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Irregular Bowel Movements and Constipation Review
Get the Most Personalized and Effective Irregular Bowel Movements
or Constipation Remedies Science and Nature Has to Offer
Irregular Bowel Movements and Constipation Review
HOW THE INTESTINE WORKS (Anatomy & Physiology)
HOW THE INTESTINE GOES WRONG (Pathophysiology)
HOW TO TELL IF YOU HAVE IRREGULAR BOWEL (ROME III Criteria)
HOW TO HELP IRREGULAR BOWEL (The Stage Approach)
REMEDY FOR IRREGULAR BOWEL DURING PREGNANCY
REMEDY FOR IRREGULAR BOWEL IN CHILDREN
Copyright © 2014 AHP WELL INC.
HOW THE INTESTINE WORKS (Anatomy & Physiology)
I think it is a good idea to start with the anatomy and physiology of the G.I. system and the gastrointestinal tract to offer
some perspective regarding your regular bowel movements. Once you have some familiarity with the G.I. system in
general, you will have better insight into your irregular bowl movements or constipation.
We start with the mouth. The mouth is where food is chewed to start digestion. Aside from chewing the food to
prepare it for digestion, we also release saliva. Saliva is an enzyme that helps break down the food we eat. Many
people have the habit of not chewing their food completely or drink fluid while chewing. Incomplete chewing of food
makes the rest of the GI system work harder. Also, drinking fluid while chewing your food minimizes the action of the
saliva to breakdown and prepare the food for digestion. This is why it is not a good idea to drink fluids including water
while you are chewing your food because it inhibits the saliva which helps break down the food. Take the drink after
you have finished chewing.
Next, we go to the esophagus. The esophagus is a muscular tube that
connects the mouth to the stomach. The esophagus uses its muscle to
generate something known as peristalsis. Peristalsis is a radially symmetrical
contraction and relaxation of muscles which propagates a wave down the
muscular tube. In much of the gastrointestinal tract, including the esophagus,
muscle contracts in sequence to produce a peristaltic wave, which forces a
ball of food called a bolus down the esophagus to the stomach. It is important
to realize the gravity does not act in this process of bringing food from the
mouth to the stomach. This is all done with peristalsis. You can still swallow
food even eating upside down.
The next area we go to down the digestive track is the stomach. In the
stomach you have the acid breakdown of food. It is important to realize there
is no absorption of nutrients that occurs in the stomach. Carbohydrates break
down and leave the stomach the fastest while fat and protein, leave much
The food that is broken down in the stomach is known as chyme. It then
passes from the stomach to the intestines; first the small intestine, then the
large intestine. The small intestine is made up of three parts called the
duodenum, jejunum, and ileum. The small and large intestine is also a
muscular tube that generates peristalsis like the esophagus except it is more
involved in nutrient absorption. The intestine also has layers and each of the
layers is very important.
The outermost layer of the intestine is called the serosa. The serosa is where the blood supply to the intestine and the
peripheral nervous system to the intestine reside. The next layer of this muscular tube called the intestine is called the
muscularis. The muscularis is where you have longitudinal or “straight” muscles and inner circular muscles. Also in the
muscularis layer is a nerve center call Auerbach’s nerve plexus in between the straight and circular muscles. The next
layer is the submucosa. The submucosa contains another nerve center called Meissner’s Nerve Plexus. The last layer is
called the mucosa. The mucosal holds the actual epithelial cells that do the absorption of the food nutrients from the
As in the esophagus, you have peristalsis in the
intestine. The inner circular muscles that crunch and
segment the food while the longitudinal (straight)
muscles help push the food along. In this way, the
longitudinal and circular muscles work together to
create peristalsis. The peristalsis generated, is in
reaction to stimulating receptors in the Meissner’s and
Auerbach’s Nerve Plexus Centers. This is very important
because regular bowel movements are dependent on
this. ANYTHING THAT AFFECTS THE NERVE CENTERS
OR THE MUSCLES WILL AFFECT PERISTALSIS AND
BOWEL MOVEMENTS. Again peristalsis is a symmetrical and rhythmic contraction of the longitudinal and circular
muscles to move the food in response to the nerve centers.
