You're listening to Life Kit from NPR.
Hey, it's Marielle.
I had this friend who was visiting me.
Must have been 10 years ago now, but I still remember something she said.
We were sitting at my kitchen table.
I got up to go to the bathroom.
And when I came back, she goes, did you poop?
I was like, girl, what did you just say to me?
For a moment, I was embarrassed.
I actually hadn't pooped, but just the idea that she knew that I do that sometimes was distressing.
It also made me laugh and feel a lot more comfortable with her.
Like if we could talk about pooping, we could talk about anything.
Yeah, I think that's a really keep that friend.
Yeah.
Don't lose that one.
She's a keeper.
This is Dr. Trisha Pesricha.
She's a gastroenterologist at Beth Israel Deaconess Medical Center.
She also teaches at Harvard Medical School and has a column in The Washington Post called Ask a Doctor.
Trisha says many of us are pooping wrong.
In fact, that's the title of her new book.
You've been pooping all wrong.
How to make your bowel movements a joy.
There's a statistic that has been floating around for a few years now, which is that 40 of Americans their daily lives are disrupted by their bowel movements.
But you probably wouldn't know that because pooping is not considered polite conversation.
After we potty train.
For the most part everyone just shuts the door, locks it and nobody really knows what anyone else is doing there behind closed doors.
And nobody's checking in from time to time.
Not really your doctor, not your parents.
Certainly not your friends.
Nobody's asking like, hey, do you like squat down when you go?
Like nobody's checking in on these kinds of like very fundamental questions.
The cone of silence around this topic is also why there are so many pooping myths like the one that you have to do it every day to be healthy.
People seem to like cling to that so fiercely in America.
And you know, like I said, if you're meeting your fiber goals, you're probably going to poop more often than that.
And like, great for you.
Congratulations to you.
You don't have to worry about being irregular because it's more than once a day.
And similarly, if you poop, if you take a day off from pooping every other day and you feel fine, you're not bloated, you're not worried about it.
I'm not worried about it either.
So.
Just remember, it's really not about frequency.
It's about how you feel and whether it's disrupting your daily life that seems to matter most to me.
On this episode of Life Kit, we're going to give you five tips on how to poop better.
Trisha wants to get you to a place where going to the bathroom is the least of your concerns for the day, where it isn't bothering you, isn't causing you pain and isn't disrupting any of the activities that you love.
It's a state she likes to call Poo-phoria.
That's coming up after the break.
Okay, let's walk through some of the tips.
So one that you call out in the book, you say it's important to go when you have the urge.
Why is that?
Yeah.
This is like, I think, a big cause of self-made constipation.
We have decided that Some of the most natural times to go, when our colon is contracting the most strongly, which would be like, for example, during or right after a meal.
Well, we've decided it's inappropriate.
It's poor taste to get up and leave the table or to have to explain to your friends that you need to have a few minutes in the bathroom, because that's just not good manners.
And so we suppress it.
We say this is a bad time.
And one big reframe I want people to think about is that one, this is just your body.
There's nothing to be ashamed about.
And you are actually doing yourself a favor by responding to the call of nature when it comes.
Because the call of nature is simply this.
It is simply your colon contracting strongly.
If you ignore that.
And you say, you know what, this is horrible.
I'm just about to get to work.
I don't want to deal with this.
I'm going to go later tonight.
Well, guess what?
At 8 p.m., your colon's not contracting.
It's not doing the work for you.
Yeah, you think the timing, the atmosphere is right.
Suddenly, you are faced with having to do all the work yourself, meaning you have to generate an even stronger Valsalva maneuver to bear down.
We all know what that's like where you're straining because your colon is just not playing ball.
And then second, the longer that poop sits in your colon waiting to be expelled, your colon is going to do its other big, important job to just continually suck water out of it.
So 12 hours later, you're not going to return to the same poop you would have had at 8am.
At 8pm.
