are the primary sources of fibre in the mainstream American diet.  But besides fibre, wheat flour also contains gluten — a highly allergenic plant protein.  Ethnic groups that hadn’t historically consumed much wheat lack the enzymes needed to break down gluten — hence these severe food allergies.

The intestinal inflammation caused by an allergy to gluten is called celiac disease, or sprue.  Inflammation ALWAYS precedes ulcerative colitis and Crohn’s disease.  So what do concerned people usually do after getting diagnosed with any of these?  They, of course, listen to their parents, consult their doctors, research the Internet, and consume even more whole wheat bread, more bran-fortified cereals, and more fibre because that’s what everyone is recommending.

It’s also worth noting that the female reproductive organs reside side-by-side with the small and large intestines inside a tightly packed abdominal cavity.  It’s common knowledge that the uterus is swollen and highly sensitive before and during periods. The unremitting pressure on the uterus from the intestines, expanded by large stools and gases, may easily cause the symptoms of premenstrual syndrome (PMS) and dysmenorrhea (menstrual pain).  (Please note, Konstantin says, ‘I am the first to identify this connection’.)

According to the National Institutes of Health, “An exact cause of PMS has not been identified”.  How could it be if they are still looking at the wrong organs and wrong causes?  Feel free to add PMS and menstrual cramps to the long list of ailments suffered by unwitting and unsuspecting victims of dietary fibre.

Men aren’t off the hook either.  When expansion room inside the abdominal cavity is exhausted, inward pressure from abdominal muscles may protrude the small intestine past the inguinal canal into the scrotum.  Vigorous laughing, coughing, or straining may cause inguinal hernias just as easily as heavy lifting.  Unlike PMS, inguinal hernia requires “repair” surgery.

SOLUBLE FIBRE

Thanks to the incredible adaptability and resiliency of our internal organs, the wreckage from insoluble fibre takes decades to knock you down for good.   And once you learn about its perils, it’s easy to avoid.  Not so with soluble fibre.  In the immediate realm, it’s far more harmful than insoluble because it’s so insidiously stealthy.

Soluble fibre is widely used as an artificial stabilizer and volumizer (filler) in all kinds of processed foods, such as yogurt, cream cheese, sour cream, ice cream, preserves, jellies, candies, snack bars, canned soups, frozen dinners, sauces, dressings, and endless others.

All traces of soluble fibre are always expertly concealed from scrutiny behind obscure names such as agar-agar, algae, alginate, β-glucan, cellulose gum, carrageenan, fructooligosaccharides, guaran, guar gum, hemicellulose, inulin, Irish moss, kelp, lignin, mucilage, pectin, oligofructose, polydextrose, polyols, resistant dextrin, resistant starch, red algae, and others.

The damage from soluble fibre is accomplished by slowing down the intestinal absorption of water, gases (produced normally during digestion), and essential nutrients from foods including carbs, proteins, fats, vitamins, minerals, and microelements. This property (malabsorption) lies behind soluble fibre’s inflammatory, diarrheal, laxative, bloating, cramping, flatulence, and malnutrition side effects, just as described in medical references.

“Colonic bacteria ferment unabsorbed carbohydrates into CO₂, methane, H₂, and short-chain fatty acids (butyrate, propionate, acetate, and lactate).  These fatty acids cause diarrhea.  The gases cause abdominal distention and bloating.”  (Source: The Merck Manual of Diagnosis and Therapy).

The soluble fibre (either natural from food, laxatives, or additives) is especially incendiary for young children, because their tiny intestines need only tiny amounts of fibre to induce inflammation and diarrhea.  The natural soluble fibre in juices, purees, fruits, vegetables, legumes, and grains is just as harmful, particularly for toddlers.

According to the Centers for Disease Control and Prevention:  “diarrhea remains one of the most common pediatric illnesses.  Each year, children less than 5 years of age experience 20-35 million episodes of diarrhea, which result in 2-3.5 million doctor visits, greater than 200,000 hospitalizations, and 325-425 deaths.”

