The Art of Manliness - You’ve Been Pooping Wrong — Here’s How to Do It Better

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Sign up for your $1 per month trial today at shopify.com/manliness. Go to shopify.com/manliness. That's shopify.com/manliness. Brett McKay here, welcome to another edition of the AOM podcast, which since 2008 has featured conversations with the world's best authors, thinkers, and leaders that glean their edifying life improving insights without the fluff and filler. The AOM podcast is just 1 part of the McKay mission to help individuals practice timeless virtues through thought, word, and deed.

Also, sure to explore our articles in artofmanlies.com, read the deeper dives we do in our substack newsletter at dyingbreed.net, and turn our content into real world action by joining the Strenuous Life program at strenuouslife.com. Now on to the show. Pooping. Everybody does it, but a lot of people are embarrassed to talk about it. That's a shame, my guest says, not only because your digestive health is incredibly linked to your overall health, but simply for the fact that there's much happiness to be found in an easy, worry free constitutional.

Harvard gastroenterologist, Doctor. Tricia Pusricha is the author of You've Been Pooping All Wrong: How to Make Your Bowel Movements a Joy. Today on the show, Tricia and I have a fun and frank conversation about the art and science of bowel movements, including the color of healthy stools, how often you should be pooping, if laxatives are safe to use, the food we eat that's even better than prunes for getting things going, why you feel the urge to go poop at Barnes and Noble, the wonders of

the bidet, the danger of

using your smartphone on the toilet, how to get more comfortable pooping in a public restroom, and more.

After the show's over, check out our show notes at aowimp.is/poop.

Alright. Doctor. Tricia Plasricha, welcome to the show.

Thank you so much for having me, Brad. Glad to be here.

So you are a medical professor of gastroenterology. That's a hard word to say. I to look it up how to pronounce it. You specialize in gut health and a big part of your work involves researching and talking a lot about poop.

Oh yeah.

How'd you end up doing what you do?

Well, I kind of am a second generation gastroenterologist. I grew up as the daughter of a gastroenterologist. And when you grow up like that, you think that talking about poop every day is perfectly normal. And you think that that's what everyone else is doing. And it was delightful.

My father was and still is a gastroenterologist but he was also a researcher. And he was just so excited to tell me and my siblings about the cool stuff he was discovering in his lab every day after he came home from work and he was describing how colonoscopies worked. And all of this I know now sounds really bizarre but at the time it was just what we talked about at the dinner table and how cool science was and specifically when it came to our gut. So I loved it, and it was kind of what I grew up thinking was the coolest thing in the world. So I knew I wanted to be a gastroenterologist since I was, like, a little girl.

Like, I had never imagined wanting to be anything else. But then, you know, when I came to medical school and then I started doing my own training, I really started to realize what a weird gap there was between what other people seem to have learned about poop and their bowel movements and how their gut works and what I learned. And people, for the most part, it seems like didn't really talk about their guts and their poop after they turned, like, 3 or 4. And it was, like, something everyone just, like, stopped bringing up at the dinner table. And so I kind of went on this mission and it just started with me talking to my patients about trying to normalize these conversations and having them out loud.

Ultimately that led to writing the book. But I really do think that people need to have conversations more loudly because 40 percent of Americans are suffering from bowel habits that disrupt their daily lives, but you wouldn't know that because we're so quiet about them.

Yeah. I mean, I I I unlike you, we didn't talk about poop at the dinner table. I don't even remember having conversations about my bowel movements with my family. And that carries over, I think, a lot of Americans to how they approach talking about it with their doctor. As you said, a lot of Americans have bowel problems, and it can cause a lot of discomfort, a lot of inconvenience in in their life, and a lot of it is preventable.

Yeah. Well, let's talk about this. I think 1 of the

reasons why people have a hard time talking about it is they don't know how to talk about poop. So when they go to the doctor saying, I got this problem with my bowel movements, I mean, what should they call it? You're always like, Do I call it bowel movement? Do I get scientific and call it stool, feces, human soil? Like what do you call it?

Yeah, liquidating your assets, like whatever you want. I have found that I use the word poop usually, unless somebody leads with another word that they find more comfortable. And the reason I do that is when I was in medical training, the kind of formal word that all doctors use is bowel movement. And so that's what I was trained to start saying. And I certainly started saying that.

And I had 1 professor who was a gastroenterologist and he was my research mentor in medical school. And I shadowed him and he was the first guy I had ever seen, like this doctor, middle aged gentleman. And this young patient came in and he was like, so tell me what your poop looks like. And I like looked at this guy and I was like, this is so weird. You're this doctor in this white coat.

That's the weirdest you know, I've never seen a doctor say that like that in a clinic before. But when he said it, this young patient in his twenties, like suddenly smiled for the very first time. And, like, just the whole atmosphere in the room changed, and this guy just totally shared exactly what was going on with him. And you could just tell it broke the ice. It made it comfortable.

And after that, I never looked back because I know oftentimes when I tell people, oh, tell me about your bowel movements. You know, everyone stiffens up a little bit, and they they and they too try to match my level of medicalization. And if you could just tell me what's bothering you, I wanna use whatever words make you comfortable. So I think someone should lead with the words they want to use that allows you to talk about it most freely. And my hope is that your doctor's gonna meet you right there.

Okay. That's great. It's funny bowel movements. My name's Brett McKay. This is sort of a tangent.

So when you get the initial things, it started when I was in like middle school because I got really self conscious about it. Initial BM.

Oh my gosh.

And I had some kid be like, oh, BM, poop. And so now ever since then I do BHM. That's my middle initial.

Oh my gosh. Now you should embrace it. I've embraced TP as a gastroenterologist. All

right. So if you can do that, I can go back to BM. I'm going to embrace the BM. A 100%. So you described this idea of poophoria in your book.

What is poophoria?

