Rachel Feltman: For Scientific American’s Science Quickly, I’m Rachel Feltman.
Your social media feed is probably full of “maxxing” right now: “looksmaxxing,” “protein maxxing,” “sleep maxxing.” But what about “poop maxxing”? This year’s hottest trend might just be having regular bowel movements.
So what can we all learn from the current discourse on bathroom habits—and what advice should we try to tune out? Here to help us sort through it all is Wendi LeBrett. She’s a board-certified gastroenterologist and the founder of Modern Gut, a gastrointestinal education platform for patients.
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Thanks so much for coming on to talk to us today.
Wendi LeBrett: Yeah, happy to be here.
Feltman: So we’re here to talk about, uh, one of many “maxxing”-related trends on the Internet right now, uh, “poop maxxing.” Do you remember, like, when you started coming across not just the phrase itself but this kind of vibe in talking about bowels on social media?
LeBrett: I definitely have heard of the vibe before hearing about the phrase itself, and maybe that’s, you know, partially my bias as a gastroenterologist who posts about poop on social media.
Feltman: Sure.
LeBrett: But since I’ve been posting on social media, since 2022, people have always been fascinated and interested about poop, and it’s funny, all the things people love to share on the Internet about poop and how to make your poop better. So anytime I share tips on how to poop better, I always get a warm reception.
Feltman: Yeah. Do you feel like people are more open to talking about poop on the Internet than they are in real life?
LeBrett: Absolutely. I think there’s a lot that people share on the Internet about their poop very freely, and I’m always really proud of them because I think it’s really important to talk about poop. Um, when I see patients in the office, you know, they’re seeing me, I’m a gastroenterologist. That’s literally my job to talk about their poop, and people are sometimes still embarrassed or shy, and they say things like, “Oh, like, this is so embarrassing, this is so awkward.” And I think the Internet kind of breaks down all those barriers.
Feltman: Yeah. Well, so let’s talk a little bit about why it is so important that people feel comfortable talking about this?
LeBrett: So I think a couple things. So firstly, your poop is—a lot of gastroenterologists say this—a vital sign. It tells you about what’s going on within your body. We are seeing rising rates of colon cancer in younger adults, so people under the age of 50, and your poop could be the first sign that something is wrong. And if we don’t talk about poop, a lot of people don’t realize what’s normal, what’s not normal, and people suffer in silence. I’ve seen patients who’ve had poop issues all their lives, and they didn’t know it was abnormal because nobody ever talked about it.
Feltman: Absolutely. And speaking of, you know, those indicators of health, one of the things that has, uh, become very popular on social media that apparently other people didn’t used to talk about all the time—it’s definitely been a big part of my conversational toolkit for ages—but the Bristol Stool Chart. Many people are encountering this for the first time. Could you tell us a little bit about what it is, what it’s good for and then maybe what its limitations are in terms of telling us about the health of our bowel movements?
LeBrett: Yeah, absolutely. So it’s a scale from one to seven. It’s really helpful because it has both pictures and descriptors about the different types of poop you could have. So types one and two, those are like those little hard, lumpy stools, that’s considered constipated. Four is what I like to refer to as the gold standard of poop, kind of like a smooth sausage shape. Between three and five is within the range of normal. Six and seven, it’s sort of mushier stool, diarrhea. And so it’s really helpful to have a guide because sometimes patients tell me, “I am constipated.” And it’s not that they’re constipated; it’s that they’re not pooping every day, and somebody told them, “You have to poop every day,” which is not true, and we’ll come back to that. But it gives them a guide to: What should your poop look like? What are we actually talking about when you mean you’re constipated? It’s just a, a reference so we’re all on the same page.
Feltman: Yeah.
LeBrett: So it’s not a perfect measure, and, you know, there are other markers of your stool that are not captured in the Bristol Stool Chart like color, frequency, how much you’re straining. So it’s not a perfect tool, but it’s, it’s a good reference and a good starting point
Feltman: Yeah. So you mentioned the misconception that pooping every day is, uh, a prerequisite to having healthy bowels. Could you tell us more about what we actually know about frequency but also just, you know, other indicators of what healthy bowel movements are that maybe people have misconceptions about?