It's going to be drier harder, more pebbly, and that's going to be way more difficult to get out than if you had just gone in the first place.
Takeaway one is to go when you have the urge.
If you don't, it can get drier and harder and more difficult to push out.
And I know this doesn't always feel possible for a lot of reasons.
One is that you're always running around at your job and you don't feel like you can take a minute to poop.
To that I would say this is a basic human need and it is your right to make space in your schedule to do it.
Another reason is fear or embarrassment, especially in the workplace.
A lot of bathrooms are set up with stalls and it's hard to settle in when you know one of your coworkers could walk in at any moment and spot your shoes, and then they'll know that you poop.
A couple things here.
Trisha says scout out the single person bathroom or the one that's the quietest on the floor.
Nobody goes to.
Also, once you're in the bathroom, try to tune out the world.
I actually genuinely tell my patients to do this put some headphones on and tune out the environment.
Maybe it's you're putting on white noise, maybe you're playing some music, but that's half.
The battle is to just stop being hypervigilant and listening for every footstep outside the door, every rustle of someone who may be passing by, because that's gonna keep you on high alert.
And in order to have a bowel movement, you have to relax because you have to relax your sphincters.
That's the final door on the way to the exit.
And if you can't relax those sphincters, that poop is not gonna come out as easily.
And of course, treat others as you'd like to be treated.
Get into the bathroom, do your business and get out.
Don't linger, especially if there's somebody in there struggling for their life on the toilet.
Give them some space.
Lastly, I'd say if you can't poop in the bathroom, where can you poop?
Remind yourself it is a reasonable thing to do in there.
Okay.
So another tip is to incorporate certain foods into your diet, specifically kiwis, prunes or psyllium husk.
Why these foods?
Yeah, these three foods...
And one of them being like a little bit more, I'd say, like a supplement than a food the psyllium husk.
They have just been incredibly well studied and studied for their natural laxative properties.
Now, prunes are probably the one that we've all heard of, because that's the ones that our grandmothers have been using for a long, long time.
And I found when I started my GI practice that it was very hard to get any of my younger patients like my high school or college patients to eat prunes.
That just didn't strike them as the cool thing to do.
Randomized control trials came on the scene of two kiwis a day, which seemed to be just as efficacious as prunes in eliciting more complete spontaneous bowel movements every day.
But also the nice thing about kiwis is that it doesn't seem to cause bloating.
Which is a big complaint of people who eat a ton of prunes is that they feel pretty bloated afterwards.
Kiwis don't seem to do that.
So if you're looking for that natural option.
And you're like, I think I'm eating a lot of fiber.
I think I'm drinking a lot of water.
What else can I do?
Kiwis are something I recommend all the time.
You don't have to eat the peel.
Let me just say that up front.
Although you could, it's packed with fiber.
I've tried it.
It's kind of tangy.
But you don't have to.
And then you could eat the studies.
They've actually looked at gold and green kiwis.
So you have whatever is available in your grocery store, that's the one for you.
And can I just say on the prunes front, they've just gotten some bad marketing, because prunes are actually just dried plums like raisins or dried grapes.
And I feel like they're more appealing if you call them dried plums.
You know what?
I totally agree.
There's something about the word prune.
I think it's because we think about our skin getting wrinkly and pruney in the water.
That word is not very evocative of joy and poo-phoria, but dried plums sounds delightful.
Who wouldn't want that in the summer?
Yeah, a couple dried plums.
Yeah.
Yeah.
Okay.
And then what about psyllium husk?
Yes.
So psyllium husk is great.
So what's interesting about psyllium husk is that not all fiber and fiber supplements are created equal.
So psyllium husk?
It comes from this thing called the Plantago ovata plant, and it is a soluble fiber.
Soluble fiber is notable because it dissolves in water and it forms a gel.
And that gel is the key to why psyllium husk is so special.
When you are constipated.
It softens up that hard stool through the gel and it makes it softer and easier to pass.