Yeah. Poophoria. It is a state that I want everyone to reach, and that is where having a bowel movement is the absolute least of your daily concerns. It's this easy, effortless thing that happens quickly without straining, and then you go about the rest of your day and live your best life. You're not worried about feeling heavy for the rest of the morning or day because you didn't have that window to go, or you're worried, should I go out to brunch with my friend, or should I even meet people for dinner because I'm so worried about the bathroom situation?

That's not I don't want you to live like that. And and tragically, I think a lot of people are right now. So Puforia is a state of mind, and it's a lifestyle that I think we can all reach, some of us with just a little bit more knowledge about our bowel habits that we just never cut because we the last time we talked about our bowel habits with another soul was usually when we were potty training with our mom and dad. And that was a long time ago. Most of us cannot remember that conversation.

So a healthy bowel movement, you're not even thinking about it because it's just not even on you don't have to worry about it at all.

Yeah. You're you're not obsessed about mean, there there's another end of the spectrum where people I mean, and and this can be quite understandable, but people fixate on their bowel movements all the time. Like, they're worried about, like, did I go yet today? If I don't go, I feel off. And, you know, even if there's someone who you might look from the outside and say, okay.

They're going once a day. They're regular. But if you're thinking about it all the time, you're becoming paranoid if you haven't gone, that's not poop for you either.

Well, let's talk about

what healthy poop looks like, and hopefully we can answer some questions that people have always wondered about it. Let's start with the color of poop. First off, why is poop usually brown?

Yeah. The natural color is actually not brown. The natural color of our poop is like this whitish clay colored, like kind of like a grayish. And what gives it its beautiful brown color is bile. So our body produces this digestive juice.

It has bilirubin in it. And that's just this chemical that gives it that brown color. But if we were to take that away, it would actually look bizarrely whitish. And that is why if you ever see like a pale whitish creamy stool, that's a problem. That's an emergency.

It means that that bile is somehow being blocked somewhere. Maybe it's a gallstone. It could even be a cancer. But if you ever see that, that's a big, big red flag. Go to the emergency room.

But then other than that, the normal color should be some shade of brown. And then, of course, everybody poops the rainbow from time to time. I get these kinds of DMs, like, every week where someone's like, I had a really weird purple poop, or my poop was kinda greenish. Is that normal? And it can be normal.

A lot of times we eat things that we don't put together could impact our poop. Like, for example, a classic 1 is beets. If you've ever eaten beets, you are probably gonna have a maroon poop the next day or maybe the next day or 2. And that's just the beets. That's okay.

But if you haven't eaten those beets and you see anything that looks like red, that would be really worrisome for bleeding. So, like, bright red, maroon, or even, like, pitch black and shiny, that could all be blood.

Gotcha. So, yeah, black poo, that could be okay. Sometimes it suggests there's some sort of internal bleeding going on up your tract. But sometimes there's like, I think iron supplementation can cause Yeah. Black poo.

Yeah. You can have this real chicken and egg situation because sometimes people are taking iron because they're having some bleeding and they've lost blood. But then you see black poop and you're like, is this because you're taking iron to treat bleeding or is it because you're bleeding?

Yeah. And then I guess Pepto Bismol can also cause black poop.

Yeah. I feel like we always forget to warn people about Pepto Bismol because it can turn your tongue black. It can make your poop black, and then people are really horrified the next day. But that if you've taken Pepto Bismol black poop, you're allowed to have a few black poops.

And another interesting fact about Pepto Bismol that you put in the book is that if you don't want your farts to stink before, you know, like a date or something, take Pepto Bismol before and that will make your farts less stinky. Okay. So poops naturally clay color until it meets with bile. But this is 1 of those things that that can freak me out because, like, I mean, you hear if you have, like, a clay colored stool, you know, that can mean you have pancreatic cancer or bile duct blockage. And I can be looking at a light poop thinking, like, what is is that a is that clay color?

Like, I think there are different colors of clay, I think, well, clay's maybe a light tan, so maybe my poop is looking like clay. But we're talking about like white clay. Like it has to be basically white.

Yeah. I guess you're right.

There's like nice different there's earthy tones of clay. This I'm talking about more like a whitish creamy color or kind of gray. And I would say, you know, when in doubt, I mean, everyone's poop is gonna look a little different. If you have any doubts, I always tell my patients, pics or it didn't happen. Take a picture of it and then send it through your like electronic medical record and show your doctor and just like have them lay eyes on it.

A doctor will be able to tell you really quickly, am I worried or excited about this or not?

Gotcha. And then red, if it's you haven't eaten beets, if you see red, that's another thing you might you wanna go see your doctor about because it it could be colon cancer, but it could be something as benign as a hemorrhoid or an anal fissure or something like that.

Totally. Yeah. And most of the time, you know, it is going to be something not worrisome. It's going to be a hemorrhoid, but what I never want someone to do, especially in this stage in 2026, where we are seeing this really disturbing rise in early onset colorectal cancer is for someone to see bleeding and brush it aside. I mean, this is the trend we're seeing in studies and with this this rising cases that young people, when they see blood, they're like, this is just my hemorrhoid, or I'm I'm pretty sure this is no big deal.

It's always better to just quickly let your doctor know and let your doctor reassure you and be like, oh, yeah. We'll just do a quick exam. We'll make sure it's your hemorrhoid. No problem. But make sure that someone's taking a look and and giving you that reassurance rather than just brush it off yourself.

What's talking about the shape and consistency. What does a healthy poop consistency and shape look like?

Yeah, I think most people think that a perfect shape would be like this nice, like smooth sausage shaped and then you go and like people really aim to get this like wipeless wonder. And that is wonderful. That is like a nice consistency that a lot of people have, but there's really such a range of what could be normal. And I would tell people that for the most part, if you start eating a lot more fiber, which a lot of us are not doing, like 95 percent of Americans are not meeting our fiber goals, if you start to do that, it actually becomes less and less likely that you're gonna have that smooth little sausage that everyone wants. You're gonna start to have fluffier and fluffier stool.