As a result, the anatomical structures that are most responsible for normal bowel movement are:
1. The Peripheral Nerves at the Serosa Layer – They contain the Parasympathetic Nerves and the Sympathetic
Nerves which affect bowel movements.
The Sympathetic Nervous System is responsible for controlling and responding to the bodies stress “fight or flight”
responses. This is the system that prepares you for stress of danger. It gets your body ready to fight or flee. It makes
your heart pump faster and generally makes you more alert and aware. In the bowel, it slows or stops your bowel
movements. Therefore things like pain, fear, depression, and decreased sleep affect the Sympathetic Nervous System
and can lead to decreased gut motility and constipation. Moreover, anger, anxiety, hostility, can lead to gut motility
problems that induced diarrhea.
The Parasympathetic Nervous System counteracts the Sympathetic Nervous System. It generally works to promote
maintenance of the body at rest or comfort and not in stress. The Parasympathetic Nervous System helps calm and
regulate you. In the bowel, it dominates motility in the gut to promote peristalsis and helps maintain regular and timely
2. The Longitudinal (straight) and Circular Muscles at the Muscularis Layer – Together they generate peristalsis;
which cause bowel movements.
The wave like motions of peristalsis in the bowel, occur at about a rate of five waves per minute. The peristalsis wave
rate is not only affected by nerves and neurotransmitters; but mood and the type of food you eat as well.
3. The Meissner’s and Auerbach’s Nerve Plexus Centers at the Muscularis Layer (including Submucosa) – To
activate and regulate the Longitudinal and Circular muscles.
These nerve plexuses centers that reside between the two muscle layers respond to three important body chemicals
called neurotransmitters. A neurotransmitter is a chemical that is released from the end of a nerve when it is
stimulated. Different types of nerves have different neurotransmitters. Neurotransmitters then go to stimulate a target
called a receptor to cause something to happen. The three main neurotransmitters in the bowel nerve plexuses centers
are acetylcholine, dopamine, and serotonin.
All of these neurotransmitters are very important in the brain and the central nervous system for proper mental
function. However, many people do not realize that 50% of the dopamine used with the dopamine receptors occurs in
the gut. People also do not realize that 90% of serotonin and the serotonin receptors also reside in the gut. We will talk
about these neurotransmitters in greater detail later. For now, you should realize that dopamine is important in the
brain and gut for mood. Serotonin is important in the brain and gut for things like mood and sleep. Acetylcholine is
important for muscle contraction and the sympathetic or parasympathetic nerves.
4. The Epithelial Cells at the Mucosa Layer – They absorb the nutrients and water from the broken down food.
What they absorb and their ability to absorb it affects bowel movements.
Epithelial cells are important because they line most organs and body cavities. If you take your tongue and rub it against
the roof of your mouth or the inside of your cheek; you are feeling epithelial cells. There are several types of epithelial
cells. In your mouth they are flat. In the bowel, they are tall so they can fit the biochemical machinery necessary to do
what they need to do. As they line the inside of the muscular tube called the bowel, they contain the biochemical
machinery to: absorb nutrients from food; secrete (including the neurotransmitter serotonin) and filter water in and out
of the bowel; regulate bacteria in the bowel; and provide a protective barrier. All of these functions of the intestine
epithelial cells can affect bowel movements.
HOW THE INTESTINE GOES WRONG (Pathophysiology)
Let us now take a closer look at intestine motility and the things that may affect its function or dysfunction.
Understanding the anatomy and physiology of the bowel in the previous section may give you some clues as to what can
As with many systems in the body, the intestine
works in a delicate balance of nerves, cells,
feelings, and habits. Like a stack of dominos,
throwing one thing out of kilter can, eventually
affect others. Because of this, there are, of course,
many things that can cause irregular bowel
movements with constipation or diarrhea.
However, we are going to discuss the most likely
sequence based on the evidence.