Metamucil? — one of the most ubiquitous laxatives out there — is made from powdered psyllium seed husks, an abundant source of soluble fibre.  A single adult dose of Metamucil contains 3.4g of fibre.  Two medium apples contain 3g of soluble fibre.   For a three-year-old weighing 35 lbs., two apples will have about the same “punch” as four capsules of Metamucil for adults weighing 140 lbs.  Add to the mix one orange (1.8g of soluble fibre) and one kiwi fruit (2.4g), and that’s the equivalent of almost nine capsules of Metamucil for adult per pound of body weight.  Try taking nine Metamucil tablets throughout the day and see what happens a day or two after tomorrow.  Actually, you don’t even have to try it — just read Metamucil’s web site:  “Keep out of reach of children.  In case of overdose, get medical help or contact a Poison Control Center right away.”

Think about it: overdosing children with laxatives may get parents into family court — but stuffing them senseless with more fibre than that which equals a safe dose of laxatives is considered good parenting, good nurturing, and good doctoring.  The ensuing diarrhea is commonly “diagnosed” as food poisoning or “stomach bug,” and usually gets “treated” with the BRAT-like diet, antibiotics, or both.

BRAT stands for banana, white rice, applesauce, and toast. White rice is harmless — almost pure starch with 0.4% fibre. Bananas and apples are abundant sources of pectins — a soluble fibre well known for its diarrheal properties.  The gluten in toast causes intestinal inflammation.  Consequentially, the BAT in BRAT whips up even stronger diarrhea.

What do well-meaning parents do?  It’s back for more antibiotics to wipe out the remnants of bacteria to stop fermentation, instead of simply excluding fibre.  (The BRAT diet has been out of vogue for some time now, but what replaced it is even worse — a regular unrestricted diet, and this time around with more fibre.)

CONSTIPATION

Constipation, irregularity, and hard stools have many causes.  Major among these are the damage to intestinal flora, or dysbacteriosis; the use of fibre to replace dead bacteria; the enlargement of internal haemorrhoids; an unfortunate tendency to withhold stools until the right bathroom is available; the use of laxatives; nerve damage related to medication, diabetes, or nutritional deficiencies; the fear of having pain or bleeding while moving bowels; the side effects of many commonly used medicines; and some others.

Your age, doesn’t affect natural bowel movements directly unless you’ve been experiencing problems for a long time, and your colon, rectum, and anus have already been irreversibly damaged by large stools.  Obviously, the older you are, the more profound the damage.  That’s why people connect abnormal bowel movements with age.

If your colorectal organs are healthy, a normal diet doesn’t play a significant role in natural bowel movements, even with moderate amount of fibre, except for the dietary fat factor.   Fat is essential to stimulate defecation. This diet-constipation connection is one of the most difficult to accept, because people commonly equate food with stools.

LET’S EXPLAIN THIS:

The largest component of stools is water — 65% to 85%.  With low-fibre diets, undigested food remnants represent from 5% to 7% of total stool volume.  With high-fibre diets, they represent 10% to 15%.  That’s why healthy people who fast, or can’t eat solid food because of a sudden medical emergency, still continue to move their bowels — food, as they say, doesn’t make the weather.

This surprising disconnect between food and stools becomes self-evident after breaking down food staples into five basic components — water, carbohydrates, protein, fat, and fibre.   Only fibre is indigestible.  The rest are digested either completely or almost completely:

• Water from food and drinks is completely absorbed in the small and large intestine.  Only about 100 ml (3 Oz) of “embedded” water is excreted along with normal stools, but this is proportionately more in a high-fibre diet.  Water content in excess of 85% — just a 10% difference — is characteristic of diarrhea.
• Simple and complex carbohydrates (sugars and starches) digest completely in the small intestine (except lactose, which is fermented), and are absorbed into the blood as glucose, fructose, and galactose.  More than 0.5% of undigested carbohydrates in the stools is considered abnormal.
• Protein from meat, fish, fowl, dairy, seafood and plants digests completely and is absorbed into blood as amino acids.  So there’s no protein in normal stools (except burned meat).
• Close to 95% of all consumed fat is absorbed in the small intestine.  Fat in stools in excess of 6% of consumed fat is considered abnormal.  This condition is called steatorrhea.
• All food contains insoluble mineral salts and the earth’s minerals, which reach the large intestine undigested.  This indigestible portion of food is called ash, and is determined by cremation.  Normal stools contain from 0.2% to 1.2% of ash.