You might even start to go more often. That's perfectly normal. It can be totally normal. And people sometimes when they do that, they're like, I have diarrhea because I'm going 3 times a day and it's so soft. That's fine.

As long as it's not, like, interfering with your social life, you know, there's a range of normal. And in fact, you should embrace that new you because it means you're doing something healthy for yourself. And then, you know, on the flip side, sometimes when people are having these, like, really, really tiny rabbit pellets, usually I say that that indicates that there's an issue with constipation. But sometimes the fix can also be quite simple. It can be you need to hydrate more or you need to not hold it in.

We do that as adults. We have this urge to go. Sometimes it's like when we're at work or we're on a date at a restaurant and we say, no. No. No.

I'm not gonna go right now. I feel the urge. I'm not gonna go. And when you do that, you're setting yourself up for failure because that stool is just gonna dry up and become more hard so that when you decide you wanna go later, it's not the same 1 that you started with 12 hours ago. It's a totally different 1.

It's gonna be more pebbly. So it's better to try to go when your body tells you to, and you're gonna get a little bit closer to that median.

Gotcha. So what what happens to our stool whenever we get diarrheas? Why does the body decide this stuff needs to be liquid and get out fast? Like, what's happening there?

Yeah. There's lots of different causes. But in terms of your anatomy, your small bowel, which is that first part of the tube after your stomach, the main point of your small bowel is to absorb all the nutrients. And it's sucking out everything that it wants and breaking it down. And then the stuff that it can't break down, which is usually like the fiber, which we actually don't possess the enzymes to break down.

It makes its way to our microbiome in our colon. Well, the colon has several jobs. 1 of them is to suck water out of the stool as it passes through. And stool passes a little bit more slowly through the colon, so your colon has a lot of time to get that water up. But if something happens that triggers that poop to move forward, and sometimes it's stress, stress can cause our colon to suddenly start to contract.

That means we haven't had time to remove and absorb all the water out of it yet, so it's gonna gush out like diarrhea when we're stressed. Spicy food does that. Spicy food sends this signal down to say, okay. Evacuate everything we have. That too will make whatever comes out to be a little bit fiery, a little uncomfortable, and it'll also be pretty liquidy.

And then there's other things like infections or just depending on how things are going with with other aspects of your life, travel and exercise, those things can also help speed things up. But before, you've really had a chance to absorb all the water.

Gotcha. And constipation is just the reverse. It's been in the colon too long, so all that water's been sucked out.

Yeah. Exactly. And there's a ton of different reasons why we things slow down and why we can get constipated. And and and you're right. The longer we sit there, the longer that stool is just your colon is gonna keep doing its job, and it's gonna keep making it harder and harder, which is why I sometimes think the most important thing people can do who are constipated is just as soon as they hear that call, feel that urge, respond because it's not gonna be the same poop later on.

What causes constipation? You said there's lots of potential sources.

Yeah. Well, when someone comes into my clinic and they have constipation, I I try to explain the way the colon works in terms of trying to get toothpaste out of a toothpaste tube. So sometimes the issue is that we're not squeezing that toothpaste tube. And that means that maybe there's something that's stopping the colon from contracting so much. We need to do that.

We need to generate pressure in order to push the stool outwards. And maybe the problem is actually not that we're not squeezing the tube, but that the toothpaste itself is rock solid. And sometimes that happens because maybe we're not getting enough fiber. Maybe we're not drinking enough. Maybe there's something else that's making that stool really, really hard.

But then the third and I think most underappreciated part of the problem is that, yeah, we're squeezing hard enough. The toothpaste is super soft, but we forget to take the cap off the toothpaste tube. And then we're just pressing up against this pelvic floor that is not cooperating. And that is very common. That happens to about 1 in 3 people who have constipation and who have tried different laxatives and different things and they failed.

And basically what that means is that our pelvic floor, which is this set of more than a dozen muscles sitting there at the bottom of our rectums, and they need to coordinate in this really highly orchestrated dance. Some need to contract at the right time, some need to relax. And for a lot of people, the sphincters that are supposed to be relaxing actually contract when we bear down. If you think about it, we're like generating all this pressure to try to push our poop out, and people's sphincters contract. And and that's very paradoxical.

It's not supposed to do that. So sometimes when you've tried everything, the most obvious answer is actually something that doesn't involve anything related to your colon, but actually it's all the muscles in your pelvis that's the problem.

Yeah. You just went through what you call the 3 p's of a of a good poop. So propulsion, that's that, you know, that bearing down, that Valsalva maneuver. We kind of and, you know Yeah. Get that thing going.

Then the, this consistency, it's the pliability, the softness. If it's hard, it's not gonna come out. And that pelvic floor aspect, sort of the cap on the toothpaste.

Yeah. And I think for someone to reach poophoria and to have healthy, effortless bowel movements every day, you have to think about how you're optimizing all 3 of those things. All 3 of those things need to be working at their best in order to have a bowel movement. Because if even just 1 of them is off, it's going to be hard to overcome it with just the other 2.

With the pelvic floor piece, I think we think about that with just women because pelvic floor problems can result after childbirth. But men can have pelvic floor problems too. And you recommend that if you have a pelvic floor issue to go to a physical therapist who specializes in that. We'll talk about something else you can do to help your pelvic floor when you're pooping later on our conversation. Going to the pliability part of the 3 P's of a good poop, the consistency of the poop, Why does poop float sometimes?

Yeah. A couple of different reasons. Sometimes if it's just soft enough because it has enough soluble material, like enough fibroid, it'll float. Sometimes fat, like fat floats in poop. So it depends on kind of what you've eaten and how well you've absorbed it.

