Graphic of a toilet and roll of toilet paper to represent a healthy bowel movement.

Healthy bowel habits

Written by Jessica McKinney, PT, MS and Samantha Pulliam, MD and sponsored by

Ever wondered what is considered normal or healthy when it comes to your digestion and bowel movements? Usually, the process of digestion happens without us thinking much about it. There is a wide range of normal bowel function, with typical frequency of bowel movements ranging from three times per week up to three times per day.

Tell the difference between a healthy and unhealthy bowel movement

When the digestive system is not working right, your ability to have bowel movements at your normal frequency can be disrupted. Of course, there can be many different causes for digestive complaints – medications, hormones, diet, activity levels, or underlying bowel disease. But did you know that the pelvic floor may be the cause, or at least be a part of digestive problems? When the pelvic floor muscles are not functioning properly, the most common bowel problems that occur are constipation and Accidental Bowel Leakage (ABL).

Pay attention to your bowel movements. Here are some things to watch:

  • Normal bowel frequency – the number of times you go to the toilet to defecate – can range from 3 times per day to every three days.
  • Physical activity and exercise increase the muscle activity in your digestive tract and can improve bowel function.
  • Your posture and position on the toilet affect your ability to have a bowel movement. Supporting the feet with a stool or similar item will position you in a relative squat position by keeping the knees are higher than the hips. This helps the pelvic floor muscles relax and makes it easier to have a bowel movement.

Healthy bowel habits to consider

  • Stay hydrated! Water is absorbed into the feces as it moves through the digestive tract. If there is not enough water available to go into the feces, the stool will be hard and difficult to pass and may lead to constipation.
  • Eat foods with dietary fiber, such as fruits, vegetables and whole grains to maintain healthy stool consistency.

What it means to be constipated

Constipation refers to difficulty emptying the bowels or having a complete bowel movement. The inability of the pelvic floor muscles to relax to allow stool (feces) to pass through the anus can be a contributing factor to constipation. Dietary issues, such as not drinking enough water or poor fiber intake can make the stool too hard to pass and also lead to constipation. Constipation leads to smaller or less frequent bowel movements, and may be accompanied by abdominal pain, bloating, straining and/or painful bowel movements.

What is accidental bowel leakage (ABL)?

There are many factors that can cause ABL, including damage to the pelvic floor muscles, nerve damage, and scar tissue. Pregnancy and childbirth place stress on muscles, nerves and connective tissues of the pelvic floor and is a major risk factor for developing ABL. ABL is more likely to occur with diarrhea or loose watery stools because it is much harder for the pelvic floor muscles to control stool with a watery consistency. If you experience symptoms of ABL, your healthcare provider may be able to help.

About the authors:
Ms. McKinney is a physical therapist and has specialized in pelvic and women’s health throughout her career. Her background includes women’s health education, advocacy, and business and program development in the US as well as in low-resource global health settings. She currently serves as Vice President of Medical Affairs and Clinical Advocacy at Renovia Inc.

Dr. Pulliam a fellowship-trained and board certified urogynecologist, a subspecialty of medicine focused exclusively on female pelvic health. She has been in clinical and leadership positions at Massachusetts General Hospital and the University of North Carolina (Chapel Hill), as well as within the American Urogynecologic Society, and she currently serves as the Chief Medical Officer at Renovia Inc.

  • Walter SA, Kjellström L, Nyhlin H, Talley NJ, Agréus L. Assessment of normal bowel habits in the general adult population: the Popcol study. Scand J Gastroenterol. 2010;45(5):556-566. doi:10.3109/00365520903551332.
  • Drossman DA. Functional gastrointestinal disorders: History, pathophysiology, clinical features, and Rome IV. Gastroenterology. 2016;150(6):1262-1279.e2. doi:10.1053/j.gastro.2016.02.032.
  • Bharucha AE. Pelvic floor: Anatomy and function. Neurogastroenterol Motil. 2006;18(7):507-519. doi:10.1111/j.1365-2982.2006.00803.x.
  • FernándezFraga X, Azpiroz F, Malagelada JR. Significance of pelvic floor muscles in anal incontinence. Gastroenterology. 2002;123(5):1441-1450. doi:10.1053/gast.2002.36586.
  • Iovino P, Chiarioni G, Bilancio G, et al. New Onset of Constipation during Long-Term Physical Inactivity: A Proof-of-Concept Study on the Immobility-Induced Bowel Changes. PLoS One. 2013;8(8):1-8. doi:10.1371/journal.pone.0072608.
  • Rane A, Iyer J. Posture and micturition: Does it really matter how a woman sits on the toilet? Int Urogynecol J Pelvic Floor Dysfunct. 2014;25(8):1015-1021. doi:10.1007/s00192-013-2284-7.
  • Wennergren H, Oberg B, Sandstedt P. The importance of leg support for relaxation of the pelvic floor muscles. A surface electromyograph study in healthy girls. Scand J Urol Nephrol. 1991;25(3):205-213.
  • National Academies of Sciences E and MH and MD. Dietary References Intakes: Water, Potassium, Sodium, Chloride, and Sulfate.

Related Topics

Get the Ovia Fertility app
Get our app at the Apple App Store Get our app at the Apple App Store Get our app at the Google Play Store Get our app at the Google Play Store