Dr. Jacqueline Gerhart: Fiber, Hydration Are Key For Regular Trips To Bathroom

UW Health Family Medicine physician Dr. Jacqueline GerhartMadison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that appears Tuesdays on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.



Dear Dr. Gerhart: I always thought I was normal by going to the bathroom once every three days. But I read in a magazine that you should go to the bathroom at least once per day to eliminate toxins. I feel like I already eat a ton of fiber. What else do you recommend?


Dear Reader: When you say "going to the bathroom," I am going to assume you are referring to "going number two," "having a bowel movement," "stooling" or "going poop." I want to congratulate you on not feeling shy about writing in on this topic. Some people are embarrassed to talk about it with their health care provider, but having a healthy GI tract is essential to eliminating toxins and keeping your other organ systems healthy.


In medical school, I was taught that the spectrum of "normal" ranges from

stooling as few as three times per week to as much as three times per day. However, there are many other factors to consider. In fact, in medicine we have a poop scale — yes, a poop scale. It's called the Bristol Stool Scale. It rates on a scale of 1-7 what your stools look like.


This factors in to your colon health as well. A person's "number" may vary based on current diet, stress, medications, exercise, family history and hydration level. So frequency, consistency and ease of passage all should be considered.


If you feel your stools are infrequent or hard, or that you need to strain to make a bowel movement, I would suggest three strategies: increase your fiber, increase your hydration and use supplements to soften your stool or stimulate your colon to move.


First, increase your fiber. Some people make the mistake of eating a bunch of whole-grain bread or cereals for the majority of their fiber. In reality, eating too many grains can actually make you constipated. I suggest increasing your fiber by eating more whole fruits and vegetables. You also can drink a fiber supplement such as psyllium, which is a natural bulking agent, or a product like Metamucil, Fiber-Con or Citrucel. For people with chronic constipation, they may need to take these on a daily basis for maintenance of colon health.


Second, increase your hydration. Start by drinking eight glasses of water per day. You also can increase the amount of water in your stool by drinking Sorbitol or Miralax, which help fluids remain in your colon to hydrate your stools.


For occasional constipation that persists despite increasing your fiber and hydration, consider using a stool softener or a stimulant. Stool softeners, such as docusate sodium or Colace, help to moisten the stool. Stimulants like Dulcolax or Senokot cause rhythmic contractions of the colon to propel the stool along.


On rare occasions when my patients have not had a bowel movement for more than three days, I suggest they use a laxative or an enema. This allows for the "blockage" to be taken care of, and then they can start up again on a daily regimen of fiber and hydration.


In summary, I like to treat constipation from multiple angles. I recommend drinking eight glasses of water per day, eating vegetables and fruits five times per day and taking a daily fiber supplement that you mix into water. If that doesn't work, I tell patients to add daily Miralax.


If these strategies don't work, then I meet with the patient to do further testing and go over symptoms. It is possible the patient may have an underlying condition — such as pelvic floor dysfunction, hypothyroidism or even colon cancer — that we need to further evaluate and treat.


This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.


Date Published: 03/13/2012

News tag(s):  jacqueline l gerhartfamily medicine

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