There are certain conditions where people do not absorb nutrients and the food that they eat as well as we'd like them to. And and, traditionally, we think about those as resulting in, like, really serious floaters. If you're so there's, like, a range that could be normal. But if this is your consistent pattern and you have any other symptoms, like you get pain, bloating when you eat, if you have a lot of floaters in your stool, you should actually just run that by somebody and make sure that you don't have an issue with absorption.

Gotcha. I mean, so this is always a concern for me because I read these articles like, oh, pancreatic cancer, colon cancer. It's like, floating poop. And I'm like, my okay. I'm I'm I'm I'm gonna be t TMI here, but, like, mine are regular regular floaters.

They look normal. They feel normal. I think it's because I just eat a lot of fiber. I eat, like, 60 grams of fiber

Good for you. Day.

So I think that's what it is. Am I right?

Yeah. Or should I

go see my doctor?

Well, you can always you should always run anything by your doctor you're concerned about, but but what you've described sounds very, very typical for somebody who's just eating a lot of fiber. Once we start eating a lot of fiber, and 60 grams is a is like an a plus amount of fiber, then, you know, people's poop does change and people are really caught off guard by it. The reason people say that that floating poop is a sign of pancreatic cancer is because the pancreas helps break down and helps you absorb that food. And when suddenly that stops working so well, then you might see new floating poop for the first time. But that's not the only sign often.

Like sometimes people, you know, their skin turns a little yellow. They have pain in their stomach. So if you're otherwise living your best life, you know, run it by your doctor, but, you know, it's most likely just because you're eating a ton of fiber, which is a great thing.

Yeah. I'm I'm a big I'm I'm I'm a fiber maxer as the kids are saying these days. Yeah. Yeah. Me too.

Let's talk about the schedule. What does a healthy bowel movement schedule look like? Because I think there's this idea that you have to have a daily constitutional to be healthy. Yeah. Is there anything to that idea?

There definitely is something to that idea. And I think that this is because our bodies are naturally primed to have a bowel movement first thing in the morning. And the reason for that is 1 of the things that makes the colon a little bit different and special compared to other organs in our bodies is it really operates on a circadian rhythm and it's a creature of habit. So when we go to sleep, the colon goes into this really quiet state. It doesn't move around too much.

That's why for the most part, you know, people sometimes talk about waking up in the middle of the night to go pee. It's pretty rare for people to wake up in the middle of the night to have to poop. And that's because your colon's not really moving. But when it wakes up, when you wake up and it operates on the same circadian clock as you, then that first 1 to 2 hours upon waking is when you see some of the strongest contractions naturally occurring in your colon that you're ever gonna get the rest of the day. For that 24 hour period, it's during those first 1 to 2 hours that your colon is doing the work for you.

And if you have a bowel movement when your colon is already contracting, it means you have to do way less work. You have to bear down less. You don't have to strain as much. So it's a nice window. And then people often in the morning start to stack on other habits that help the colon contract too.

Like, for example, a third of people who drink coffee, their colon is gonna start to contract pretty quickly. People who go for walks in the morning, just a little exercise can help stimulate those contractions. And we do a lot of those things early in the morning. So it's a great time to have a bowel movement. All of that said, there's just like a large portion of people whose mornings are totally hectic, totally crazy.

They don't have time for any of this and they don't go. That doesn't mean that you have a problem or that you're weird. It just means that you need to find a time to respond when your colon's ready. And some other times during the day, the colon will start contracting if you eat a meal. So oftentimes there's another wave of people who poop after dinner or poop after lunch.

That's totally normal. A lot of times people come to my clinic and they're like, it's so weird that I have to poop every time I eat. And I say, no. No. That's a completely normal reflex.

In fact, you know, it's like a reflex that we're born with. Kids are pooping multiple times a day in response to eating. And then later on as adults, we try to suppress that and try not to respond to that reflex for no reason whatsoever. We should just respond. But it's actually a perfectly normal part of our human physiology.

So there's a range of what I'd consider normal. And what I usually tell people is, no. It's not once a day. If you go once a day, wonderful. But you don't have to do that in order to be closer to God.

What I do want you to do is have an effortless bowel movement whenever you go. It should be easy. If you go once a day, but you're straining your eyeballs out for 20 minutes, I wouldn't consider that normal. So they've done a study in The US where they found that people who consider themselves to have normal bowel movements go anywhere from once every 3 days to up to 3 times a day. And anywhere in that big range could be considered normal as long as, you know, it's effortless and you're comfortable and happy with that pattern.

And I imagine if you see a change in your schedule that lasts a long time, you're like, well, maybe I should look at this. So if I usually do once a day and then I'm going 3 times a day, well, that's interesting. I should probably check that out.

Yes. I tell people to get to know your own path. And everyone's gonna be different and have some variation in their own life. Like you might be somebody who goes like clockwork every day and that's perfectly wonderful and healthy, but you may also see that you have some variations depending on whatever else you have during your week and how you travel and how you exercise. These things will change, but get to know what kinds of patterns are normal for you.

And then most importantly, you should start looking every day. Like, before you flush, have a peek. The the number of times I ask people, what did it look like? What color is your poop normally? And people just get all embarrassed and say, oh, I don't know.

I don't really look. Well, I mean, first of all, like, how can you not look? I don't know how you resist that temptation, but but you should look so that you then you know when something is different.

Yeah. Speaking of looking, have you kept up with these new AI devices you can attach to your toilet that takes a picture of your poop and give you

I've seen some of that chatter. I'm excited about I mean, 1, am well, I I think we're all like, oh my gosh, a little horrified about the idea of a camera down there, but I'm sure they've sorted out the privacy issues. But I think, well, yeah, I I mean, I'm excited about what those those could show us 1 day.

