Are you pooping all wrong?

Talking about poop can be taboo, and this social norm may be hurting our health. Dr. Trisha Pasricha https://www.trishapasricha.com/#dataItem-irq95dvw says around 40% of people in the U. S. have bathroom issues so bad it affects their daily lives. Pasricha, a gastroenterologist, says her patients' bathroom and bowel education ends during potty training and doesn’t continue into adulthood. This is why she wrote the book You’ve Been Pooping All Wrong https://www.trishapasricha.com/youvebeenpoopingallwrong. In this episode, Pasricha speaks with host Regina G. Barber https://www.npr.org/people/1082526815/regina-g-barberabout the three P’s of pooping: pliability, propulsion and pelvic floor. They address whether to squat and whether certain fiber is the answer to better bathroom breaks. If you liked this episode, check out our episodes on urine myths http://lnk.to/pj4jSn and recurring UTIs http://lnk.to/QnCc1F. Interested in more health science? Email us your question at [email protected] mailto:[email protected]. Listen to every episode of Short Wave sponsor-free and support our work at NPR by signing up for Short Wave+ at plus.npr.org/shortwave http://plus.npr.org/shortwave. See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

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• 0:18Regina Barber?

  You're listening to Short Wave from NPR.

• 0:23Regina Barber?

  Are you regular? That's a question that I remember hearing from older movies or sitcoms when I was a kid, and it took me a while to understand what it meant, that it was a delicate question to ask if your bathroom schedule was regular or disrupting your life.

• 0:38Speaker 02

  Forty percent of Americans report that their bowel habits disrupt their daily lives.

• 0:43Regina Barber?

  Wow.

• 0:44Speaker 02

  Isn't that a huge number? That's like almost half of us.

• 0:47Regina Barber?

  That's gastroenterologist and medical journalist Dr. Trisha Pasricha, who's taken it upon herself to help this 40% of people who need help.

• 0:56Speaker 02

  There's a lot that we just don't talk about, don't know. And if we could just, all of us lean in a little bit more to our physiology and know how our body's supposed to work, then I think we could solve a lot of this problem on our own.

• 1:08Regina Barber?

  Tricia's latest push to solve this problem is a new book called You've Been Pooping All Wrong. And she's never been shy when it comes to talking about, well, poop.

• 1:20Speaker 02

  I grew up in a poop-positive family, and I hope I am currently raising a poop-positive family, but my dad was and is also a neurogastroenterologist, so we talked about poop all the time.

• 1:31Regina Barber?

  I was the same. Growing up in my family, we talked about going number two all the time. But for a lot of people, the education we get when it comes to going to the bathroom, it stops once we're out of our potty training phase, around two and a half or three years old.

• 1:46Speaker 02

  It's a huge issue. I mean, for example, a lot of people can't poop at work. Well, a lot of us who don't have the luxury of working from home, the urge to go is going to strike. And like, if you have decided that you just can't go, you're constipated in yourself almost by choice, and you're creating a big problem for yourself later.

• 2:05Regina Barber?

  Today on the show, for your health and happiness, let's make pooping less taboo. A medical doctor shares what every person should know about going number two. I'm Regina Barber, and you're listening to Short Wave, the science podcast from NPR.

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• 3:41Regina Barber?

  Short waiters, we know your day doesn't stop, and neither do we. Whether you're starting your day or finishing a commute, we're right there with you. The NPR app has global and local news plus hours and hours of this podcast ready and waiting for you. Download the NPR app today. OK, back to the show.

• 4:02Regina Barber?

  OK, so Dr. Tricia, can I call you that?

• 4:06Speaker 02

  Please.

• 4:07Regina Barber?

  Dr. Tricia, you write that the heart of why people are pooping wrong starts with the fact that, as a society, we do not talk about pooping. I mean, other than me, I talk about pooping all the time. We're trying to change that today, starting with, like, how are people pooping wrong?

• 4:23Speaker 02

  Well, I think that people don't have a good framework for how to poop. And so I think about it in terms of three things, and I call these the three Ps. But one, I think that pliability is off. And that is how, basically, how soft or pillowy that poop is.

• 4:41Regina Barber?

  More fiber.

• 4:42Speaker 02

  Often, but not always, but often, the issue is fiber. And truthfully, 95% of Americans, we are not meeting our fiber goal. So like, more often than not, you need more fiber. Propulsion is the other problem. Propulsion refers to how your muscles are generating these contractions in your own gut to push that poop forward. So that's the second P. And then the third mistake that can come into play is in our pelvic floor. And I think this is the most underappreciated part of it. Like, we are often like, oh, yeah, we need more water. We need more fiber. How many of us are asking, what is my pelvic floor doing? And the pelvic floor is this complex set of more than a dozen muscles that kind of hold all of our internal organs together and kind of the floor of this box.