But then interestingly, it can also boost bind loose stool together.
So studies have also found that psyllium husk is great if you have diarrhea, and it's particularly helpful for people this is often the case in irritable bowel syndrome who have poop that a couple of days in a row might be constipation.
The next day suddenly it's diarrhea and they flop back and forth.
Psyllium husk does a really good job.
It's kind of the great equalizer of just finding a nice neutral spot for that poop to land.
Ideally, you'd get up to about 10 grams a day of psyllium.
And that actually can be a lot if you go from zero to 100 really quickly.
So there's two things I tell people about psyllium when they're just getting started.
Which is one, Because it's a soluble fiber, you got to drink it with a lot of water like a full 10 ounce glass of water per teaspoon.
That's one, because you want that water to hit it in your small bowel and form a gel.
Two, go slow.
So start at even half of one teaspoon, a fourth of one teaspoon.
See how you do for a couple days and then ramp up.
Because, like a lot of things, if you were to just suddenly start on a high fiber diet, even from just the foods that you're eating, if you do too much too quickly I'm seeing a lot of this with our fiber maxing social media trend you're going to feel sick within the next two days.
And you're going to say, I give up.
This is horrible.
I don't feel good.
But if you just ramped up slowly, giving your body time to adjust, you could hit that high dose over time and actually just realize how wonderful life is once you're that regular.
Okay.
If you're someone who feels like your poops are fine, like you're not having trouble pooping, then should you do any of these things like the Kiwis, prunes or psyllium husk.
Or is this just if you're feeling constipated or, in the case of psyllium husk, if you're having diarrhea?
I'm so glad you asked that question because yes, you should be doing some of these anyway.
And I think that's the whole issue here is is that sometimes people think some of these interventions are just for people who have a problem, who identify as feeling ill or having symptoms.
And eating enough fiber is something that 95% of Americans are not doing.
And we know that that's something that will be associated with lowering our risk of dementia, lowering our risk of heart attacks, lowering our risk of colorectal cancer.
So even if you don't have GI symptoms, being regular eating a high fiber diet is really really important for you.
Takeaway two, the right foods and supplements can help you go.
To help with constipation, eat prunes and kiwis.
For prunes, aka dried plums.
The dose that's been studied in randomized trials is 50 grams twice a day, or about five prunes in the morning and five in the evening.
For kiwis, it's two a day.
And a plus with kiwis is that unlike prunes, they don't seem to cause bloating.
Psyllium husk can help for both constipation and diarrhea.
It comes in different forms.
The most common is a powder.
Tricia likes to mix it with her coffee and drink it quickly so it doesn't get gelatinous.
And she says if you're new to psyllium husk, just go slow.
Try about half a teaspoon a day for a week.
And if you feel good, try increasing to one teaspoon and then two.
We'll have more Life Kit after the break.
You also suggest, this is another tip, that people work on their form when they're pooping.
And you can do that using a poop stool.
You can do that just by angling yourself in the right way.
Can you talk about this?
Yes.
So most people go to their toilet and they sit down at this 90 degree angle, which is pretty much exactly how we sit when we're sitting at our desk chair, sitting on our couch.
And that's not conducive to a healthy bowel movement.
Our modern toilets are not designed for our actual anatomy.
Now, remember, you think about the colon, which is this long tube.
And at the end I mentioned, there's this part of the colon called the rectum, which is this reservoir.
Well, we all have this thing called the pelvic floor, which is this set of muscles that are right there, at the finish line, and they have to coordinate and contract and relax in this right sequence in order for everything to exit.
Well, actually, there is this muscle in the pelvic floor.
It's called the puborectalis muscle, which when we are sitting, like we are at our desk chairs, it chokes the colon shut.
It acts like a sling around it, almost like your body stepping on its own hose.
And that's a good thing when we're at work and we're like just trying to type this email.
But you really don't want that tube to be kinked when you're trying to poop.