Yeah. I think looking at your poop tells you a lot about your overall health. We're going take a quick break for you Wordsmar sponsors. So when I was a young man starting out, I made a lot of boneheaded money mistakes. I'd be down my last few bucks in my checking account, but I'd still grab a burger I probably couldn't afford and then get hit with an overdraft fee.

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And now back to the show. Speaking of schedules, and let's say someone they're like, I don't poop as often as I want. It makes me uncomfortable. I need to take a laxative. But they're like, well, I don't wanna take a laxative because I don't wanna become dependent on it or something.

Is there a problem with taking laxatives to have a bowel movement?

Yeah, no. So I have a few thoughts about this. 1 is that just to take a big step back, I don't think there's any problem with someone taking a laxative, especially because I know that for some people, we can help and improve constipation with a lot of these different tweaks and lifestyle changes and a lot of the sort of things I lay out in my book. But there's also a group of people who have conditions and diseases and changes in the neurons, the nerve cells of their colon, that some of these lifestyle changes are just not gonna fix. Constipation can be a disease like any other disease, like high blood pressure, like diabetes, and there's no shame in taking a medicine to treat that.

And so I do feel that there's often a lot of shame and a sense of like self failure for when you take a laxative. If that's what you need to be well, I don't think that that's the case. Now that said, there are a lot of ways to treat it that don't require laxatives, but know that laxatives are safe. You should use them as directed by your doctor. And a lot of the earlier studies that kind of got people worried that you could become dependent on laxatives, you were somehow damaging your colon, Ultimately, that data was not very consistent or proved to be robustly true.

So I worry a little bit less about that. But I will say there are a lot of ways that you can improve your bowel habits, become less constipated just by changing things about what you're eating and what you're doing, and even the position of how you're sitting on the toilet. I mean, it's very common that people don't wanna take medicines, but you can take things as natural as, like, kiwis. Right? Like in our grandparents' times, people were taking prunes, and prunes are incredibly effective.

But I have never successfully convinced a college student to take prunes. It's like 1 of those things that people just don't reach for anymore these days. But kiwis have been shown in multiple randomized controlled trials, 2 kiwis a day, that they are as effective as prunes, but they also don't cause bloating. Like a lot of these, like, fiber supplements and prunes can cause, kiwis don't seem to do that. So it's a pretty simple fix that's relatively effective, all things considered.

And and it's not really a laxative. It's actually just something that's high fiber, got a lot of nutrients, and is good for you in other ways.

I like prunes. I'm a prune booster.

You're pro prune.

I'm pro prune. I mean, it's it's a dried plum. What's not to like?

I think they're fantastic. And and I'm sure you've noticed they're, like, in they're very good at their job.

Oh, yeah. For sure. Yeah. Oh, you mentioned something that I thought was interesting. I wanna talk about.

Say if you're having problems getting your poop out, you're constipated, or it's a struggle, The position. So I think people might have seen these things on Instagram, the squatty potty.

Oh, yeah.

Is there anything to that? Does that actually help?

Yeah. So this is an interesting thing that we've done to ourselves, as a mankind. You know, we thousand and thousand years ago, they I mean, they have found, like, these upright chair like potties, like, back in the Roman empire. But, like, well before that, we were just squatting. All of us squat in our most comfortable natural way to poop, and we've trained ourselves out of that.

But I have a 2 year old and a 4 year old. And if you ever go to a daycare and you see a bunch of kids in diapers, like, waddling around, they all pop the deepest squat when they are pooping. You know, they don't like go sit in a chair and poop in their diaper. They squat. And that's because that's the easiest, most natural way to have a bowel movement.

And here's why. You know, we talked about the pelvic floor and there's so many muscles that make up the pelvic floor. 1 of the muscles there is called the puborectalis muscle. If you think about your colon like a long tube, this puborectalis muscle is like this sling that goes across the tube and chokes it closed. It's almost like your body stepping on its own hose.

And it's like that when we're just sitting around in our chairs at, like, at a desk at work, for example. And that's kind of a good thing. Like, it's nice to have, like, that little, like, extra closure of that door so that there's nothing leaking out. There's no pressure. But you don't want that door to be closed.

You don't want there to be a kink in that hose when you're trying to poop. And that's how we poop though when we sit at this 90 degree angle. Well, it turns out that if we try to recreate a little bit more of those dynamics of squatting, and we don't have to actually squat because I recognize, obviously, nobody wants to nobody wants to do that. But if you just raise your knees above the level of your waist, everybody will poop more easily. They've done these studies that show that, yeah, people who identify as having who've been diagnosed with pelvic floor dysfunction, identify as constipation, they poop better when they do that.

But even healthy people who think that they poop just fine, studies have shown that when you raise your knees up, even if you think you're already doing really well, you would be amazed at how much better you do.

That's awesome. So bring your feet up with a stool. I'm a fan of the Squatty Potty. Speaking of the scheduling, there's this famous bit in 30 Rock, the television show, where Liz Lemon talks about every time she walks into a Barnes and Noble, she has to poop. And Yeah.

I'm like, that happens to me. I I don't know how many times I mean, I've pooped in Barnes and Noble several times. As soon as I walked through those doors, I'm like, I got to poop.

Yes.

What's going on there? Why do you have to poop when you go to Barnes and Noble?

Yeah. You are not alone. That is such a thing. And it's funny. It's Barnes and Noble's for some people.

For some people, it's like the Target. I think the Target is like a big 1 for a lot of people. And it's been described like, I think it was back in the 19 eighties. It was described in the Japanese literature. Like, what is it about bookstores that make people poop?

And there are a lot of theories about this, and I'll give you mine. I mentioned earlier that your colon is this creature of habit. And the interesting thing about your colon is that it can be trained to respond and react to external cues, cues in your environment that will start contractions and start things to change. And if you go, like, way back in time to remember Ivan Pavlov, the scientist we all learned about in, like, middle school who used to ring a bell and then the dogs would come and start salivating because when he rang the bell, he brought food in. But eventually, he would start ringing the bell and not bring food in.