• 5:25Speaker 02

  And very paradoxically, when we bear down to have a bowel movement, we're building up all of this pressure in our chest cavities, but we're asking our sphincters to relax in that critical moment. And it's actually kind of counterintuitive to what the rest of our bodies are doing.

• 5:42Regina Barber?

  And when we're talking about the pelvic floor, it's important to remember that everyone has one, right?

• 5:46Speaker 02

  Yeah, you're exactly right. Sometimes when I suggest to people, you might need pelvic floor PT, a lot of the men are like, wait, what are you talking about? Like, that's, my wife got that when she gave birth. That's a different kind of pelvic floor PT or physical therapy than what I'm talking about for constipation. It affects men and women. And we sometimes just develop these problems where those sphincters clench instead of relaxing at the critical moment. And so it's like trying to squeeze toothpaste out of a toothpaste tube, but you never take the cap off. And sometimes when you can just retrain those muscles, finally, it's like taking the cap off that tube. And suddenly, the toothpaste comes flying out. But the whole issue was never that you needed more water, that you needed to soften the toothpaste. You just needed to open that door.

• 6:27Regina Barber?

  I love it. I love the analogy. So I have the quintessential question that everyone has been asking, the most controversial pooping topic, to squat or not to squat? Like, what's the case for squatting?

• 6:44Speaker 02

  Squatting, you know? If you go to a daycare and you look around at all the kids in their diapers who are potty training and one of them has to poop, what do they do? They drop the deepest squat you've ever seen in your life. And they go. Physiologically, squatting is the correct way to go. And this comes back to our pelvic floor, which we always underappreciate, we don't think about. There is this muscle in our pelvic floor called the puborectalis muscle. And that muscle forms a sling around our colons, almost like our body stepping on its own hose. It like creates this kink that causes this block. And that block is present when we're just sitting down, as you and I are right now.

• 7:27Speaker 02

  But when we squat, that puborectalis muscle relaxes and the tube straightens out again. So we're able to go and push things out effectively. If we're not squatting, we just have to generate a lot more force. Now, I don't think that anybody is gonna go back to squatting. We used to do that thousands of years ago. Nobody wants to do that in the comfort of their own homes.

• 7:49Regina Barber?

  Well, I mean, there's a, there's a lot of places around the world that do still have the squat toilets, right? Where it's like a beautiful porcelain, you know, you put your feet in the porcelain thing.

• 7:57Speaker 02

  Yes, like little hole on the floor.

• 7:59Regina Barber?

  Yeah, yeah.

• 7:59Speaker 02

  Yeah, I've seen those, I've lived those.

• 8:02Regina Barber?

  So some people still love squatting.

• 8:04Speaker 02

  And those people are on to something. And actually, I'm sure they have like better balance than a lot of us have. But if you're not ready for that, or you just like are gonna say like, there's no way I'm gonna swap out my toilet in my house for one of those porcelain holes, then you can do the bare minimum, which is just to raise your knees above your waist. You just need a stool, or you need a stack of books, or something that you can lift your knees up on. And people who don't even identify as having constipation, just like healthy people, once they do this, even they say, oh, my gosh, wait a minute. This is way easier to go than before. And they've, they've studied this, that even healthy people find that lifting their knees up allows them to go more easily. And this is a great example of that.

• 8:48Speaker 02

  You actually could be doing a lot better in so many ways than you think.

• 8:52Regina Barber?

  Yeah, like I, I'm gonna go out and get a stool, like a squatting stool for my toilet, like tomorrow, honestly.

• 8:58Speaker 02

  Yeah, your life will change.

• 9:00Regina Barber?

  It will. And you said in the book that because a lot of us in the in the Western world, you know, have these seat toilets and we've been conditioning our body and our pelvic floor. And it's actually not good for us. Is that right?

• 9:15Speaker 02

  Yeah, modern life has done us this disservice. And there are a lot of people who like need that seat because balance is really, really hard. But for a lot of people, we've made a moment that actually shouldn't be that comfortable. Like, we shouldn't be so relaxed that we should be able to just watch an episode of The Pit on our phones while we're doing this other job. Like, if you had to squat in like this porcelain hole on the ground, how many of us would be pulling out our smartphones and relaxing? None of us. We would all just get in and we would get the heck out of there.

• 9:46Regina Barber?

  But we'd be pooping better.

• 9:48Speaker 02

  We'd have fewer hemorrhoids. We'd probably be happier people. But we've kind of turned it into this little mini spa because that chair can be pretty comfy.

• 9:56Regina Barber?

  Totally. So I think we should circle back to this first P that you mentioned, pliability. And I think you're right that like when people do stop to think about how to poop better, they think of fiber to soften the stool. So how much fiber should I or everybody be getting each day?

• 10:14Speaker 02

  Yeah, for women under 50, it's 25 grams per day. And men under 50, it's 38 grams per day.

