According to the conventional criteria, 3 or more bowel movements per week and bowel movements up to 3 times per day are defined as normal weekly and daily frequencies. However, in my opinion, a bowel movement once in the morning before breakfast is physiologically healthy. In the animal world, bowel movements occur at dawn to evacuate the bowels before feeding starts. In my opinion, it is the same for humans. In my opinion, it is ideal to empty your bowels once in the morning and not to have another bowel movement until the next morning. Some people have bowel movements after each meal; men, in particular, have frequent bowel movements. This is called the gastrocolic reflex. The gastrocolic reflex itself is not indicative of a problem; however, in terms of bowel movement control, the recommended frequency is once a day. Basically, lifestyle guidance and drugs to control stool consistency and bowel peristalsis will be used to alleviate constipation. However, if you can form the habit of a bowel movement once every morning regardless of whether you currently have frequent or infrequent bowel movements, you will be able to pass surprisingly good stools.
There is no problem with 2 to 3 bowel movements a day. It is important for patients to "feel stools pass through the anus" at defecation. For patients who are constipated, it is not recommended to control bowel movements by taking irritant laxatives to induce diarrheal stools. Even if patients think that they have emptied their bowels by passing diarrheal stools induced by such laxatives, residual stools remain in the bowels, causing a sensation of inadequate defecation. It is often said that banana-like stools are good, and it is important to pass solid stools smoothly. Recently, new types of laxatives have been developed, so it is recommended that patients consult their primary care physicians.
It is generally accepted that fluid intake is important. It is sometimes misunderstood that eating less can relieve constipation. This is clearly counterproductive. There is a mechanism for bowel movement in which adequate oral food intake leads to increased fecal volume and feces accumulated in the rectum produce a sensation of increased pressure in the anal canal to evacuate the rectum. Eating less means less fluid, resulting in decreased fecal volume, which is inadequate to produce a sensation of increased anal canal pressure. There is no need to eat more than necessary, but it is recommended to eat three meals a day. Laxatives are effective, but irritant laxatives may impair this bowel movement mechanism and are not recommended. When there is no bowel movement for 3 days, some people may promptly use a laxative, thinking that “they have to move the bowels.” However, it is important to wait for spontaneous bowel movement if there is no abdominal bloating or nausea. Even if there is no bowel movement for 3 days, there is probably no problem if you have a bowel movement on the fourth day. Be patient.
The normal frequencies of bowel movements are within the range of once every 3 days to 3 times a day. Defecation once every 3 days may be considered to be constipation but it is medically acceptable. However, defecation once every 3 days may lead to hard stools. It is also important to shorten the duration of sitting on the toilet. Some people continue to sit on the toilet despite having no bowel movement, which can cause problems. During a bowel movement, the perianal region moves to evacuate stools, and the bowels also move to evacuate stools from the rectum. Immediately after the bowel movement, the bowels are still moving, which produces a sustained sensation of urgency to defecate. This is a "sensation of inadequate defecation." Persons who are concerned about such sensation will not be able to leave the toilet. It is important to leave the toilet. Even if there are bowel sounds, leave the toilet. When a sensation of urgency to defecate increases, sit on the toilet again.