There would be no they wouldn't see that there was food, but they'd start salivating anyway. And that idea tells us that just something about our environment that we've associated once with a good poop or a good moment in our digestive history can start to trigger those same cues and those same movements again when we start to build that into a pattern. So I think what happens is, 1, in order to poop, you have to feel relaxed. That is like a fundamental truth about pooping because your sanctors have to relax at that final part. And I think bookstores put people in that relaxed place.

And a lot of people actually find that they have to read in order to have a bowel movement. We can talk a little bit more about that, but like just a quick light read. It's just distracting enough. It gets things moving and helps them feel good about it. And I think for some people I've heard this, like it's the smell of the pages.

Something about it triggers disassociation and you have 1 you go maybe you go poop once in a Barnes and Noble. Now the second time you walk in, now you smell the same pages, you feel relaxed and happy, you know it was a pleasant experience last time, so you go again. And now you've ingrained this pattern and it keeps happening. And now you've got this like whole sensory experience every time you walk into a bookstore that's like a safe space and it's pleasant and you go. And I think that's how we build habits.

And I also think that's what happens in the Target. Like, you go in there, you pick up your coffee, you're by yourself, you're having a nice walk around, and it feels safe and it feels lovely. And then you have a nice bowel movement. That's my theory.

Okay. Yeah. Yeah. I think there might be something to that. And if you're gonna read in Barnes and Noble, leave the books on the shelf.

Yeah. Don't bring the merchandise in.

Yeah. No merchandise. They have a sign that says don't do that.

Listen. They know. They understand.

Right. Well, let's talk about reading on the toilet. A lot of people do this. When I was growing up, you didn't have smartphones. And so I would read like the back of my deodorant.

Yeah. I read, you know, about tampons, like my sister's tampons are there and be like, what's going on? Me because it's it's the only thing there.

You learned so learned

so much while I was on the toilet. But a lot of people these days, they take their smartphones in there and they're on there for a long time. Why is that a problem?

Yeah. Yeah. I was like you. I would learn all 30 weird ingredients on the back of the air freshener. I would read like the far side comics.

Like, people used to have these, like, little discreet bathroom readers that were just like the kind of reading material that could not actually suck you in. You know? Toilet books. Yeah. Toilet books.

Yeah. And it would be like a quick read just to distract your mind for a few minutes. It'd be like last week's sports section of the newspaper. Like, whatever it was, you do it, you'd relax, you get the job, and you'd move on. Today, you never see those little bathroom bookshelves anymore.

Nobody has that because we're all bringing our smartphones in. And the problem is that just like we've learned in other spheres, like when we're trying to go to sleep or when we're trying to have some social connection at the dinner table, the smartphones distract us and really hijack our brains to keep us fully engaged with whatever app we're on. The same thing happens in the bathroom. And so we did this study in my laboratory 2 years ago where we asked people who were coming in for their screening colonoscopy all about their bowel habits and whether they use their smartphone on the toilet. And then we looked to see when we did their colonoscopies, whether they had hemorrhoids or not.

And it turns out that 1, yes, all of us are bringing our smartphones in. Like 2 thirds of the people who we interviewed were bringing their smartphones into the bathroom. But the ones who did, they were 46 percent more likely to have hemorrhoids. So yikes. And then 2, they were 5 times as likely to be spending more than 5 minutes at a time in the bathroom, just bringing your smartphone in.

And that was after controlling and taking into account how constipated they were or how much they strained. Those things were actually there were no differences between the smartphone users and not. So really what we think is the problem is the time. The amount of time you spend there sitting on this open bowl with no pelvic floor support. Hemorrhoids are just these cushions of veins.

And those veins eventually start to passively fill with blood. And when they become engorged, they pop out. That's when we call them hemorrhoids. And that's when we say they're uncomfortable and painful. But if you sit there like that, you it's know, not gonna happen after just doing it for 1 time.

But if that's your pattern, you do that every day for weeks to years, eventually we think that connective tissue around them weakens and you get a problem. So that's why we tell people, 1, bring back the old fashioned bathroom reader. Like, throw in that like weird old comic book that you actually can only read 1 page of before you have to move on or just set like a 2 TikTok limit. But sometimes I go into these public bathrooms like at work and like I'll hear somebody watching an episode of the pit. That happened to me last week.

And I was like, first of all, I know what episode you're on. And like, this is not the place. Like, just pull your pants up and go watch it at your desk. You don't have to do this in the current compromised position that you're in.

Alright. So you limit your time on the toilet unless you want hemorrhoids and hemorrhoids are

fun. Exactly. No. Indeed.

Speaking of going to the bathroom in public, a lot of people have problems with that. And some people, you know, we talked about earlier, you know, they feel relaxed enough to poop at Target, but some people don't feel comfortable pooping in a public bathroom. But as you said earlier, if you feel on that urge, you should probably go if you don't wanna get constipated. So how do you get over that, I don't know, reluctance to go to the bathroom in public?

Yeah. It's a lot of strategizing, but I do feel really strongly about this that you should go when your body tells you it's time to go because you're gonna make it harder on yourself and you're gonna strain harder later if you don't respond. And so 1, I think, and this is something that like medical doctors are just surprisingly very good at. You should identify like well in advance, do a reconnaissance mission. Like what are the safest bathrooms in your building?

What is the safest bathroom if it's not in your building in the cafe next door or at the Barnes and Noble's nearby? If you're out in public, like, find what the safe, quiet bathroom is well in advance, and then don't share that secret with anyone. Keep it to yourself. But if you're in a situation where you are, like, just caught with whatever bathroom is on hand and there's lots of people there, I actually sometimes tell people put some headphones in and just tune out. Like, do a noise canceling thing or play some nice music so that you're not distracted and worried and thinking about what everyone else is doing.