And that's exactly what happens.
Now, the way that you can open that tube and relax that muscle is to squat.
Keep something but around the toilet.
That will help you elevate your knees above your waist when you go.
And that could be a stool, could be a box, could be a pair of stilettos.
Whatever it takes, just elevate your knees as much as you can above your waist.
And they've done these studies that obviously not only is this very helpful to people who know that they have constipation, who experience constipation, but actually even healthy people like that group of people who think they're doing it just fine, who are just living their lives.
When they start to lift their knees above their waist, they say, oh my goodness, I was doing it all wrong.
This is way better.
And that just goes to show how much you don't know how much you're missing until you try something new.
I think in the book you say if you don't have something to prop your feet up on that you can lean forward and do basically the thinker pose, like that statue the thinker, where you're putting your chin in your hand and your elbow on your knee.
Yeah, everyone knows it.
I mean, if you just lean forward a little bit like the thinker, Even that will help straighten up that angle right there of the colon.
If you have absolutely nothing on hand to prop up your knees.
And of course, even better if you can do both.
Takeaway three, work on your form.
Most people sit on the toilet at a 90 degree angle, but that is not the optimal angle for your colon.
Try using something like a box or a stool or a stack of books to lift your knees higher when you're pooping above your waist, ideally.
And if you don't have a prop, you can also lean forward in the thinker pose.
That helps, too.
One other tip that stood out to me is to cut back on ultra processed foods.
How would you define ultra processed foods?
Ultra processed foods are really anything that you couldn't make in your own kitchen.
And there are some degrees within that, right?
Like there are some foods that the original structure of the ingredients are so different, so removed from how they started.
Like take a lot of breakfast cereals.
They look nothing molecularly like the original grain from which they started.
That's probably the most extreme end of ultraprocessing.
But then there's a lot of stuff that's in the gray zone, that's in the in-between, like pasta sauce.
That's tomatoes.
Maybe they've thrown in some seasoning, some onions. and maybe some emulsifiers or preservatives.
That's still ultra processed, but you could probably name most, though not all, ingredients on that list.
And so what I tell people to do is really not necessarily always to cut everything out all the time, because I think if I said that to people they would just give up early and they wouldn't listen.
And what I want to do is try to do something that's realistic.
But I would say try to make these small swaps.
Like, for example, pick something where there's at least most of the ingredients are things that you can get in your kitchen and maybe there's no more than five chemicals you can't pronounce.
If that's the case, it's probably closer to being more of a real and whole food than something where most of the ingredients are words you cannot pronounce, because that means it has more emulsifiers and more chemicals.
And the reason I keep bringing it back to that is that We've done these studies over the last 10 years that show that it is those chemicals and emulsifiers that contribute to microscopic levels of inflammation in the gut that they change the microbiome.
And we've done those studies on a molecular level.
If you look at a population, people who tend to eat more ultra processed foods have worse symptoms of IBS.
They have worse abdominal pain.
They have worse constipation, probably linked back to what those additives and emulsifiers are doing to the lining of the gut.
Do they also have a higher risk of diseases like colorectal cancer?
Yeah, absolutely.
This has actually become one of the biggest conversations in the last five years is that we've had a lot more data emerge about the role of ultra processed foods in cancer, and then specifically in colorectal cancer, and in these early onset cases, which keep rising.
And so there's a number of different reasons to cut back on ultra processed foods, one of which is that you will feel better.
And in fact this is something I tell my patients to actually do when they're coming in with kind of chronic abdominal pain or GI symptoms that you know a lot of the basic tests are negative.
Is we say for one month, do your absolute best to cut out as much ultra processed foods as you can and see how you feel.
I have never had a patient who didn't feel some percent better.
Like maybe it's 10, 20%, but that's a big deal considering it's just all you changed was the food.
And not only do you feel better within just a matter of weeks, but then you're right.
