Bowel Movements - Normal vs. Abnormal

The digestive system is the one system that I review with every patient, and the first question I often ask is: “how many bowel movements do you have in a day?” The most common answer I get from patients is: “one.” However, over time I have come to realize that in most cases there is a repeated theme of needing a cup of coffee or tea, a magnesium supplement or some form of laxative in order to have this one bowel movement.

It goes without saying, but having regular and complete bowel movements is crucial for overall health as this is the body’s way of eliminating waste and toxins. When things aren’t being eliminated effectively from the body it ends up impacting multiple systems, most notably our hormones and mental health.

Elimination, which is the movement of food, waste and metabolites through the digestive tract can be classified into three main categories. Peristalsis is the involuntary muscular contractions that moves food from the throat, through the esophagus, the stomach and intestines. Segmentation is another form of movement that allows food to move in a back and forth motion to further assist with digestion and the migratory motor complex is responsible for sweeping bacteria and residual particles out of the intestines.

When it comes to issues with gut motility, we often think of constipation. Most people view constipation as an inability to have a bowel movement, ranging anywhere from one to several days. However, constipation can show up in many different ways including:

• Needing a coffee in the morning to have a bowel movement
• Going to the bathroom multiple times in less than an hour
• Experiencing trapped gas and bloating
• Not feeling fully evacuated after bowel movements
• Having bowel movements that are small and broken apart
• Having the urge to go but not being able to
• Lots of straining during bowel movements
• Relying on laxatives

Over the years I have noticed that majority of patients, regardless of whether they are dealing with loose or hard stools, actually have impaired gut motility, which can show up differently for each person.

Even if someone is experiencing looser stools they can still have impaired gut motility, which often becomes apparent after the underlying imbalance in the gut has been addressed. In these cases patients go from having looser stools or diarrhea to formed bowel movements but with clear signs of impaired motility.

One of the main contributing factors to motility issues within the gut is an imbalance in the microbiota (bacterial population) of the gut. This imbalance typically results in inflammation within the gut which both impairs gut motility and causes intestinal permeability (“leaky gut”).

Now, if you were dealing with functional constipation due to lifestyle factors, adding fibre into your diet or staying active and hydrated should resolve your concern. However, when those who are dealing with an overgrowth of harmful bacteria, parasites or yeast are told to increase their fibre intake, instead of improving they often end up feeling worse. These imbalances make it very challenging to heal the gut with dietary changes alone.

My recommendation is to determine the status of the gut through comprehensive digestive testing and from there take a focused approach with treatment. The most important thing to remember is that healing the gut is a multistep process and in order to repair gut motility we first have to remove whatever is causing the impaired state in the first place.

Below I have listed some common things to look for when it comes to normal versus abnormal bowel movements.

Normal bowel movements:

• 1-3 daily
• Formed
• Brown in color
• Easy to pass

• Zero bowel movements daily
• Chronic loose stools
• Requiring - coffee, magnesium, laxative etc
• Difficulty passing stools
• Blood in the stools
• Mucus in the stools
• Undigested food in the stools
• Discoloured stools - black, grey, orange
• Oily looking stools on in the bowl
• Floating stools

To learn more about imbalance within the gut, check out our blog post on Dysbiosis.

 

References:

King CE, Toskes PP. Small intestine bacterial overgrowth. Gastroenterology. 1979 May;76(5 Pt 1):1035-55. 

Pimentel M, Saad R, Long M, Rao S. ACG Clinical Guideline, Small Intestinal Bacterial Overgrowth. The American Journal of Gastroenterology. 2020

Cleveland Clinic. Peristalsis: Definition, Function & Problems. Cleveland Clinic. https://my.clevelandclinic.org/health/body/22892-peristalsis. 2024

Kim G, Deepinder F, Morales W, Hwang L, Weitsman S, Chang C, Pimentel M. Methanobrevibacter smithii is the predominant methanogen in patients with constipation-predominant IBS and methane on breath. Dig Dis Sci 2012; 57:3213–18. 

Villanueva-Millan MJ, Leite G, Morales W, Sanchez M, Parodi G, Weitsman S, Celly S, Cohrs D, Do H, Barlow GM, Mathur R, Rezaie A, Pimentel M. Hydrogen Sulfide Producers Drive a Diarrhea-Like Phenotype and a Methane Producer Drives a Constipation-Like Phenotype in Animal Models. 2023

Zhao, Q., Chen, Y.-Y., Xu, D.-Q., Yue, S.-J., Fu, R.-J., Yang, J., Xing, L.-M., & Tang, Y.-P. Action Mode of Gut Motility, Fluid and Electrolyte Transport in Chronic Constipation. Frontiers in Pharmacology, 12, 630249.

Itoh Z, Aizawa I, Honda R, Takeuchi S, Mori K. Regular and irreg- ular cycles of interdigestive contractions in the stomach. Am J Physiol 1980; 238:G85-G90.

Lacy BE, Koch KL, Crowell MD. Manometry. In: Schuster MM, Crowell MD, Koch KL, eds. Atlas of Gastrointestinal Motility. 2nd ed. Hamilton, B.C. Decker. 2002:135-150.

Nieuwenhuijs VB, Verheem A, Van Duijvenbode-Beumer H, et al. The role of interdigestive small bowel motility in the regulation of gut microflora, bacterial overgrowth, and bacterial translocation in rats. Ann Surg. 1998; 228:188-193. 25. 

Gunnarsdottir SA, Sadik R, Shev S, et al. Small intestinal motility disturbances and bacterial overgrowth in patients with liver cirrhosis and portal hypertension. Am J Gastroenterol. 2003;98:1362-1370.