Hygiene of Elimination


(Resolving problems of the lower intestine with natural techniques is an area of key interest for Dr. Chan, and he is happy to provide private consultation in this area. For more information, please see our Treatments and Services page under Other Health Counseling.)


An anal fissure is a tear in the lining of the lower rectum (anus). The condition is quite common and causes pain during bowel movements and, sometimes, bleeding. Most anal fissures heal on their own, though over-the-counter medications such as creams or suppositories can alleviate pain during healing. However, some fissures fail to heal, become chronic, and cause severe discomfort. For these, surgery may provide relief.

Because anal fissures among adults are caused by passing large or hard stools during bowel movements, it makes sense to try to prevent this uncomfortable (and embarrassing) problem with natural methods if possible. This article offers frank discussion of this issue, along with some simple and natural techniques to help:

• encourage regular bowel movements
• soften the stool
• lessen strain on the bowels

Part 1: The Problem with the Western Toilet
Throughout history, people have had to deal with the problem of human waste (the "bathroom" variety) or—more specifically—where to put it and how to dispose of it.

Today, most Americans and Europeans use the conventional "Western" toilet, wherein an individual sits upright on a (somewhat low) chair-like device with a hole cut out of the sitting area, with his or her feet planted on the floor. The problem with the Western toilet is that it does not work with the body's own elimination process, and in fact, puts the user in a posture that hinders this process.

The "Natural" Posture for Eliminating Waste
The ideal posture for human defecation is the squatting position. This is most easily observed in the animal kingdom; most animals (including household pets) squat during elimination. In the squatting position, the gut (a long tube surrounded by muscles) is stimulated; peristalsis (involuntary muscle constriction and relaxation of the intestine) sets in; and this wavelike movement pushes waste forward and through the lower rectum. This lessens the need for straining.

In Japan, China, regions of the Middle East, and some parts of France, people use "squat" toilets, wherein the individual squats over a trench or hole in the floor. This type of toilet (though often daunting for those accustomed to Western toilets) puts the user in a much more natural posture for elimination.

Devising Your Own Squat Toilet
The purpose of this technique is to put your body in a more natural posture for eliminating waste, thereby reducing the chance of anal tears (fissures), hemorrhoids, and other problems:
 

1. Purchase two small footstools, or small buckets that you can place upside down (such as a child's plastic beach bucket). 2. Place the footstools (or upside-down buckets) about an inch from the base of your toilet, at 10 o'clock and 2 o'clock. 3. To use: After you are firmly seated on the toilet, put your left and right foot on each bucket or footstool (you can adjust their positions for comfort). Your thighs should be elevated a bit, with your body's weight on the toilet, not your feet. 4. When defecating, do not strain or tense up; allow your body's natural muscular contractions to do the work for you, pushing waste through the large intestine and out.

Important: Take care when getting up from your new squat toilet. First firmly plant both feet on the floor, then rise to a standing position. (Never put your body weight on the footstools or buckets, which will slide.)

See larger photos and more details on devising a squat toilet here!

Part 2: Relieving Constipation
If you are constipated—unable to have a bowel movement, or having bowel movements infrequently—there are simple, natural steps you can take to encourage the movement of waste through the large intestine.
 

Dietary and Behavioral Changes that Prevent Constipation: Incorporating these changes into your daily routine can prevent constipation before it starts.