Thus, if your daily menu includes 200g of meats (2g of ash), 100 g of fat (5g undigested), and 200g of digestible carbohydrates (1g of ash), only 8 grams (one-and-a-half teaspoons) of undigested food residue will reach the large intestine.  That’s not enough to even get noticed in the toilet bowl.

The faeces are kneaded into stools by intestinal peristalsis, with a generous serving of mucus secreted by the intestinal mucous membrane.  The mucus binds together food residue, intestinal bacteria, and metabolic debris — dead body cells and remnants of metabolic activity shed by the liver along with bile.

After all is said and done, normal stools contain around 75% water.  In other words, if you consume a low-fibre diet, your body expels 25 grams of undigested organic and inorganic matter for each 100 grams of stools, and only 8 of those grams come from food.

The water in formed stools is retained by dead cells and intestinal bacteria, which are also single-cell organisms.  Bacteria reside on the surface of the mucous membranes.  They divide and die in huge numbers round-the-clock.  The dead siblings are shed into the lumen (colon’s cavity) and become an essential part of the stools.  By some counts, dead bacteria represent up to 50% of dry stool matter, or almost 11 grams for each 100 grams of stools. (100g – 75g water – 5g fat) * 50% = 10 grams.

When bacteria are present, fibre has a moderate effect on the size and weight of stools because the bacteria ferment up to half of the insoluble fibre, while soluble fibre gets fermented completely.  Thus, if your intestinal bacteria are alive and well, and you consume daily 20-30 grams of fibre from natural sources, it may add only 30 to 60 grams (the approximation of remaining unfermented fibre along with absorbed water) to the weight of your stools.

But if the intestinal bacteria are mostly dead (which is what causes constipation in the first place), and the dietary fibre remains unfermented, your stool weight will go up by 100-150 grams, because fibre attracts water up to five times its weight. The ensuing doubling of the stool’s weight and size — the bulking up, conventionally speaking, — will eventually cause the metamorphosis already described earlier.

People who consume fibre-rich diets excrete around 400 grams of stools daily.  But that goes down to just 72 grams on a low-fibre diet, which is ideal!  But with such a minuscule amount of normal stools, it’s paramount not to miss bowel movements.  Otherwise small stools quickly dry out, become costive, and get difficult to pass out.  Keep in mind that the drying out of stools happens regardless of the bacteria count — normal stools become dry when the moisture content drops as little as 10% down to 65%.

When bacteria are missing altogether, the stools are dry from the get-go.  That’s why “fibre replacement therapy” works not just figuratively, but literally — fibre retains water in place of the missing bacteria, though it isn’t as efficient at keeping up the moisture as are bacterial cells.  Remaining live bacteria keep devouring fibre and causing all of those prominent side effects of “rumination.”

There is only one reliable way to prevent the drying up of stools and ensuing constipation — move your bowels after each major meal, because the act of eating ALWAYS initiates the sequence of events that stimulate defecation.  These successive unconscious events are called, respectively, the gastro colic reflex, peristaltic mass movement, and the defecation urge.  That’s how our gut is wired by nature to move the bowels.

Unfortunately for most Westerners, once the potty training begins, the parents and teachers work really hard to unwire this miracle of nature.  That’s so that you can finally leave the house without a diaper and sit through a class without interrupting it.  It’s possible because the final stage of defecation doesn’t take place until you consciously permit it by relaxing your external anal sphincter.

As we grow up, we learn to suppress the defecation urge by constricting our rectums with our pelvic muscles.  While still young, we squint, grimace, and cross our legs to accomplish it; later in life we can suppress all but the strongest urge, completely unnoticed and wrinkle-free.

