These 3 Nutritionists All Gave the Same Advice for Gut Health

Keeping a healthy gut is a vital part of maintaining bowel wellness.

If you’re at all checked in to the world of wellness, you know that gut health is a very buzzy topic right now. Keeping up with your microbiome is all the rage, so I decided to check in with a few nutritionists for their must-have tips for a healthier gut.

I was expecting a variety of advice, including prioritizing sleep, exercising more, going vegan or keto.

Instead, all three nutritionists I talked to had the exact same tip: Eat more probiotic foods.

Clinical nutritionist Sharon Brown explained, “Many people with digestive issues want to run to supplements and powders, but the first and most powerful step you can take toward healing and supporting your gut is to start with a diet that is based on eating foods that support gut health.” What kinds of probiotic foods? Brown told us some of her favorites are fermented foods like sauerkraut, kimchi, yogurt and bone broth – they contain nutrients like collagen and glutamine, which support the integrity of the gut lining.

Nicolette Pace, a registered dietitian, chef and nutritionist, added that since the specific health benefits of different probiotic strains are still being researched, it’s important to eat a wide variety of probiotic foods to cover all your bases. “Not any one single food contains all strains of probiotic bacteria for a healthy gut microbiome,” she told us. Still, it’s OK to play favorites when it comes to probiotic-packed snacks.

For Hillary Cecere, a registered dietitian and the nutritionist for the meal delivery service Eat Clean Bro, that means eating lots of kefir, a fermented milk drink that’s kind of like a thin yogurt.

And it’s not just probiotic foods that could help promote a healthy gut. Prebiotics, types of dietary fiber that feed the friendly bacteria in your gut, are also crucial. A 2018 study conducted by researchers at King’s College London found that prebiotic fibers in certain foods might be more beneficial for the gut than others. Among those foods is garlic, which is naturally high in inulin, a type of nondigestible carbohydrate or “functional fiber” that feeds the good bacteria in your digestive system. Per a study in Food Science and Human Wellness, garlic actually promotes the growth of friendly bacteria in the gut and prevents disease-promoting bacteria from growing at the same time.

It’s time to stock up on kimchi, friends.

Sharing ‘Poop’ Moments as a Couple

​Listen, I get it. If you’re having a nice and relaxing night out, enjoying some, say, spaghetti bolognese, you might not be itching to hear the ins and outs of my latest BMs. In fact, even if you’re not consuming a meal that closely resembles diarrhea, you may not want to hear it. This preference is totally reasonable; some people are simply poop people and others aren’t. And after enough double dates that have left me and my husband feeling like third-graders who got caught giggle-whispering curse words by a friend’s parent (ie. someone who finds the behavior so unfunny but isn’t going to punish you for it), I’m more than aware that there are also poop couples and distinctively non-poop couples.

That said, most poop couples start out as non-poop couples until someone breaks the ice​ ​– ​or, er, cuts the cheese. In my case, the event happened early on and I was the culprit. We were watching a movie one night in his bedroom, and when he got up to adjust something on the TV screen, I thought I’d pull a fast one. It might’ve been zippy, but jeez did that silent sucker linger. Sure, I was embarrassed! Being the first to fart is similar to being the first to say “I love you”; even if you can’t possibly hold it in, it’s scary business. But just like how one “I love you” often leads to a whole avalanche of ’em, one fart is well… let’s just say he quickly became comfortable airing his flatulence in my presence. And becoming a fart couple is the gateway drug to becoming a poop couple.

Thank goodness my relationship took that out-in-the-open turn when it did. Soon after gasgate​ ​– ​while bathroom talk was still novel and silly but indeed made me feel self-conscious when I was the subject of it – I had a flare-up of ulcerative colitis, an inflammatory bowel disease I’ve had since high school. While flare-ups of this condition manifest differently in each person, for me, they tend to come every few years in a fury, effectively chaining me to the nearest bathroom for a few months until I get things under control with the help of medication and diet shifts. This new normal for me gave way to a new normal in my relationship. We started talking very seriously about poop, which New York City – based psychologist and relationship expert Paulette Sherman, PsyD, says isn’t surprising because there’s nothing like a health issue to press a couple to chat about all the dirty details. “The value of health might supersede the usual value of decorum or privacy,” she says.

He even started setting a morning alarm for me to wake up 15 minutes before either of his two roommates so I could get my turn in the bathroom first. If that’s not romance, what is?

During this time, the notion of privacy couldn’t have felt farther from reach. I was often in pain, worried about whether the flare-up would heal itself without more aggressive medical attention, and always anxious about where the nearest bathroom was located. But he stuck by me as we made a game of creating a mental map of all the public restrooms in Lower Manhattan (just knowing every Starbucks location didn’t cut it). He even started setting a morning alarm for me to wake up 15 minutes before either of his two roommates so I could get my turn in the bathroom first and avoid an urgency emergency. We were in on it together, and if that’s not romance, what is?

