The Science of Bowel Urgency

That feeling when you just can’t hold it any longer. The mortification of an almost (or not) accident. The feeling of horror or shame as you contemplate having to explain your situation to another adult.

Everyone goes, but not everyone experiences bowel urgency. In IBD and IBS-D patients, bowel urgency is one of the most frequent symptoms, hijacking daily routine and reducing it to a map of the nearest bathroom stalls and constant checks for your bowel urgency kit. It’s uncomfortable and scary when you don’t understand why or how this could have happened. 

We’re here to help. If you’ve ever felt this way, know that you aren’t alone, and there is a whole world of scientifically-backed strategies and knowledge to shed light on this very murky situation. 

What is Bowel Urgency? 

Bowel urgency is the feeling of needing to empty one’s bowels, and feeling unable to hold the movement. It is a common symptom in IBD and IBS-D patients, and defines a sensation of being unable to refrain from defecation for a short period of time (ranging from 5-15 minutes, depending on who you ask). 

The anal sphincter is a circular muscle that, normally, can be contracted and relaxed manually. However, due to inflammation, straining,  overactivity of the rectum, and bowel movements associated with diarrhea, nerves controlling this voluntary movement become dysregulated, leading to involuntary passing of stool or feces. Likewise, irregular movements of the gastrointestinal tract can stretch internal muscles, putting undue pressure on the rectal walls. This can lead to a signal from nerves in those tissues sending messages to the brain that there is material to pass, leading to stimulation of involuntary muscular tissue (those we don’t control) contributing to a bowel movement. This pushes poop towards the body’s exit, adding to the pressure on these walls and increasing the signal to push it forward. This creates the pressure and sometimes lower belly pain associated with bowel urgency. 

Medical Treatment for Bowel Urgency

Conventional medical treatment usually comprises a physical exam, where a doctor will examine anal and rectal tissue for abnormalities and muscular strength. Following this, they may order a series of tests: 

Physical tests for Bowel Urgency

• Balloon Expulsion: A balloon filled with water is inserted into the rectum. You will then be asked to expel it to test your ability to pass stool. 

Imaging Tests for Bowel Urgency 

• Endoscopy: a medical professional will use a camera-like device to internally examine your rectum and anus for signs of inflammation and tissue irregularities.
• Endoscopic Ultrasound: using both an endoscope and ultrasound device, medical professionals examine the inner colon, rectum and anus for contributing causes of the bowel urgency. 
• MRI: An MRI image can depict issues with the nerves or supporting tissue surrounding the rectum or anus for connectivity issues. 

Medication for Bowel Urgency

Anti-diarrheal medications are common treatments for bowel urgency, which decrease the speed of intestinal movements to prevent diarrhea and bowel urgency. Additionally, if the problem does not subside with this treatment, a doctor may move onto tricyclic antidepressants or even steroid enemas in the case of IBD flare-ups. 

Natural Treatment for Bowel Urgency 

There is an increasing pull from patients for natural solutions to bowel urgency. It’s true that lifestyle changes and supplements, as well as concentrating on diet, can help to reduce bowel urgency. Here are a few suggestions from us for treating bowel urgency naturally: 

Diet for Bowel Urgency 

Nothing is more important for patients with bowel issues (IBS, IBD, diverticulitis) than diet. Food is the material we put into our bodies, and what ultimately becomes the building blocks for healing and repair. Bowel urgency can often come as the result of too many fatty foods in our diet, which are hard to break down, and a lack of fiber, which assists in the digestive process. 

A high-fiber diet is one of the most recommended food plans for people experiencing bowel urgency. Fiber slows down digestion, increases absorptive uptake to make sure your body is getting the most out of every meal, and contributes to bile secretion, which assists in the breakdown of material transferred from the stomach to the small intestine. 

Many people with bowel urgency experience it in response to consuming dairy. Dairy, while a potent source of calcium, protein, sugars, and fats, is difficult for the commensal bacteria in your gut to break down. They produce more methane than usual, filling the GI tract with gas bubbles that press against the walls of the large intestine and rectum, upregulating the dietary tract to produce more movement. This is because the gas bubbles give the false impression that there is more food in the dietary tract than usual, and the distension of the GI tract signals the motor neurons to create quicker, harsher movements. As a result, food and gas move through the GI tract faster than usual, pressing on the inner rectal walls with more force than necessary to instigate the trigger for the feeling of needing to defecate–leading to bowel urgency. Therefore, it is ideal to avoid dairy products if this is an issue for you. 

In a similar vein, inflammation also contributes to the feeling of bowel urgency. In patients with IBD, the inner mucosal lining of the GI tract swells and bloats, creating a more constricted space for food to pass through and hit the walls, upregulating digestive movement. Therefore avoiding potent gut irritants like caffeine and alcohol are essential to reducing bowel urgency. 

Eat Small and Slow for Bowel Urgency 

Eating smaller meals, making sure to thoroughly chew your food, and eating meals properly dispersed throughout the day is another method used to stave off bowel urgency. By decreasing the amount of food that stimulates bowel movements at a time, it can be easier for the body to digest it and send it forward for defecation, while reducing the amount of stimulus the food generates when hitting the intestinal walls (less food, less wall hitting, less urge to go). For people experiencing bowel urgency, three meals a day may not be as helpful as more frequent, smaller meals containing more fibrous foods. 

Exercise for Bowel Urgency 

You’ve heard it here before and you’ll hear it again: exercise is an excellent way to regulate metabolism, increase bloodflow, and modulate digestion.

This is not to say that in the moment, exercise will help you decrease bowel urgency, but strengthening the muscles involved (core, pelvic floor) as well as stretching your limbs can do a world of good in preventing accidents and regulating the hormonal exchange between your brain and your gut that leads to bowel urgency. Yoga is particularly recommended for patients with bowel urgency, since the cardio and low-impact rhythm makes for a gentle improvement to internal balance, without leading to the potential consequences of high impact exercises like long-distance running. 

Decreasing Stress for Bowel Urgency

Ever get so nervous you almost had an accident? Most everyone has, and there’s a reason for that. Stress is stored in the body as a number of hormones called corticosteroids, which bind to receptors throughout the body to alert the system to potential threats, and to react accordingly. Through binding to the gut walls, stress hormones such as cortisol, CRFs, and serotonin increase gut permeability, raise gut motility rates, and upregulate inflammation, all of which lead to bowel urgency and changes in movements. 

Therefore, diminishing the impact of stress on the body is important for defeating bowel urgency. Engaging in breathing exercises throughout the day, writing in a journal, seeing a licensed psychotherapist, or just talking to friends and family has a huge impact on the concentration of these hormones and their effect on the body. 

Evinature’s Tips and Recommendations

Bowel urgency is a real issue that our patients struggle with. On both a physical and emotional level, we know that it is so hard to deal with this particular symptom. Seeking knowledge about how to treat your symptoms, therefore, is the first step, and we applaud you for making it this far!

That said, Evinature has a number of protocols designed for patients with bowel urgency, IBS, IBD, and diverticulitis using natural ingredients to improve internal balance and decrease abnormal urgency to excrete. Our free gut health assessment uses decades of clinical data and trial information to suggest a personalized plan for you and your lifestyle. 

People with bowel urgency may not have a lot of say in when and where the urge strikes them; but you can choose gut health and recovery with our Evinature protocols, built just for you. 

Summer Pitocchelli-Schwartzman

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