Step 1. A sustained change in mood or lifestyle
causes a change in the peristalsis rate of the
bowel. The mood changes usually involve some
form of stress, fear or anxiety which causes the
Sympathetic Nerve responses to dominate over
the Parasympathetic. The lifestyle changes usually
involve a change in diet (food or medicine), sleep,
or living habits like exercise etc.
Step 2. If the changes in step 1 are short term or
infrequent; the bowel has the ability to adapt and
re-regulate itself. However, if the changes are more long term or sustained the neurotransmitters (acetylcholine,
dopamine, and serotonin) and the intestinal epithelial cells are adversely affected.
Step 3. Step 2 can cause an abnormal release of serotonin from the epithelial cells to over stimulates the 5HT3 receptors
in the intestine which, in turn, turn off the 5HT4 receptors which slows down or turns off peristalsis and makes the
bowel and its epithelial cells more hypersensitive.
Step 4. Greater epithelial cell hypersensitivity affects the cells immune protection signals making it more susceptible to
inflammation; despite this inflammation being very low grade (almost undetectable).
Step 5. The changes in step 4 hurt the epithelial cells ability to regulate itself which affects protein MYD88. Damage to
protein MYD88 lowers the cells ability to manage the good bacteria in the bowel and destroy the bad bacteria.
Step 6. The low grade inflammation combined with a bad balance of bacteria damage the epithelial cell further. This, in
turn, causes the cell to leak and not absorb, secrete, and filter as well.
Step 7. Changes in step 6 cause more damage as the epithelial cell loses its ability to act as a protective barrier.
Step 8. All of this leads to and compounds irregular bowel movements, constipation or diarrhea. To stop this sequence
of falling domino doom, you must reverse one of the steps, or not let the sequence start at all.
HOW TO TELL IF YOU HAVE IRREGULAR BOWEL (ROME III Criteria) Since irregular bowel movements or irritable bowel
syndrome can be difficult to diagnose and treat due to its difficult nature; more objective, criteria were developed to
help solve this problem. These criteria are called Rome III Criteria by the Rome Foundation and the Functional Brain Gut
These are the three (3) category groups you should consider when trying to determine if you have irregular bowel
movements or irritable bowel syndrome. The ROME III Criteria require that you have symptoms from both category A
and B below.
You should have 2 out of 3 of these Category A criteria for 6 to 12 weeks. The symptoms for the weeks do NOT need to
1. Relief with defecation; and or
2. Change in frequency of stool; and or
3. Change in form or appearance of stool
1. You should have at least 1 of these Category B symptoms:
2. Greater than three movements a day or
3. Fewer than three movements per week or
4. Loose mushy / watery stool or
5. Urgency rush to stool or
6. Hard lumpy stool or
7. Straining during stool or
Red flag symptoms with irregular bowel movements or irritable bowel syndrome, or symptoms that may mean trouble
or something other than irritable bowel will include:
1. Pain that awakens or interferes with sleep
2. Blood in the stool visible or not
HOW TO HELP IRREGULAR BOWEL (The Stage Approach) *Be sure to consult your doctor
Anyone that has had irregular bowel movements knows how difficult they can be. You can have bloating, pain, diarrhea,
constipation. You can have a general discomfort that is very inconvenient and very hard to deal with. Irregular bowel
movements can be very frustrating and difficult because even though we have current treatments the treatments are
generally used to relieve some of the symptoms. They generally do not fix the problem itself. Also the treatments
themselves can have very harsh side effects.
If you do have irritable bowel movements you're not alone this is common in millions of Americans. We can offer you an
organized staged multistep approach with education and you can apply the best remedy for your particular regular
bowel movement issues.
The best way to approach irregular bowel movements is with a step or stage wise approach. The four stages below
progress in magnitude and each stage has several remedies to choose from. In this way you can choose the remedy that
best fits your symptoms and cause. Our objective is to give relief through personalized treatment depending upon your
body and your symptoms.