Still, plenty of duos just aren’t down to barrel past what feels like the final frontier of bodily functions. Some go to pretty imaginative lengths to preserve the mystique, but there’s for sure a spectrum of how poop-positive and poop-tolerant you are as couple.

Least restrictive is not wanting to talk about toilet tribulations while eating because it’s “not appetizing” or whatever. But that kind of goes out the window when, after three visits to a restaurant’s sole single-stall bathroom within 15 minutes, you decide to run to not even your own but your boyfriend’s apartment to let your intestinal tract settle in peace while he enjoys the rest of his pierogi plate, wistfully aware of what you’re up to. (Or, as I fondly refer to it, the Veselka incident of 2013.) But I digress. These people can talk about having a stomach bug, being constipated, and might even warn each other on occasion to avoid the bathroom for 20 minutes because… you know. To them, details aren’t necessary or funny – they’re the Upstanding Citizens of Grown-up Decorum.

Then there are the people who don’t talk about it. Ever. I have married friends who live in a one-bathroom apartment and never address the literal and proverbial smelly turd in the loo. The golden rule in these folks’ home is “whoever denied it supplied it,” and since they do indeed love and respect one another, no one ever brings up unfortunate odor wafts. Dr. Sherman says this “smell, don’t tell” tendency might have to do with how a person grew up. “Someone might come from a family where these types of things were private and were never discussed, so they may feel guilt or shame in doing so.” But despite this choice to vocally disregard the goings-on for whatever reason, both parties know what’s really up​ ​– ​and what’s getting flushed down.

Anyone who understands Santa Claus is just a seasonal employee at the mall should get that women know their way around a toilet.

Finally, what I sincerely hope to be smallest population of the non-poop couples is the sect among hetero duos in which the men say (because surely they can’t actually believe) that women don’t fart or poop. This immature mind-set – likely rooted in the notion that the natural and necessary function of going number two is unsexy and unfeminine – makes about as much sense as believing babies come from belly buttons. Basically, anyone who understands Santa Claus is just a seasonal employee at the mall should get that women know their way around a toilet.

While the (often literal) open-door policy my husband and I have regarding the bathroom isn’t for everyone, I can’t imagine living any other way. To those who say preserving the mystery and leaving certain topics untouched is alluring, I say that completely destigmatizing at least this big one is great for keeping my emotional health in check. After all, there are enough stressors in life without worrying about being “ladylike”​ ​during the 3 to 21 times a week I let my body do its natural thing.

Is a Poop a Day Necessary for Good Health? Five Experts Have the Same Answer

Some days you might find yourself in and out of the toilet, and some days might go by without a single visit for a Number Two. Should this be a cause for concern?

We asked five experts if we have to poop every day.

Five out of five experts said no.

Here are their detailed responses:

Christopher Hair, Gastroenterologist

The human body is complex, which helps to explain why so many “normal” functions differ between people, including sleep, urination, and defecation. What is perceived as normal for many, is out of normal for others. Pooping is one such example of this range. What is normal is well defined yet broad. In many studies into normal ‘healthy’ defecation, normal pooping ranges from three times per day to three times per week. Less than 40% of healthy people poop once a day.

Pooping out of the normal for an individual might signify illness such as infection (pooping more) or cancer (pooping blood). Sometimes not pooping at all might indicate illness, such as a metabolic condition.

Damien Belobrajdic, Research Scientist

Opening your bowels every day is not essential for the proper functioning of your digestive system. However, long periods without bowel movements (fewer than three stools per week) can cause a number of complications such as haemorrhoids, anal fissures, or faecal impaction. Constipation can be caused by many factors, including a range of medical conditions, some medications (such as opioids, some antacids), nutritional supplements (such as iron) and of course, a diet low in fiber.

The best way to promote optimal digestive health and regular bowel motions is to drink plenty of water and consume high fiber foods at every meal. This can be achieved through a varied diet including wholegrain breads and cereals, legumes, nuts and seeds, vegetables, and fresh fruits.

Dan Worthley, Gastroenterologist

In a recent large study of 4,775 people reporting “normal” bowel patterns, it was found that about 95% of people move their bowels between three and 21 times weekly. So between three times a day and three times a week is what I like to call the “Goldilocks zone for pooping.”

But just as important as frequency, is form. To describe our stool consistency, we use the Bristol Stool Form Scale which uses a seven-point scale ranging from Type 1 “separate hard lumps, like nuts” to Type 7 “watery no solid pieces.” Type 4 (“Like a sausage or snake, smooth and soft”) is the Nirvana of all bowel actions, but 50% of normal patients report some variation from this.

