Gut instinct: recognising bowel disorders

"I believe that good health starts with good digestion," says nutritional therapist Ian Marber. 

A sound philosophy, and yet, at any one time, a third of the UK population is suffering with one of the following digestive disorders:

• irritable bowel syndrome
• constipation 
• diarrhoea 
• stomach ache
• nausea 
• sickness 

These may not sound like conditions worth getting into a tizz about until you also consider that 14% of deaths in the UK are linked to the digestive tract.

Toilet talk is commonly the domain of comedians and new parents, but without intending to be crude, it’s time we all got a little more au fait with our faeces. 

According to new research revealed during Gut Week (in August), a quarter of people surveyed said they would ignore blood in their stools; 73% said they wouldn’t bother visiting their GP even if they suffered with persistent diarrhoea; and 69% wouldn’t investigate further even if they had to endure ongoing stomach cramps. 

No wonder, then, that the toll for digestive-related deaths is so high. That’s why we’ve decided to lift the seat on bowel movements with a guide to checking yours, ensuring you stay healthy and fit for years to come...

Constipation concerns

If your trips to the loo are about as regular as your visits to the zoo, don’t panic. ‘Anything between three times a day and three times a week can be normal,’ says Dr Anthony Leeds, senior lecturer in nutritional sciences at King's College London. But, he adds, if you’ve had a recent change of bowel habit that has no obvious explanation such as a change in diet or a lack of liquid intake, then that may be a sign of a problem, so you should see your GP.

And consistency is relevant in more than one way: your stool should be firm but not hard. The more fibre you eat, along with plenty of fluids, the larger and easier to pass your stools will become. 

“The intestine works rather like a tube of toothpaste – so by adding fibre you make it easier for the intestine to squeeze out what’s in there,” says registered nutritionist Carina Norris. “When there’s not much ‘bulk’ inside the tube, it becomes more difficult to get anything out.”

Possible causes of constipation include 

• dehydration, which slows down the digestive process
• lack of fibre intake, which hinders the formation of a stool 
• certain medications (check the listed side-effects on the packaging) 
• stress or anxiety, which can prevent the stomach from properly digesting food

See your GP if:

You also have abdominal (tummy) pain: this can be caused by straining, but if it’s a recent and persistent problem, and you’re over 40 years old, it should be checked out by your doctor. “Sometimes colon cancer starts in this way and the sooner it is detected and treated the better,” says Dr Leeds. “There are many different kinds of abdominal pain, and some are caused by serious problems like stomach ulcers or inflammation of the pancreas gland, so it’s always worth a visit to your GP.”

You also have cramps: If you also experience cramps and/or pain in the rectum, you should see a GP as you may be suffering with faecal impaction where there is a blockage in the intestine.

What colour should it be?

All the leaves are brown, as the Mamas and the Papas sang, and so should your stool be.

See your GP if your stool is:

• Black This can indicate bleeding in the digestive tract. Red blood reacts with stomach acid and enzymes turning it black.
• Red Don't panic, blood in your stool doesn't spell instant death but it does mean you should go to your GP for a check-up. "A dark stool or one containing blood shows that there is bleeding from somewhere inside the gut and this needs to be investigated," says Dr Leeds. It could be a sign of an ulcer, inflammatory bowel disease, irritation caused by drugs such as aspirin, for example, or cancer.

Diarrhoea dilemmas

With this stomach upset you get double the trouble as, bizarrely, it can also be a symptom of constipation. “Although infections from food poisoning or contaminated water are the most common causes of diarrhoea, older people can experience diarrhoea alongside constipation,” says Dr Leeds. 

If someone is suffering with faecal impaction, for example, where a blockage has formed in the intestines, a watery mucous can find its way around the blockage and the individual mistakenly believes that this discharge indicates diarrhoea, when the opposite is true.

See your GP if:

• You have ongoing cramps: this could be a sign of faecal compaction (see above).
• You have nausea or vomiting: usually indicates an infection or a toxic substance. You may need antibiotics.

What bloating means

Aside from forcing you to release your skirt or trouser button, bloating can indicate an intolerance to certain foods or that you're eating too much of a particular food group. 

• large quantities of protein or fruit, for example, will produce bloating
• if you're lactose intolerant, dairy products will also encourage gas formation
• ingesting large quantities of fructose have also been found to cause bloating, as well as diarrhoea

A recent study undertaken at the University of Kansas Medical Center in the US found that drinking just one can of soft drink that contains fructose, the sweetener often used by food manufacturers, produced bloating, diarrhoea and gastrointestinal discomfort in 50% of participants. 

But it’s not just soft drinks that contain this seemingly innocent sugar. Kellogg’s Cornflakes and All-Bran, Ribena and Yoplait Petit Filous also contain fructose. And, of course, natural fruit juice also packs a fair whack of the stuff, so if you often suffer from bloating, try diluting your juice, and check food labels.

See your GP if:

You think you may have an intolerance to a food type: write a food diary so you can ascertain which food is causing you painful bloating or other problems and take this with you. Some intolerances can be alleviated with medication.

Tips for better digestion from dietician Lyndel Costain:

• Eat regular, smaller meals rather than missing meals and then feasting
• Sit down to eat and chew your food, it’ll make it pass through your system more easily
• Drink at least six to eight glasses of water or fluid daily, making sure that of those, only two are caffeinated as they are diuretics, making water pass through you more quickly
• Include wholegrain cereals or breads in your daily diet, as well as five portions of fruit and veg, to ensure you have enough fibre in your system
• Keep your digestive system maintained by topping up with a daily probiotic drink or yoghurt