LeBrett: So I think there’s this belief that, oh, if you poop more times you’re healthier, or it’s better to poop more frequently. But what really is within the range for normal is anywhere from three times a day to three times a week, which translates roughly to every other day. And it really is, like: What is your normal? So if you’re someone who poops every other day, and you feel great, you don’t think about your bowel movements, you have no symptoms, you feel happy, I, like, reassure people, like, “That’s great. That’s your normal. You don’t need to worry about that.”
Some people actually find that when they’re constipated, they poop more frequently ’cause they have these tiny little unsatisfying poops throughout the day ’cause they’re trying to get things out. So it definitely is not “more is better.” So, I think appearance, so using the Bristol Stool Form Scale is an important marker of what is considered healthy, and then just like, how you feel about pooping. Like, do you feel like you had a good, satisfying poop? And I think many people can relate to that, that they feel better after having a good poop. Some people have the feeling that, you know, “I go every day, but I still feel like I didn’t poop adequately,” or there’s still something still left and they feel bloated, they feel gassy, they can’t get to the bathroom in time. So these are all things that are signaling to me, like, maybe your poop needs to be a little bit healthier.
And then the last thing I tell people, poop should come out easily. It should be five minutes, in and out. You shouldn’t be sitting there straining, scrolling.
Feltman: Yeah. Well, that brings me to a quote that one of our producers shared with me, from Dr. Sean O’Mara. Feels like a personal attack against me, honestly. Uh, he says, in describing what a healthy human poop should be like, you know, he says, “Animals in the wild have no residual stool” left behind. He said it should be odorless, wipe free, over in three to seven seconds, and that he could have a bowel movement behind a sheet at a dinner party in the corner of a room and nobody would know. So I guess that—more of a statement than a question—but that brings me to sort of, you know, sort of the flip side of the way people talk about health and wellness on social media. You know, I think some of the “poop maxxing” conversation people can get really fixated on this ideal of what, you know, optimized bowel movements are and the secret hack that you must need to find to get them. What advice would you have for people who are seeing this kind of stuff and being like, “Oh, no, is there something wrong with how I’m going to the bathroom?”
LeBrett: So I think three to seven seconds sounds a little aggressive to me, even as a poop doctor. Um, I think if you’re in and out within five minutes, you’re still within the range of doing okay.
Feltman: Good to know. Yeah.
LeBrett: I think smell, you know, there are lots of things you could eat that are good for your body that might produce a little bit of an odor, and that’s not necessarily a bad thing. So beans, we know, are famous for making things smell not great, but beans are really healthy for you, and sometimes a little bit of gas produced by your gut microbiome is a sign that they’re doing their work. They’re, you know, fermenting all the food that you’re feeding them, that fiber, and they’re producing all those healthy compounds for our gut. So a little bit of smell I, I wouldn’t be worried about as well.
And then things change, you know, there are fluctuations in our poop with sleep, with our hormones, the menstrual cycle, pregnancy, perimenopause. So I think, take a little bit of pressure off. If there are little fluctuations from day to day, you have, you know, one bad poop experience, a couple bad poop experiences, it’s not a sign that something is drastically wrong, especially if you go back to your normal.
Feltman: Yeah. So what red flags should people look out for that are maybe an indication that they should, you know, go see a doctor?
LeBrett: Yeah. So there’s the big belief out there that, oh, like, it’s okay if you see, like, a little bit of blood, or it’s only when you wipe, it’s probably a hemorrhoid. And as somebody who diagnoses colon cancer for a living, I’ve seen a lot of people say, “Oh, it was just blood,” or “I thought it was hemorrhoids.” I was fooled by the story, and I’ve, you know, diagnosed cancer or a large precancerous polyp that’s been bleeding for years. So I think don’t ignore that sign, and don’t diminish it, no matter how little blood that is. That is one of, like, the key signs that there’s something wrong, and you should see a doctor about it.
The second thing I would say is if you’re struggling to have a good movement, if you’re falling outside of that range, of that healthy range of the Bristol Stool Scale consistently, struggling with diarrhea, struggling with constipation, if you are feeling just uncomfortable in general, like if there is pain or discomfort, I think anything that’s impacting your ability to live your life, it’s worthwhile talking to someone about. And if there’s a change, if you were an every day pooper and all of a sudden you’re going to, you know, twice a week, we call that, kind of, a warning sign as well, a change in bowel habits.