STAGE I: Stage I remedies includes:
1. Diet: What and how you eat or exclude from your diet.
a. [Protein] Carbohydrates have a tendency to leave the stomach faster but induce slower peristalsis. Proteins,
on the other hand, have a tendency to leave the stomach slower and induce faster peristalsis. Therefore,
proteins promote more bowel movement.
b. [Fiber] Foods high in fiber will promote bowel movements. (prunes; pears; broccoli; flaxseed; carrots; beans;
peaches; figs; whole grains; pineapple)
c. [Smaller Frequent Portions] Eating smaller volumes of food more often helps promote bowel movements. In
other words, eat 4 to six smaller meals a day as opposed to 2 to 3 large meals a day.
d. Foods to avoid that help cause irregular bowel movements and constipation include: chocolate; caffeine;
dairy products; and red meat.
2. Lifestyle: What you do and how you do it in your life.
a. [Sleep] The two greatest lifestyle changes that help irregular bowel movements are sleep and stress
reduction. Sleep is greatly underappreciated. Sure, most of us would like to get more sleep; but few people
realize how important sleep is as a therapeutic agent. Sleep not only helps reduce stress and promote good
brain wave activity for refreshing alertness; but promotes serotonin as well. Proper Serotonin levels and the
receptors it interacts with have treatments affect on improving bowel movement. If sleep is an issue either
because you have trouble sleeping well; or you job or circumstances prevent you from getting the sleep you
need – we have an excellent solution here: http://bit.ly/FallAsleepFast
b. [Stress Reduction] Stress reduction is second only to sleep when it comes to how important it is in helping
bowel movements. Stress and the moods associated with stress like anxiety, fear, anger, etc. directly
decrease bowel movements and promote irregularity through sympathetic nerve response. Fair stress
reducers include biofeedback, acupuncture, meditation, exercise, and yoga. If you are interested in an
excellent resource for effective stress reduction or the best way to reduce stress from work go here:
STAGE II: Stage II remedies includes:
1. Bulking Agents:
Bulking agents act to improve bowel movements by, as the name implies, creating bulk to push stool out.
Common over the counter bulking agents include: Citrucel, Metamucil, or Fiberall.
These all contain a high fiber bulking agent like psyllium or bran. Check Amazon for the best price.
Osmotic agents work by increasing the amount of water that is secreted into the bowel. Increasing the water
helps soften the stool in the bowel making it easier to pass. There are several osmotic agents available over the
counter and by prescription. However, the best osmotic agent available over the counter is Polyethelene Glycol
(PEG) which is known in the market as Miralex. Again, Amazon probably has the best price.
Technically, anything (food, compound, or drug) that helps bowel movements can be classified as a laxative.
Laxatives here usually refer to stimulant or lubricant laxatives that promote bowel movement. The issue with
many laxatives, though effective, can cause pain, bloating, or, ironically, constipation with misuse or overuse.
Again, there are many laxatives over the counter or by prescription. However, we recommend Colace which
contains Docusate. Mineral Oil and Pepermint Oil are very good lubricants and fine for the very short term.
They should be avoided in children and pregnant women. These oils can also prevent certain vitamins from
absorbing in the bowel.
The inside of the bowel is lined with bacteria call “normal flora” under normal circumstances. These bacteria
are monitored and regulated by the epithelial cells also lining the bowel in the mucosa. These bacteria are
responsible for normal digestion and normal movement of the bowel. We discussed earlier how damage to the
epithelial cells alters the type and balance of normal flora in the bowel. The key to helping irregular bowel
movements when the normal flora is out of balance is restoring that balance. The two bacteria most capable of
restoring balance are Lactobacillus and Bifidobacterium. Because these bacteria help restore normal flora, they
are called Pro-bacteria or Pro-biotics. Make sure that any yogurt or product that claims to be pro-biotic, has
these two bacteria in them.
STAGE III: Stage III remedies includes:
This stage includes drugs known as prokinetics. These drugs usually require a prescription. These drugs act on the
bowel to increase movement directly.
1. Chloride Channel Stimulants: These drugs increase water and secretions by the epithelial cells into the bowel.
They activate chloride channels in the bowel. One of the first chloride channel stimulant drugs approved by the
FDA is Lubiprostone.
