Having a bowel movement is a normal physiological process, but the experience can vary between individuals.

When you have difficulty emptying your bowels, it can cause significant distress, which may increase tension and make the process even more challenging.

The following non-straining techniques for bowel emptying may help if you struggle with constipation or find it hard to empty your bowels effectively. You might need to combine some of these techniques, as different approaches work better for different people. If these methods are not effective, inform your nurse or specialist for further support.

It is ideal to try having a bowel movement after breakfast, as this is a common time for the body's natural rhythm to promote bowel activity. A hearty breakfast can stimulate movement in the intestines, helping to fill the rectum and triggering the urge to go.

Aim to sit on the toilet 15 to 20 minutes after breakfast, responding promptly to the urge to have a bowel movement. Ignoring the urge can lead to constipation. Working with your body’s natural rhythm, such as emptying your bowels in the morning, can make the process more manageable.

Bowel emptying position

We are designed to have our bowels open in the squatting position. You may find resting your feet on a footstall or box useful.

Your knees should be higher than your hips. Put your elbows on your knees and lean forward. Bulge out your abdomen and keep your spine straight. Please ensure you feel safe in this position and the box or stool is not a trip hazard.

The brace and lift technique

The brace and lift technique is used to help coordinate defecation. This technique can be used with the toilet position. Your nurse will show you how to do this technique. Over time you may find you have fewer problems in achieving defecation.

Step one: Take a deep breath, if you put your hands on to your waist, you will find it widen. If it does not you need to practice for a while before moving to step two. By this action you will increase the pressure in your abdomen.

Step two: Hold your breath.

Step three: Now you need to relax your bottom muscle. This muscle is the same muscle you would squeeze if you were trying to stop yourself going to the toilet.  Try the following exercises to help find the correct muscle:

• imagine your back passage is a lift which is waiting on the ground floor
• when you squeeze to stop an accident you raise the lift floor
• slowly push the lift down to the ground floor
• take the lift down as far as it will go down
• then relax for a second, do not allow your lift to rise.

Step four: You should now be holding your breath with the bottom muscle relaxed. This should be combined with an urge to open your bowels. Now say the word idge – this should help the pressure in your abdomen (made by holding your breath) go to your back and down into your bottom.

Step five: Relax slightly for one second, very slightly maintain the bottom muscle at basement level and hold a deep breath. Repeat the idge word. Then relax.

It is important – do not strain. If you strain this may damage your pelvic floor muscles. Rocking your body backwards, forwards and sideways can help. Try rubbing the base of your spine.

Abdominal massage

An abdominal massage is a clockwise massage over your abdomen with the palm of your hand in small circles, from left to right for 10 to 15 minutes. Your nurse or nurse specialist will show you how to do this.

• this can reduce the need for long term laxative medication
• it can help to relieve flatulence and / or constipation.

Please note this is not suitable for everybody, so please consult your healthcare professional.

Activity

Movement and exercise can help you empty your bowels. Increasing activity will help you to improve your bowel function. Aim for 30 minutes of activity a day, for example, swimming, walking or gardening. If you are unable to achieve this for health or mobility reasons contact your GP for advice.

Diet

It is important to eat a balanced diet. Aim to eat three meals a day and include foods from different groups.

Fibre is the non–digestible part of plant foods which passes through the stomach and bowel providing bulk. Fibre is essential for maintaining a healthy bowel and can improve faecal consistency.  Don’t forget to include five portions of fruit and vegetables a day.

Ensure you drink plenty of fluids. For more specific advice speak to your nurse.

Medication

Be aware some medications can have an effect on how your bowel works.

Medications such as pain killers, antidepressants and iron tablets can cause constipation.

If unsure, organise a review of your medication with your GP or pharmacist. Discuss your laxative use with your healthcare professional and tell them about medicines you buy from a pharmacy. Taking too many laxatives can cause you to have loose bowels.

Glycerol suppositories

Glycerol suppositories can help to initiate defecation. Moisten a glycerol suppository with water and insert the pointed end first. This should work within 30 minutes.

If you feel your bowels are incompletely empty you can use a glycerol suppository post defecation.

Some people need to use a suppository before and after defecation. Some people find inserting the suppository blunt end works better for them.

Glycerol is a mild irritant which increases the frequency of bowel movement by stimulating the bowel muscle to work. Before using glycerol suppositories read the manufacturer’s printed information leaflet inside the packet. Alternatively, discuss with your healthcare professional.