You have a reduced risk of things like colorectal cancer, heart disease, obesity, dementia.
And I mean it's really important that obviously the food industry changed.
But even the small choices that you make day to day can be helpful.
Takeaway four, cut back on ultra-processed foods.
A few tips on where to start from Trisha's book.
Bread.
Look for breads that are whole grain instead of ones with white flour as the main ingredient.
And try to get the loaves that your local bakery or grocery store baked in-house, rather than the ones that are prepackaged and sit on the shelf for a week.
If you eat nut butter, look for the ones where the ingredient list simply says peanuts or almonds and maybe salt.
The added sugar and the oils are unnecessary.
Eat Greek yogurt that has just two ingredients, milk and cultures.
You can flavor it yourself with vanilla honey berries, nut butter raisins dates, whatever you like.
And cut back on processed meats, bacon, hot dogs, deli meat, sausages.
These have a lot of preservatives and nitrates in them that can increase your risk of colorectal cancer.
All right, give us one more favorite tip on how to poop better.
I think everybody needs to look.
I mean, there's something that I find so bizarre, which is sometimes I ask people like What did your poop look like this week?
Like walk me through the kind of pattern.
They'd be like, I mean, I didn't really look this week.
And first of all, I think that's so bizarre.
Like I look every time.
How do you not look?
But if you're not looking, get in the habit of looking, because only by looking are you going to be able to identify the small changes that might occur and that might signal that there's a problem or a shift.
So you have to get in that habit. of knowing what's normal for you.
And remember, you're not gonna poop the exact same way every single day, every single week, every single month.
There are so many factors that change what your poop looks like.
It's gonna be, yeah, the food you eat.
Is it ultra processed?
Is it spicy?
It's going to be how stressed you are.
That's going to change how quickly your colon moves.
It's going to be whether you're traveling.
Is your circadian rhythm of your colon thrown off?
There are all these factors that change that.
And you want to get in the habit of knowing how these fluctuations in your daily life impact your bowels, because it's really important that when something is off, that you bring that to your doctor's attention.
And you can only do that by really getting to know your own body first.
All right, takeaway five is to look at your poop.
You don't have to like stare at it, but get a sense of what's normal for you and what it looks like when it's not normal.
If you notice a change, tell your doctor, especially if you see blood, whether it's bright, red or maroon or black tarry stools, or if your stools go from fluffy to pencil thin.
There are things your doctor can do to help, and they can also rule out more serious conditions.
Dr. Pasricha, thank you so much.
Thanks for having me on.
This was fun.
All right, time for a recap.
Takeaway one is to go when you have the urge.
If you don't, your poop can get drier and harder and more difficult to push out.
Takeaway two, the right foods and supplements can help you go.
If you're constipated, try prunes and kiwis.
And then psyllium husk can help with both constipation and diarrhea.
Takeaway three, work on your form.
Try using a box or a stool to lift your knees higher when you're pooping.
And if you don't have a prop, you can also lean forward in the thinker pose.
Takeaway four, cut back on ultra-processed foods.
Trisha suggests starting with less processed bread, yogurt and nut butter and swapping out processed meats for fish.
And takeaway five, look at your poop.
Get a sense of what's normal for you.
And if you notice a change, talk to your doctor.
That's our show.
For more Life Kit, check out our other episodes.
We have one on how to combat constipation and another on how to manage stress.
Also, we love hearing from you.
So if you have episode ideas or feedback you want to share, email us at lifekit at npr.org.
This episode of Life Kit was produced by Claire Marie Schneider.
Our digital editor is Malika Garib and our visuals editor is CJ Rikolan.
Megan Cain is our senior supervising editor, and Beth Donovan is our executive producer.
Our production team also includes Andy Tegel, Margaret Serino, and Sylvie Douglas.
Engineering support comes from Damian Herring.
Fact-checking by Andrea Lopez Cruzado.
I'm Mariel Segarra.
Thanks for listening.