2. Antidepressants: The best antidepressants to improve bowel movement are Tri-Cyclic antidepressants and
Selective Serotonin Reuptake Inhibitors (SSRI’s). These drugs act by blocking the reuptake of serotonin thus
causing more serotonin to be in the body. As we discussed before most of the serotonin receptors are in the
bowel. Depression alone can help cause irregular bowel. So improving depression, can improve bowel
movements. Therefore they have the double effect of relieving depression, and increasing serotonin which both
improve bowel movements. If your doctor suggests antidepressants for your irregular bowel even if you don’t
have depression, do not be insulted.
STAGE IV: Stage IV remedies includes surgery as a last resort.
REMEDY FOR IRREGULAR BOWEL DURING PREGNANCY
One of the most difficult issues in the irregular bowel movements is irregular bowel movements with pregnancy. It is
difficult for two main reasons:
1. Pregnancy itself has a tendency to aggravate bowel problems, particularly bloating, abdominal pain, and discomfort.
There is a 2 to 1 ratio of irregular bowel with women as opposed to men. The reason there seems to be a greater
tendency for women to have irregular bowel over men is believed to be ovarian hormones like estrogen. At first
researchers were confused because estrogen generally promotes bowel movement. However, it was later believed that
the fluctuation, or the up and down changes, in the ovarian hormones like estrogen causes the irregular bowl.
2. There are so few medicines women can take when they are pregnant for fear of adversely affecting the fetus.
However, there are some things that pregnant women can do to get relief from irregular bowel. To start, pregnant
women should confine their remedies to Stage I or Stage II things with a couple of substitutions. Start with Stage I. If
Stage I methods are exhausted without result go to Stage II. Try to avoid bulking agents because they can cause more
bloating with regards to women. For the osmotic agents try pear juice with heavy syrup. The heavy syrup will
osmotically draw in water to the bowel to soften stools and promote bowel movement. Make sure your blood sugar is
under control. The added sugar from the syrup can be a problem if your blood sugar is high. Also drink lots of water as
that will add water to the bowel and soften the stool directly. For a laxative try the herb Senna or products with Senna.
Iron in your multi-vitamin can be a problem too. This may be exchanged with a multivitamin with DHA. Of course
anything you take should be cleared with your doctor. Other Stage II substitutions include: Ginger and B6. You will also
need to see your doctor to discuss Stage III options.
REMEDY FOR IRREGULAR BOWEL IN CHILDREN
Babies with irregular bowel can be difficult too for two main reasons:
The infant’s digestive system is still developing, they can have all kinds of problems related to the maturity of their
digestive system. This means that there will be things that can give them problems just because of normal
development. Transitioning from breast milk or formula to solid pureed foods can cause problems. Even different
brands of formula can cause problems.
2. There are a great many things you can give to an adult for irregular bowel that you can’t use with a baby or child.
Again, you should stick to Stage I and Stage II remedies with a few substitutions. Also, anything you use should be
discussed with your doctor.
With a baby, dietary changes and mood are very important. If a babies irregular bowel progresses to constipation, the
pain they can begin to experience with trying to pass a stool makes them not to want to even try to pass a stool because
of the pain. This leads to anxiety whenever they feel they must go .This in turn, make them try to hold on to stools
longer which makes constipation and irregular bowel even worse. This can happen with older children and adults. To
avoid this have them drink plenty of fluids to get more water in the towel to help soften the stool. If they are old
enough to tolerate pear juice have them drink this to act as an osmotic agent. Also, you can use a glycerol suppository
to lubricate the bowel and make passing the stool less painful. If the constipation is bad and they become impacted
(rectum fills with stool than won’t pass), use your little finger with some glycerol (don’t use mineral oil or peppermint
oil) to physically and gently “dig out” the impacted stool. If they can tolerate solid foods, pureed pears or prunes is
helpful. To calm and relax them to diminish sympathetic nerve response and anxiety – use warm bath while gently
massaging their belly.