But this essential social skill has a downside.  If you keep suppressing defecation for too long, usually over a day, retained stools gradually impact, dry out, harden up, and require straining to get expelled regardless of size.  When that happens, the chaffing of dry stools against the delicate lining of the anal canal causes all the problems described earlier

To summarize, you should move your bowels as soon as you sense the defecation urge, usually after each major meal.  In this ideal situation, stools are soft, small, and barely formed, which is perfectly normal.  They weight no more than 100-150 grams.  If this optimal frequency isn’t attainable, you should pass stools at least daily, usually after breakfast.  In this case, the stools accumulated over a 24-hour period are larger, heavier, and more formed, but still passable.

BRISTOL STOOL FORM SCALE, OR THE BSF SCALE

Type 1: Separate hard lumps, like nuts

Typical for acute dysbacteriosis (pretty much all the bacteria in your bowel is dead).  These stools lack a normal amorphous quality, because bacteria are missing and there is nothing to retain water.  The lumps are hard and abrasive, the typical diameter ranges from 1 to 2 cm (0.4–0.8”) but can be as large as 3 to 4 cm (1.2–1.6”), and they’re painful to pass, because the lumps are hard and scratchy.  There is a high likelihood of anorectal bleeding from mechanical laceration of the anal canal.  Flatulence isn’t likely, because fermentation of fibre isn’t taking place.

Type 2: Sausage-like but lumpy

Represents a combination of Type 1 stools impacted into a single mass and lumped together by fibre components and some bacteria.  Typical for organic constipation.

This type is the most destructive by far because its size is near or exceeds the maximum opening of the anal canal’s aperture (3.5 cm).  It’s bound to cause extreme straining during elimination, and most likely to cause anal canal laceration, hemorrhoidal prolapse, or diverticulosis.  To attain this form, the stools must be in the colon for at least several weeks instead of the normal 72 hours.  Anorectal pain, hemorrhoidal disease, anal fissures, withholding or delaying of defecation, and a history of chronic constipation are the most likely causes.  Minor flatulence is probable.  A person experiencing these stools is most likely to suffer from irritable bowel syndrome because of continuous pressure of large stools on the intestinal walls.  The possibility of obstruction of the small intestine is high, because the large intestine is filled to capacity with stools.  Adding supplemental fibre to expel these stools is dangerous, because the expanded fibre has no place to go, and may cause hernia, obstruction, or perforation of the small and large intestine alike.

Type 3: Like a sausage but with cracks in the surface

This form has all of the characteristics of Type 2 stools, but the transit time is faster, between one and two weeks.  Typical for latent constipation.  The diameter is 2 to 3.5 cm (0.8–1.4”).  Irritable bowel syndrome is likely.  Flatulence is minor, because of dysbacteriosis.  The fact that it hasn’t become as enlarged as Type 2 suggests that defecation is regular.  Straining is required.  All of the adverse effects typical for Type 2 stools are likely for type 3, especially the rapid deterioration of hemorrhoidal disease.

Type 4: Like a sausage or snake, smooth and soft

This form is normal for someone defecating once daily.  The diameter is 1 to 2 cm (0.4–0.8”).  The larger diameter suggests a longer transit time or a large amount of dietary fibre in the diet.

Type 5: Soft blobs with clear-cut edges

This form is ideal.  It is typical for a person who has stools twice or three times daily, after major meals.  The diameter is 1 to 1.5 cm (0.4–0.6”).

Type 6: Fluffy pieces with ragged edges, a mushy stool

This form is close to the margins of comfort in several respects.  First, it may be difficult to control the urge, especially when you don’t have immediate access to a bathroom.  Second, it is a rather messy affair to manage with toilet paper alone, unless you have access to a flexible shower or bidet.  Otherwise, Konstantin says, “I consider it borderline normal.”  These kinds of stools may suggest a slightly hyperactive colon (fast motility), excess dietary potassium, or sudden dehydration or spike in blood pressure related to stress (both cause the rapid release of water and potassium from blood plasma into the intestinal cavity).  It can also indicate a hypersensitive personality prone to stress, too many spices, drinking water with a high mineral content, or the use of osmotic (mineral salts) laxatives.