Eat a high-fiber diet. Certain foods are high in fiber (which is indigestible polysaccharides, cellulose and/or hemicellulose). Fiber is more likely to be found in whole grains, and fruits and vegetables closest to their natural state (i.e. unprocessed). It should be noted that fiber is not only found in solid foods and isn't necessarily a solid strand. Dairy products and meat do not have fiber. Eating a high-fiber diet provides the following benefits: • Fiber provides bulk, which pushes waste through the intestinal system and creates the feeling of "having to go." • The colon's job is to remove water from the stool, and fiber balances this action by causing the feces to retain some moisture. This means a softer stool; hard stools are a main contributor to constipation and anal fissures. Finding high-fiber foods: When grocery shopping, look for "high fiber" labels on food packaging. Or simply incorporate more whole-grain cereals; legumes, nuts, and seeds; and a variety of fruits and vegetables into your diet. Also remember that fiber is often found in the peel or outer layer of foods, so leaving certain foods (like an apple or potato) unpeeled before eating is a smart move. A side benefit of bringing more whole grains, fruits, and vegetables into your diet is that they offer additional health benefits because of the vitamins and nutrients they contain. And fiber itself may reduce the risk of heart disease and diabetes.* Prunes are commonly known as a high-fiber food, but there are many others. Topping the list are pears, dried figs, and apples with skins; whole-wheat pasta, bran flakes, and oatmeal; lentils and black beans; and peas, artichokes, and Brussels sprouts.* An Internet search will bring up many websites with lists of high-fiber foods. High-fiber tip: Every day, find time to sit on a footstool (or low chair) and eat 2 raw carrots. Your gut will be stimulated by the chewing action and body posture, and carrots are high in fiber so they provide bulk. This vegetable passes through the body virtually unchanged. You may not have to "go" right away, unless there is digested food waiting in your large intestine, but this daily practice should encourage regular bowel movements. Drink lots of water. Dr. Chan has seen a dramatic improvement in patients previously suffering from constipation who simply increase their daily water intake. Some of these patients now have bowel movements daily, instead of every few days or longer! In addition, adequate water intake encourages frequent urination, which is key in the body's process of eliminating toxins. (For more information on the value of hydration, see Dr. Chan's article Health Tip: Hydrate for Better Health.) Exercise. Exercise (in addition to offering other health benefits) jiggles and stimulates the bowels. Also, we have more carbon dioxide in our bloodstream during exercise, and carbon dioxide stimulates our intestinal muscles. Keep clean. Make it a daily habit—while showering or bathing—to clean the anus. Do this by inserting a soapy finger inside the anus and moving the finger around. Such a daily practice can help prevent constipation, hemorrhoids, and other issues of the lower rectum. A common problem in the anal area is itching, which is caused by inflammation. Itching means something is wrong, and may signify the beginning of an anal fissure. Keeping clean will help your body heal. "Clean and drain" is a basic concept behind surgery. We can take care of the cleaning ourselves, and prevent the formation of any abscess that will require draining by surgery. Cleaning is often a key step that allows the body to heal. Just like when we get a cut on our skin—we clean the area, and the body's own healing process takes care of the rest. For one of Dr. Chan's patients who previously suffered from hemorrhoids, instituting a daily practice of cleaning the anus greatly remedied the problem.

Quick Fixes for Constipation: If you are already in a constipated state and seek immediate relief, below are natural techniques that can help.

Don’t "bear down" or strain. Straining during elimination is a key factor in the creation of anal fissures (tears in the rectal wall). Bearing down also contributes to hemorrhoids, which are swollen and inflamed veins in the anus and rectum. By age 50, about half of adults have hemorrhoids and the itching, bleeding, and pain that often accompany this problem.* It is best to prevent such problems before they start. Make a chewing motion with your mouth. This tip might seem unusual, but medical doctors performing rectal exams routinely advise their patients to do just this. Because the gut (intestinal system) is a tube running from the mouth to anus, making a chewing motion suggests to the body an intake of food, which spurs peristalsis (intestinal muscle constriction and relaxation). This relaxes the rectum and anus. In the same way this technique helps a doctor examine the rectum and/or prostate of an otherwise tense patient, it helps remedy constipation by easing the process of defecation. Finger dilation method. Before attempting to defecate (in the morning, etc.), coat your index finger with liquid soap; the soap provides lubrication and will also help kill bacteria. Insert your finger into the anus and circle the finger around. This will stretch out the rectal opening and facilitate defecation. This method prepares the anus, and is an almost sure-fire prevention for anal fissures, which occur when the anus is tight, and feces (generally a hard stool) moving through the opening causes tears. Note: This method is very similar to a technique Dr. Chan once witnessed in a delivery room. Obstetricians trained in the U.S. will often—in fact, sometimes automatically—perform an episiotomy during labor (a procedure in which an incision is made at the vaginal opening and then sutured back together after the baby's birth). But Dr. Chan knows a Chinese doctor who, once an expectant mother's contractions and cervical dilation have begun, inserts his fingers inside the vagina and massages the area, stretching the vaginal opening. The baby passes more easily through the opening, there is no need for an episiotomy, and the vagina's elasticity causes it to easily return to normal size after the birth.

Summary
Because hemorrhoids, anal fissures, and constipation are so prevalent in American society, it makes sense to tackle these problems with natural methods when possible. It makes even more sense to use natural methods to prevent them entirely.

In addition to being uncomfortable and embarrassing, these problems can pose serious health risks. For example, anal fissures often become infected, because feces passing from the body rubs against the anal tear and leaves bacteria behind. A person generally notices the infection during defecation because a fistula will be created by the body to drain the infection. A fistula is a tunnel of sorts, running from the anal gland to the surface of the skin near the buttocks. Along with this drainage, a fever and pain will often result from the infection. Chronic anal fissures (and fistulas) may require surgery.


*This page includes information from www.mayoclinic.com.