• 10:21Regina Barber?

  And what does that translate to for food? Like, what's your favorite fiber-filled food?

• 10:25Speaker 02

  I like to fiber-max my vegetables, meaning like, I mean, we all can only eat so much in one day, right? And so at dinnertime, I try to eat like the highest value vegetable I can. Like, if I'm making fish or pasta or something, I will eat peas. Or I'll eat like Brussels sprouts. Like, I just try to like really eat an adult vegetable when I'm having like vegetables. And so like, I guess like my favorite ones, I do love peas because peas are like, peas are not for the weak, right? Like, they have so much fiber. And they will, yeah, they'll destroy you if you eat too much of them. But it means like you can very quickly meet your fiber goals without like eating a ton of stuff that you weren't going to do anyway.

• 11:09Regina Barber?

  You talk about kiwis in your book. If you have two a day, you're good.

• 11:12Speaker 02

  Yeah, within the last about five years, two excellent randomized controlled trials have shown that kiwis, one, yeah, they have a great amount of fiber, but they specifically help with bloating and constipation. They're actually even better for bloating than prunes.

• 11:28Regina Barber?

  And they taste better.

• 11:29Speaker 02

  Taste better. I actually make my son, he's two years old. He eats kiwis every day. He loves them. We don't have a constipation problem there.

• 11:36Regina Barber?

  I don't eat the skin. I just eat the fruit.

• 11:38Speaker 02

  Oh, okay, okay. That's gonna be your, your challenge then in your homework.

• 11:43Regina Barber?

  Do you have to eat the skin?

• 11:45Speaker 02

  You don't have to. Okay, calm down, everyone. You don't have to. My son does not eat the skin.

• 11:49Regina Barber?

  But it would, it's even better if you eat the skin, is what you're telling me?

• 11:52Speaker 02

  Yeah, I mean, you're only gonna get more fiber, more nutrients.

• 11:54Regina Barber?

  Fair, fair, okay. And it would help counteract my anxiety, which you write can also harm people's ability to go number two, which leads me to this last question.

• 12:04Speaker 02

  Yeah.

• 12:04Regina Barber?

  Can we think away some of our gut problems?

• 12:06Speaker 02

  You can, to some extent, find that your stress, your anxiety and your depression are closely mirrored by what your bowels are doing. But also know that the opposite is also true, that your bowels, what you eat and how you treat them will also influence your anxiety and your depression. And you're stressed in a lot of ways. Like these, it's funny that like, when it comes to the gut and the brain, so many of the same things that are good for the brain and your head are the same things that are good for your gut. And that's because the physiology, in a way, is very similar, right? Like, eating high fiber diet is excellent for your gut.

• 12:50Speaker 02

  It's excellent for your brain and mood, partially because of the microbiome that then produces these new compounds based on that fiber that can get absorbed in your bloodstream and make their way up to the brain. Exercise is wonderful for your gut. It's wonderful for your brain and for your mood. And so, um, these two things can be really closely linked. If you're in a moment of high stress, if you activate your vagus nerve, that is gonna calm you down, it's gonna lower your heart rate. So, um, there's a A couple of different ways you could activate the vagus nerve. Um, one of them is box breathing. Box breathing is where you can imagine you're going to draw a box with your hand and you might inhale, one, two, three, four, up the side of a box. And then as you draw the next side, you're going to hold it.

• 13:35Speaker 02

  One, two, three, four. Now you go down the other side. One, two, three, four. As you exhale, then you hold it. One, two, three, four. And you close the box.

• 13:42Regina Barber?

  Oh, beautiful.

• 13:43Speaker 02

  And if you do that two or three times, that activates the vagus nerve and your heart rate comes down, those cramps disappear, and all of it kind of gets better.

• 13:53Regina Barber?

  Oh, what a calming way to end this show, Tricia. Um, I didn't expect that. Thank you so much for coming on our show and talking to us about fiber and the merits of squatting and hopefully helping all of our listeners figure out how to poop even better.

• 14:10Speaker 02

  Thank you.

• 14:11Regina Barber?

  If you liked this episode, do us a favor and share it with the first friend you thought of when you heard you were pooping all wrong. It really helps our show and hopefully it'll help them, too. This episode was produced by Burleigh McCoy and edited by our showrunner, Rebecca Ramirez. It was fact-checked by Tyler Jones. The audio engineer was Jimmy Healy. I'm Regina Barber. Thank you for listening to Short Wave from NPR. Do you want to hear a diarrhea joke?

• 14:37Speaker 02

  Of course I want to hear a diarrhea joke.

• 14:39Regina Barber?

  Did you know that diarrhea is hereditary?

• 14:42Speaker 02

  No.

• 14:42Regina Barber?

  It runs in your genes.

• 14:44Speaker 02

  Oh, my God. I was going to say it runs in the family. But runs in the genes is like two times better.

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