Type 7: Watery, no solid pieces

This, of course, is diarrhea, a subject outside the scope of this lesson with just one important and notable exception – so-called paradoxical diarrhea.  It’s typical for people (especially young children and infirm or convalescing adults) affected by fecal impaction – a condition that follows or accompanies Type 1 stools.  During paradoxical diarrhea the liquid contents of the small intestine (up to 1.5–2 liters/quarts daily) have no place to go but down, because the large intestine is stuffed with impacted stools throughout its entire length.  Some water gets absorbed, the rest accumulates in the rectum.  The reason this type of diarrhea is called paradoxical is not because its nature isn’t known or understood, but because being severely constipated and experiencing diarrhea all at once is, indeed, a paradoxical situation.  Unfortunately, it’s all too common.

Let’s summarize:

• Abnormal stools are any stools that require straining and/or you feel pressure from stools passing through the anal canal.
• Abnormal stools may be small or large size-wise, depending on fibre consumption, and frequency of defecation.
• Normal stools can be loose or slightly formed (Such as BSF Type 5).
• Normal stools (between BSF Type 4 and 6) aren’t perfectly round.
• Normal stools for one person may be abnormal for another. The degree of normality is determined by the anatomy of the anal canal.
• Normal stools require zero effort and zero straining for elimination.
• Normal stools pass through the anal canal without any perception of pressure.

There are several good reasons behind morning stools. First, while you are asleep horizontally, the large intestine propels faeces toward the rectum.  The propulsion up the ascending colon in the upright position is quite limited.  Second, you are relaxed and not yet constrained by clothing.  Third, eating breakfast stimulates the defecation urge.  Finally, because you may be more comfortable using your own bathroom, you are less likely to suppress the defecation urge and will take immediate advantage of all of the above circumstances.

If you don’t eat breakfast at home, you may stimulate defecation by slowly drinking a glass of warm water.  This simple method is often as good a stimulant as eating.  If you don’t experience any urge, you may have anorectal nerve damage caused by fibre, straining, hemorrhoids, scarring, enlarged colon, medications, laxatives, diabetes, vitamin deficiencies, surgeries.

RECOVERY

Step 1. Reduce fibre consumption and break any dependence on laxatives to the absolute minimum.  Obviously, it’s best if you read Fibre Menace – its last three chapters deal exclusively with a trouble-free transition to a low-fibre lifestyle.  This step is essential to reduce stool size and restore proper (physiological) stool morphology.

Step 2. Reduce water consumption as described in Chapter 2 of Fibre Menace: Water Damage.  This step is important, particularly if you already have upper digestive disorders or are over 40, because over-consumption of water causes indigestion, gastritis, enteritis, and, surprisingly, dehydration related to the loss of essential electrolytes with excessive urination — a condition that may contribute to the onset of dehydration.  You are better off avoiding and preventing all these conditions to avoid their cascading influence on constipation.

Step 3. Get off fat-free diets.  Fat is the single most important factor in the physiology of defecation.  This, we have already established above.  Fat is also critical for normal digestion, a healthy GI tract, vitamin absorption, heart and brain function, blood cells, hormones, supple bones, and, of course, to overcome constipation.  If you are doing this course, then you have this step covered already.

Step 4. Normalize stools.  Where possible, move your bowels as soon as you sense the defecation urge and at least once daily.  Make sure you are getting enough salt.  This is probably one of the easiest and most effective ways for most of us to ensure we start to return to normal.  The goal is to eliminate straining, reduce pressure on internal hemorrhoids, and restore anorectal sensitivity.   If you are still relatively young and “undamaged,” you should be able to restore natural bowel movements within a few weeks to a few months.

Step 5. Restore your intestinal flora.  This step is executed in parallel with Step 4.  Healthy gut flora is at the core of everything.  Now that you are no longer killing off the bacteria in your gut, you can start to re-establish it again.  A simple probiotic will do the trick and you should continue to take these any time you feel your gut may have been compromised by ill health or an unhealthy meal.   L-Glutamine – an amino acid that stimulates the regeneration of intestinal mucosa can also help tremendously.

Step 6. Restore/awaken your anorectal sensitivity. Without this you’ll never feel the urge to move your bowels, and won’t be able to initiate unassisted, regular bowel movements.  Even when the anorectal sensitivity is beyond repair, there are “ways and means” to attain desired results.  More on this subject can be found here.