And you're so worried that everyone's thinking about you, and they're listening for any sound you might be making. And once you just tune them out and put the headphones in, it can really help you just focus on the moment at hand because your goal is to just get in and out too. And this actually goes 2 ways. If you're somebody who's sitting in a stall and since somebody else comes in next to you and has to go and you're just sitting there on TikTok, you have to be a good citizen and pull your pants up and get out of there. Like, don't keep scrolling because you have to do unto others as you'd like to be treated yourself.

And I guess the other thing I tell people to do is you can make a little bit of white noise if you need to, if you, like, really feel like you have to. You can shake the toilet paper holder. You can like play some alarm ringtone on your cell phone and something to distract yourself and distract everybody else if you really feel like you want to.

I actually don't mind going to the bathroom in public. And like when I hear when other people are taking care of business, I'm like, oh, okay. You're taking care of business. That's what you're supposed to do here.

Yeah. Good for you.

You're in the right spot.

You know? Besides pooping in public, 1 thing that can throw off your bowel movement schedule is traveling. I've got an issue with this. Whenever I travel, my intestines are just like, we're we've we've closed up shop.

Yes.

What's going on there?

Yeah. This is very, very common. When we travel, a lot of different factors cons fire against our colon at the same time. So first of all, like your colon operates on a circadian rhythm. And like, let's suppose you're going to Europe for spring break.

And suddenly your colon is waking up like at 2AM and it's not actually time to go and it's all thrown off or you start to sleep in late. You don't wake up on time. You sleep in. Maybe you would usually drink coffee in the morning and take the dog for a walk. Now you're not doing that.

Now you're lounging in bed and just transferring your body from bed to beach, and you're not doing all those things that usually prime your body success successfully for bowel movement. And then second, I mean, a lot of us, this is myself included, the best part of travel is the food half the time. Like, we go, we wanna try local cuisine. But, you know, when you go to Europe, and this is what I see with a lot of college students who are my patients, you should go eat the local food for sure, but you can't eat 6 bowls of pasta in a row without any form of impunity. And I really think that people need to aggressively seek out fiber when they're on vacation more so than they would at home.

Like, if you eat a ton of fiber at home and then suddenly you eat half of that or less than half of that, your colon's going to respond and react, and it's not gonna be happy. And then lastly, I think people do get dehydrated on vacation. People are drinking more often, like alcoholic beverages. They're out walking around being tourists. They're just not drinking as much water.

And all of these things together and let's, like, not even forget about the fact that we're stressed because we're traveling with our families half the time, or maybe we have to share a bathroom with our cousins. Like, all of these things come together at once, and it makes it really hard to stay regular.

Okay. So I I think we've covered a lot here about poop. Let's say we've taken care of business. There's the wiping part, but you you make the case for the bidet.

Oh, yeah.

Why do

you think everyone should get a bidet?

I love a bidet. And you'll never meet somebody who has a bidet who feels like just medium about it. It's yeah. Once you try Yeah.

We got

a bidet a couple years ago, and I'm like, everyone should have this. What have we been doing in The United States that we haven't had this?

Exactly. You feel like you're born again. It's like you wanna make sure everybody knows about this. You make people feel bad if they haven't seen the light. Like, that's what bidets do to you.

It's obnoxious. But bidets are so wonderful. And the weird thing is, like, well, you know, and I talk about this all the time, and normally the pushback I get from Americans who haven't tried them before is like, you know, this is 1, this is really weird. Like, why would I want, like, anything touching me back there? And first of all, like, obviously, bidets are for external use only, but it's not any weirder.

If you take a step back, wiping is the weirdest thing we can do. Right? Like, if I so I'll you know, I mentioned I had a 2 year old. If I'm changing his diaper when he was a baby and I got a little poop on my hand, this happens. The last thing I would do is just wipe that poop off my hand with a paper towel and then just go about my day

Yeah.

As normal.

Yeah. The analogy I've heard is like if you've got if you're out in the garden working and you got mud on your arm, like you wouldn't get a paper towel and just rub the mud because like it wouldn't come off. You wouldn't put it

under And that's the the mud. Yeah. Totally. You gotta get some water on that. And yet for some reason, this like absolute most delicate part of our body, I think this part is underappreciated.

That area is that skin is actually quite delicate. I think we think it must be so sturdy because it's standing up against yucky poop, but actually it's really soft and delicate and it can tear quite easily. A bidet is gentle, clean, hygienic. And I found a lot of people who don't even realize they're the kind that would benefit from it. Like, you know, I I tell people who I treat a lot of patients who have Parkinson's disease or trouble moving.

They love bidets because they don't have to worry about balancing and reaching back there. A bidet just takes care of that. But actually, like, everyone would benefit from it. Think about women who are on their periods. A bidet is so delightful because you have a lot going on at once half the time.

When you're postpartum, a bidet is lovely because you wanna be very gentle. People who have hemorrhoids, people who have fissures, people who just have really hairy bums, people feel like just wiping and it doesn't really, like, get everything out when you have a lot of hair back there. A bidet solves all of this for you.

Yeah. No more dingleberries.

Yeah. And then you can get, like, the kind with the, like, heated sink

and stuff. What we have. And then it it's got a fan. So after you're done,

it dries your butt. Full service.

Yeah. And then they're affordable. They're not that expensive, and they're easy to install. Like, you don't have to get, like, a separate bidet that you put next to your toilet. It's just it's an attachment right on your toilet.

Yeah. And let's just, like, emphasize, it's an attachment that runs through your clean water supply. This is a common, like, concern. Like, are you just splashing dirty water back at you? Like, absolutely not.