Feltman: Yeah.
LeBrett: So those are all the red flags. And it doesn’t hurt; you know, you can go see someone, and they can tell you, “Oh, that’s fine. That’s within the range of normal,” Better to get those answers and, you know, be overreactive than to underreact.
Feltman: Yeah. I tell people all the time, because I know people are so anxious about colonoscopies, I had a better-safe-than-sorry colonoscopy when I was, like, 30. Very, you know, whatever, younger than when you need to be getting them necessarily. And it was fine. It—I have had much worse days. So highly recommend doing it, uh, just to make sure.
LeBrett: I think most people after their colonoscopy tell me, “Oh, like, the colonoscopy is fine. I had a great nap.” And, you know, they enjoy that part. I think the prep, I won’t, you know, diminish that it’s not fun.
Feltman: Right. No, it’s hard.
LeBrett: But it’s, it’s not as bad as, as you can be, especially if you’re prepared for it, and if you know what to expect.
Feltman: Yeah. Do you see at all on social media, uh, people getting too anxious or fixated on their bowel health, on tracking it or trying to optimize it?
LeBrett: Yeah, I think there can definitely scale to that anxiety about poop and, you know, I’ve, I’ve seen people on social media or also in my clinic, and they’ve tracked things down to the day and the time, and I think with any sort of health marker, there can be a little bit of, like, overtracking and, like, causing more anxiety, and we know that, you know, the gut-brain connection is something that’s really real.
So if you’re more anxious about something, there’s sort of, like, that anticipatory, like, nervousness. We know that when people are nervous or anxious about feeling pain or discomfort in their gastrointestinal tract or having GI symptoms, that can actually feed like a positive feedback loop where that intensifies your pain. So sometimes a lot of what I’m doing is reassurance and telling people, “That’s okay. That’s, that’s normal.” And a big part of what I like to do is try to normalize that there are differences between everyone, and, you know, how you and your digestive tract reacts is not the same as your mom, your sister, your boyfriend. There is a lot of variation there, and, and it’s okay if you’re a little bit different from the next person.
Feltman: Yeah. With that in mind, what are some of the most common missteps that you see or hear about people doing—like, things that people might not realize are making it harder for them to have good, healthy bowel movements?
LeBrett: So I think a big thing is fiber. Over 90 percent of Americans don’t get enough fiber in their diet. I think maybe part of that is that we’re victims of, like, the “protein maxxing” trend and, like, shifting gears to protein instead of fiber. And then when people hear, “Oh, I should be eating more fiber,” I think that’s the next mistake, they kind of go from zero to 100. They think, “Oh, I have not been eating enough fiber. I’m gonna get 50 grams of fiber tomorrow.” And then they feel awful, and they tell me, “Oh, I, I can’t. My body can’t tolerate fiber.”
And, and I think the main advice I give to folks is that it takes a while for you to get used to getting that much fiber because your bacteria in your gut are not used to all that food. So most people can only tolerate an increase of, like, two to five grams of fiber per every few days before they start to get gas, bloating. Sometimes it can make constipation worse if you’re not hydrating properly. So those are two big ones. And then other mistakes or traps people fall into, I think scrolling on the bathroom is a big one.
It can increase your risk of hemorrhoids. It can also cause, like, over [the] long term, like, pelvic floor dysfunction ’cause you’re sort of in that position. And so I think that’s another one that I try to discourage. I know it’s tempting, ’cause I, I sometimes get the urge to scroll on the bathroom. But I think that is definitely something I try to educate people about as well.
Feltman: Well, thank you so much for, uh, coming on to talk to us today. This has been super informative.
LeBrett: Yeah. I wish you healthy, happy bowel movements.
Feltman: Oh, thank you. [Laughs.]
LeBrett: Okay, take care.
Feltman: That’s all for today’s episode. We’ll be back on Friday with part two of our collaboration with Vox’s podcast Unexplainable.
Science Quickly is produced by me, Rachel Feltman, along with Fonda Mwangi, Allison Rodgers and Jeff DelViscio. This episode was edited by Alex Sugiura. Marielle Issa and Aaron Shattuck fact-check our show. Our theme music was composed by Dominic Smith. Subscribe to Scientific American for more up-to-date and in-depth science news.
For Scientific American, this is Rachel Feltman. See you next time!