Jakob Begun, Gastroenterologist

Stool is the end product of our gut metabolizing our food, and it consists of non-absorbed material, microbes and water. Each week the average person produces between 500 and 1,100 grams of stool. The frequency of defecation is governed by many factors including diet, the intrinsic motor activity of the gut, the rectal capacity, behavioral factors, as well as the gut microbiome. Studies have generally confirmed the “three and three” rule—that normal bowel frequency varies between three times a day, and once every three days.

When assessing whether people have constipation there’s an emphasis on symptoms in addition to stool frequency. So a person who moves their bowels less often than once a day, but does not have any discomfort, straining, or other symptoms, is normal.

Vincent Ho, Gastroenterologist

Studies in the UK and Sweden found almost all patients had a frequency of bowel motions between three times per week and three times per day. So this is thought to be the normal range for how often you should go to the toilet. Experiencing temporary changes in bowel frequency or consistency is normal. Many non-disease factors are known to affect the frequency of bowel motions including fluid intake, physical activity, diet, age, and social factors such as embarrassment in going to the toilet at work.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What is Sphincterotomy?

Sphincterotomy is a surgical procedure to cut or stretch sphincter. Sphincter is the circular muscles around the anus that control bowel movement (BM).

Sphincterotomy is a treatment for patients that suffers from anal fissures, piles or sometimes described as passing of glass. The purpose of sphincterotomy is to loosen the sphincter muscles and facilitate healing.

The procedure or operation is not to be confused with fistulotomy. Fistulotomy is a surgical operation on fistula, an abnormal growth in various tracts in the body organ. However, it is common to have both sphincterotomy and fistulotomy performed in the same operation.

There are 2 types of sphincterotomy :

  1. Lateral Internal Sphincterotomy (LIS) – This the only type of sphincterotomy used to treat anal fissure.
  2. Endoscopy Sphincterotomy (EST) – This is a type of surgery using endoscope to remove gallstones from bile (not a treatment for anal fissure)

Sphincterotomy is not the only treatment available for anal fissures. Below are some other common treatments, usually for less serious cases of anal fissure :

  • High fibre diet
  • Stool softneners
  • Botox

Botox (botulinum toxin) treatment is also known as chemical sphincterotomy. It is performed by injecting Botox into the internal sphincter. It involves no surgical procedure.

In many anal fissure cases, sphincterotomy usually is the final solution suggested when all other treatments failed.

Sphincterotomy Medication and Supplements

Many who suffers from anal fissure can agree that medication and supplements have helped them in managing the problem. In fact, medication is one important aspect for pre-sphincterotomy and post-sphincterotomy care.

Below is a list of medication and supplements for sphincterotomy. Some of them are quite common, while others are based on tried-and-tested recommendations by patients.

Note : This is not a prescription. You should consult your doctor for your sphincterotomy medication based on your medical condition and history.

  • Miralax
    A stool softener, available mostly in US. Where to buy?
  • Lactulose
    A stool softener.
  • Movicol
    A stool softener, an equivalent of Miralax in UK.
  • Fybogel
    A laxative.
  • Milk of Magnesia (MoM)
    A laxative. Not really milk, but solution of magnesium hydroxide which gives it a ‘milky’ color and also available in tablet or pill form.
  • Citrucel
    A laxative. Where to buy?
  • Metamucil
    A natural laxative and fiber supplement.
  • Ibuprofen
    A pain-reliever and anti-inflammatory drug.
  • Nitroglycerin Ointment
    An ointment applied to the anus or anal fissure area to reduce pressure and allow healing. Usually dispensed in the form of 0.2% nitroglycerin ointment.
  • Lidocaine
    A local anesthetic drug, usually prescribed in topical form to relieve anal fissure pain or itching. Low concentrations of Lidocaine ointment is also available over-the-counter. Where to buy?

Lateral Internal Sphincterotomy

Lateral internal sphincterotomy (LIS) is the name for the surgical operation to make a cut on the sphincter muscle of the anus. LIS is a treatment for anal fissure. More accurately, the main purpose is to help the fissure to heal by itself, by relaxing the sphincter muscle through sphincterotomy.

“Lateral” is the surgical approach to start the incision entry. For some types of surgery, all lateral, posterior and anterior approaches can be used. For sphincterotomy, however, lateral approach is the only method used.

“Internal” refers to the internal sphincter, where the incision is targeted. The cut is often made to the superficial sphincter as this reduces the chance of side effects later.

Despite its rather complex-sounding name, lateral internal sphincterotomy is really a simple surgery to make one small cut to the anal muscle. It generally takes about 20 to 30 minutes to perform. And patients are admitted and discharged on the same day.

Lateral internal sphincterotomy operation itself does not remove skin tag. Anal skin tag can be removed by either ligation or cauterizing. Nevertheless, it is not uncommon to have both sphincterotomy and skin tag removal performed in the same operation.

