Let’s talk number twos – what’s ‘normal’ and when should I worry?

Lyndal Mcnamara - Research Dietitian, 11 April 2017

When it comes to number twos, there is surprisingly large variation in what might be considered ‘normal’. In fact one individual’s ‘normal’ is often very different to another’s, even if they are healthy, live in the same household, eat the same food and are part of the same family.

IBS is a condition where for reasons not fully understood, your toilet habits all of a sudden go haywire, and this is associated with significant abdominal pain. In fact, the ROME IV diagnostic criteria for IBS recognises the significance of altered bowel habits as a primary feature of the condition.(1) It is very important that IBS is NOT self-diagnosed, as many other, more serious conditions can also cause abdominal pain and altered bowel habits. Speak to your local GP if you are concerned about your symptoms.

An IBS diagnosis can be further broken down into sub-types, depending on whether constipation, diarrhoea, neither or both is the main bowel symptom.

- Constipation predominate IBS (IBS-C): when more than 1 in 4 bowel movements is Bristol stool form type 1 or 2 (small, hard and difficult to pass stools) and less than 1 in 4 stools is classified as type 6 or 7 (watery, mushy stools).(1)

- Diarrhoea predominate IBS (IBS-D): when more than 1 in 4 bowel movements is Bristol stool form type 6 or 7 (watery, mushy stools) and less than 1 in 4 stools is classified as type 1 or 2 (small, hard and difficult to pass stools).(1)

- IBS with mixed bowel habits (IBS-M): when more than 1 in 4 bowel movements with Bristol stool form types 1 or 2 (small, hard and difficult to pass stools) and more than 1 in 4 bowel movements with Bristol stool form types 6 or 7 (watery, mushy stools).(1)

- IBS unclassified (IBS-U): when patients meet diagnostic criteria for IBS but their bowel habits do not meet any of the above IBS classifications.(1)

Often after commencing a low FODMAP diet, many IBS sufferers note that their gut symptoms improve and they are more satisfied with their number twos. In saying this, it is important not to get too caught up in examining every bowel movement you have, as your stools may not necessarily return to exactly how they used to be, and this is OK. Worrying about your bowel movements not being ‘normal’, even when your other symptoms have drastically improved, can be an added source of stress and anxiety for those with IBS. So let’s break it down….

It’s OK if –

·You don’t use your bowels every day, but when you do your stools are comfortable and easy to pass

·Your stools look like a type 1 or 2 but they are comfortable and easy to pass

·Your stools feel ‘a little loose’ but are comfortable to pass, you have no other concerning symptoms and you don’t need to hurry to get to the toilet in time!

Speak to your GP, gastroenterologist or dietitian if–

·You stools continue to be hard and difficult to pass, causing pain and discomfort

·Your stools continue to be watery, meaning that you need to hurry to the toilet to make it in time (this may or may not be accompanied by other symptoms like abdominal pain or cramping)

·You notice blood in your stools

·You have any ongoing concerns regarding your bowel movements or other symptoms

Looking for more strategies to assist with ongoing constipation or diarrhoea? Check out our past blogs on these topics:

Constipation: https://www.monashfodmap.com/blog/ibs-constipation/ & https://www.monashfodmap.com/blog/alleviating-symptoms/

Diarrhoea: https://www.monashfodmap.com/blog/alleviating-symptoms-part-2/

References:

1. Lacy BE, Mearin F, Chang L, Chey WD, Lembo AJ, Simren M, et al. Bowel Disorders. Gastroenterology.150(6):1393-407.e5.