Are YOUR bowel habits normal? Gastroenterologist answers 9 burning questions you’re too embarrassed to ask

Although it’s often a hush-hush topic, going to the toilet is something we all need to do.

After all, what goes in, must come out.

But things don’t always run smoothly down there and knowing what’s normal and what’s not, can help you work out whether there’s a problem. 

From dealing with piles to knowing what your number two should look like, an expert answers your most common toilet-related questions…

1. How often should I go for a poo?

If you haven’t been for a couple of days, or you seem to be going a lot in one day, you might be wondering if your bowel habits are ‘normal’.

Dr Philip Mayhead, Consultant Gastroenterologist at Benenden Hospital, part of Benenden Health, says: “What’s ‘normal’ is what’s ‘normal for you’. 

“The average bowel function across the population is between three times a day and once every three days, but it is possible for a healthy person to sit outside this range.

“It’s important to contact your doctor if your bowel habit changes significantly.  For instance, contact your GP if you are going much more frequently or much less frequently than you usually do over the course of several weeks.”

Changes in your bowel habits may be a sign of bowel cancer, including constipation, diarrhoea, blood in stool, feeling like you have not emptied and going more often.

2. Why am I having to strain so much?

It might be normal for you to not go often, such as once a day. But if it is difficult too, you may be constipated. 

Straining or even pain when you go for a poo, bloating or a stomach ache are signs too.

Dr Mayhead says that the most common cause of constipation is a lack of fibre in the diet. 

The UK’s government guidelines suggest that adults should eat 30g of fibre a day, however according to the British Dietetic Association  the UK average intake is only 18g per day.

Dr Mayhead says: “Eating foods like oats, beans, pulses, fruits and vegetables, alongside plenty of fluids each day can help you to go more regularly.

“It’s important to remember that straining, or difficulty straining, can be associated with other issues, such as pelvic floor dysfunction, which needs to be addressed in a different way and by different medical specialists.”

Book an appointment with your GP if you’re concerned or an increase in fibre over time doesn’t seem to resolve the issue.  

3. How smooth should a number two be? 

There are in fact, broadly speaking, seven different types of poo, which are classified by the The Bristol Stool chart.

“This was developed to help people describe their poo to doctors and as a shorthand for medical staff to record what patients told them,” explains Dr Mayhead.

According to The Bristol Stool chart, an ideal poo is one which is ‘a sausage shape with cracks in the surface’ (type 3) or ‘like a smooth, soft sausage or snake’ (type 4).

“However, sometimes the concept of a perfect ‘type 4’ poo can be unhelpful,” says Dr Mayhead.

“Many factors will change what your poo looks like and the outside texture of it.

“A poo that exists without too much effort, irrelevant of its appearance, is always the best kind.”

4. What colour should my poo be? 

The colour of your number two can vary (from yellow through to brown or even green!) often depending on what you’ve been eating.  

However, there are some concerning colours that need to be investigated by a doctor, according to Dr Mayhead.

Red poo could indicate blood.

“This can just come from piles, but it can also be an indication of more worrying problems like inflammatory bowel disease or bowel cancer,” says Dr Mayhead.

“Sticky, black poo can be caused by passing digested blood from higher up your gut and poo can also go completely white if the bile from your liver is unable to get into your gut.”

Book an appointment with your doctor if you experience red, black or white poo. 

5. Do I have piles?

Piles, also known as haemorrhoids, are lumps around and inside your bottom. 

They can be uncomfortable and itchy or, you may not realise you have them unless you physically feel them. 

Straining and the passage of hard poo past these piles can also irritate them causing pain and bleeding. 

Some ingredients in our diet, such as artificial sweeteners, especially those ending in ‘ol’, (such as xylitol, sorbitol, mannitol) are a laxative.

Dr Philip Mayhead Consultant Gastroenterologist at Benenden Hospital

Dr Mayhead says: “Piles happen when large veins in your anus expand in much the same way that varicose veins happen in some people’s legs.

“Piles can occur naturally as part of wear and tear on your body as you get older, but it is also common in people who have been pregnant or are prone to constipation.”

Piles do tend to go away on their own, and a high fibre diet along with plenty of fluid can help them to go. 

There are also creams available to help with itching and pain; ask your pharmacist for help.

However, if your piles do not disappear, they get worse or you keep getting them, it’s best to book an appointment with your GP who can check your symptoms and perhaps offer stronger medication.  

6. Why am I gassy all day?

Dr Mayhead says that everybody produces gas in their bowel, adding: “It is healthy and normal to do so.

“The gases are a mixture of those produced by fermentation of food in your gut and ones naturally swallowed as we eat.”

So why do you feel particularly gassy today? Or compared to others?

Dr Mayhead says: “Those who eat a diet high in fermentable carbohydrates may pass gas more frequently, but these diets are also often rich in fibre, fruits and vegetables and have a positive benefit to our long-term health.”

The problems arise however if your gas is causing painful bloating or other difficulties throughout the day. In this instance, book an appointment with your GP. 

7. Why do I have diarrhoea?

There are many reasons why you might be experiencing loose, liquid or watery stools, regularly throughout the day. Causes include disease, diet and stress. 

Dr Mayhead says: “Most causes of diarrhoea are unlikely to be harmful in the long term but diarrhoea that is different from your usual bowel habit and goes on for more than a couple of weeks, can represent something that needs medical investigation.”

Dr Mayhead says that your diet can be a common cause of diarrhoea.

He says: “Eating a lot of foods high in fibre in one go when your bowel is not used to this, such as a whole bunch of grapes or a bag of dried apricots, can cause diarrhoea.

“If you are trying to increase fibre in your diet, do this gradually over the course of a couple of weeks. 

“Some other ingredients in our diet, such as artificial sweeteners, especially those ending in ‘ol’, (such as xylitol, sorbitol, mannitol) are also a laxative.”

Stress and IBS can also cause diarrhoea.

“This is thought to affect around one in three people globally and is likely the most common cause of diarrhoea,” says Dr Mayhead.

“Conditions such as inflammatory bowel disease, diverticular disease, bowel cancer, radiation damage from cancer treatment and gut infections also cause diarrhoea.”

If your diarrhoea doesn’t subside, book in with your GP. 

8. Why is there blood in my poo? 

Seeing blood in the bowl after a number two isn’t something that should be ignored. 

Dr Mayhead says: “Blood in your poo can come from benign causes such as piles or diverticular disease but can be a sign of other more concerning problems such as polyps, bowel cancer or inflammatory bowel disease and should always be investigated by a doctor.”

9. Why is my bottom always itchy?

Can’t stop scratching? Dr Mayhead explains: “Itchiness around your back passage is often a sign of piles but can also be caused by anal fissures, gut worm infections or allergies to washing powders or material in someone’s underwear, for example.”

It’s best to avoid scratching if you can and visit a pharmacist who can suggest creams and potential treatments to relieve the itch.

If your itch is accompanied by pain or blood, visit your GP as you may need a rectal examination and/or stronger treatments.