Other related operation that might be performed with sphinterotomy (depending on the anal fissure conditions) are :

  • hemorrhoidectomy
  • fissurectomy
  • fistulotomy

Again, these operations can be performed together during lateral internal sphincterotomy. You should check with your surgeon the exact name of the operation to be performed. It is a good idea to confirm this with your nurse too, as they are the ones usually checking you into the operation theatre.

Overall, lateral internal sphincterotomy is not a risky procedure and complication rarely happens. Similarly, probability of side effects appears to be low, although there are no official statistics on patients sampling. With the right post-operation care, most patients can expect a full recovery and a normal life again.

Botox vs Sphincterotomy

Botox is commonly suggested as an early stage treatment for anal fissure. However, based on experiences of patients who went for Botox, their problem and pain usually comes back after a while.

Below is a comparison for Botox vs Sphincterotomy.

Botox Sphincterotomy
Uses Botulinum Toxin A Uses surgical operation and requires local or general anaesthesia
Treatment takes up to 3 months Same day admission and discharge. Operation takes 20 to 30 minutes
Success rate are 50% with 50% requiring treatment again Very effective with 90-95% success rate
Few side-effects Incontinence observed in 5% of the patients
Cost $400

Botox remains a reasonable method to treatment for anal fissure. However, sphincterotomy is considered the best treatment that will cure anal fissure once and for all. Whether you should go for botox or sphincterotomy depends on which treatment your are more comfortable with and of course, advise from your doctor or CRS.

Sphincterotomy Recovery – A Guide

You have done sphincterotomy, now what? Will this be a start of another harrowing experience? The path to sphincterotomy recovery is not a difficult one. With the right care and medication, you will be on your way to a normal and active lifestyle.

Many even reported signs of improvement as early as 2 weeks.

Below is a guide to sphincterotomy recovery, compiled based on real experience of patients and what worked for them.

Week 1

This is the week of patience as you will probably not see any improvement to your condition. In fact, you may still be in pain during this week. Taking care of personal hygiene is important during this time to avoid infection. You should also continue with medication prescribed and visit your doctor regularly.

Week 2

You most probably see some improvement during BM during this week. A key to recovery is to make sure you have enough of liquid and fiber intake to prevent hard stools.

Week 3

This is the week of healing. BM will be smooth and with little pain (or none at all). You could probably start doing some normal activities during this week. However, care should still be taken to continous healing.

Week 4 thereafter

After this week, you should be able to start work and your normal activities again. You should feel glad that you took sphincterotomy. BM is painless and spasms rarely occur. Although full recovery may take up to 2 months, with the right care, many sphincterotomy patients see recovery much earlier.

Do you really need to go for Sphincterotomy?

Chances are, you are here because your doctor suggested sphincterotomy procedure to treat your piles or anal fissures problem. You barely can pronounce the name correctly, let alone hear or know what it is.

Some questions ran quickly through your mind. How is it performed? Is it painful? What are the risks? What are the chances of recovery? What are the side effects?

I know. It is scary. But this article will explain based on real experiences of sphincterotomy treatment and recovery.

By the way, sphincterotomy is pronounced as sfink-ter-ro-te-mi. A surgical incision of a sphincter (muscles that control the anus). See What is Sphincterotomy?

Sphincterotomy is usually suggested to patients with the following conditions:

  • Anal muscle is abnormally tight.
  • Frequent spams during passing motion or BM (What is BM? See Glossary).
  • Scar tissue has formed from previous wounds and it takes long time to heal.

That being said, a sphincterotomy is a viable choice if you have been suffering from piles or anal fissures for a long time. You should also consider this procedure if the wound or tear is becoming bigger and taking longer to heal.

The sphincterotomy procedure is performed by cutting the sphincter to weaken the muscle, thereby reducing pressure and promote healing of the wounded area. It may also involve cleaning of scar tissues to prevent further tearing.

It may sound painful, but sphincterotomy can be performed with only local anesthesia. Many who went through the operation claims that the pain is much less compared to the pain of anal fissures itself.

You may feel continuing pain a few days after sphincterotomy (some reported up to a week). This could be quite depressing for some, especially those who think of sphincterotomy as the last resort.

However, the situation usually improves starting from the second week after the operation. Full recovery may take up to 2 months. See Sphincterotomy Recovery – A Guide. BM is painless and normal for most people after that.

Post-sphincterotomy care is necessary to ensure quick recovery and to help you deal with the temporary side-effects. Side-effects may include mucous around the scar, itching to inability to control BM and gas movement. It varies from person to person, so it is best to consult your doctor or surgeon.

During sphincterotomy recovery, you can take medications and supplements to soften stools (best taken at night for BM the morning after). A diet containing generous fiber and water intake is recommended.

Nowadays, sphincterotomy has almost 100% of success rate!