This is splashing clean water. It goes to your clean water supply. There's no risk of weird backsplash.

And then some people, if they don't go bidet, they'll all just use like the wipes, like adult diaper wipes essentially. Those are nice, but the problem is you're you're not supposed to flush them down the toilet.

Exactly. Even the ones that say flushable, which a lot of them do, you actually can damage your pipes, they're not actually as degradable as we'd like. So if you're starting to throw those in the little can next to your commode, eventually, when those build up, you're like, why didn't I just get a bidet? Like, that's not pleasant either.

It's interesting the cultural differences about wiping. So I lived in Mexico for 2 years when I was in my twenties. And I remember when I first got there and I was living with some Mexicans, a lot of them don't flush the toilet paper. They'd have, like, a wastebasket, and they they just wipe and put it in the trash. I'm like, that's interesting.

So I I had to start doing that. It was kinda weird for 2 years to wipe and

then throw it away. It was weird. I I saw that a lot in Europe too, where there was no bidets and like in Morocco when I was traveling. And I think it's like a plumbing issue. Like the pipes were really old and like you have to be really careful, but like, good God, what if ever there was a sign to get a bidet at that point.

But if you do have to wipe, you suggest not to wipe, but to blot.

Yeah. I'm a blotter or a dabber.

Dabber.

I like a dab. And again, that's because I see people in, you know, like in my line of work, people are often prepping for colonoscopies or they have some condition where they have diarrhea and they're constantly wiping. That area just gets inflamed and red and unhappy very, very quickly if you're doing a lot of wiping. Just dab. Like, you don't need to go, like, overly aggressive.

Just dab because that skin is so, so delicate.

So speaking to this pliability of the 3 p's of pooping, making our poops easy to get out, what can we eat to for optimal poop health?

Well, there's 3 layers of what I tell people to do. So, like, the first 1 is eat more fiber. And actually, like, if I could do nothing else, that's like 1, 2, and 3 because we're all struggling. I'm actually, like, delighted that you hit 60 grams. For men 50, it's like 38 grams.

For women, it's 25. And a lot of us just aren't meeting that. So if you can do that by any means necessary, even if that's a fiber supplement, I I would chalk that as a win. But the second sort of thing that has been shown like, if you're doing that and and you're ready for the 1 0 2 level course, the second thing that's really been shown to help with your gut microbiome, those are the trillions of microbes living in your colon and their genetic material, is to have a diversity of plant based sources in your diet every week, and that contributes to the diversity of those microbes. And you want that.

That's a marker of good health and a of a healthy microbiome is the different different numbers of species in there. And those microbes, you know, just remember, they're not just sitting there. They're not passive actors in your colon. They're taking what you're feeding them and fermenting it and creating these new compounds, which sometimes are called postbiotics, but they're like things like short chain fatty acids that get absorbed into the bloodstream and go to other parts of your body. So it is really important what you feed them and how you think about them.

So eating a diversity of plants is the second thing that I tell people to try to aim to do. So meaning, like, don't eat the same routine thing every single day for lunch, every single day for dinner. Like, start to diversify that. But then 3, and this is, I think, the hardest 1, the 1 0 3 level course, is to start incorporating fermented foods into your diet. This is like the thing that every gastroenterologist, like, loves to preach about, but there have been some really powerful studies showing how even 2 groups of people both eating a high fiber diet, when 1 of them adds fermented foods, their microbes produce even more anti inflammatory compounds, and you can measure those in the blood.

And so fermented foods are, like, kind of hard. Sometimes they're not, like, necessarily the obvious things that we think of in a typical American diet, but you can get them through just like Greek yogurt, which is the most common thing that I usually eat and incorporate into my diet every day because it's very filling. It's like makes a great breakfast. I eat it that way, but it's also stuff like kombucha, sauerkraut, kimchi. They're even present to some extent in, like, sourdough bread or soy sauce.

Like, they're there. So the more you can incorporate and start getting in the habit of throwing in fermented foods into your diet, like, that'll give you even that extra boost.

So, yeah, my morning my diet in the morning is like my colon morning. And so in the morning, I have eggs with these, like, fiber wraps. That's where I get a of the fibers, these fiber wraps. And then Yeah. I have, a mid morning meal where I'll have, you know, oatmeal or it could be like a high fiber cereal, and then I'll put some Greek yogurt in there and then some blueberries.

And then I also eat some either sauerkraut or kimchi with my eggs first thing in the morning.

Oh, wow. I love that. That's like a perfect breakfast. You've got all of the components in there.

Yeah. Well, Tricia, this has been an amazing conversation. I've been doing this for, you know, 17 years. I never thought I'd have a podcast about poop, but I did.

Oh, it's a first.

This is a great 1. Where can people go to learn more about the book and your work?

Well, they can get the book You've Been Pooping All Wrong anywhere that they get books, and they can follow me on Instagram at Tricia Pesricha MD.

Fantastic. Well, Doctor. Tricia Pasricha, thanks for time. It's been a pleasure.

Thanks, Brett. This was so much fun.

My guest today was Doctor. Tricia Pasricha, the author of You've Been Pooping All Wrong. It's available on amazon.com and bookstores everywhere. You can find more information about her work at our website, trishapasricha.com. Also, check out our show notes @aom.isslashpoop, where you can find links to resources where you delve deeper in this topic, including an article on our top 10 toilet books so you can start building your bathroom library.

Well, that wraps up another edition of the AWIM Podcast. If you haven't done so already, I'd appreciate if you take 1 minute to give us a review on the podcast player you use. And if you've done that already, thank you. Please consider sharing the show with a friend or family member who would think with something out of it. As always, thank you for the continued support.

Until next time, it's Brett McKay. MindTown Listening 1 podcast, but put what you've heard into action. Before you hit stop, here's another episode to check out. It's episode number 7 67, where we stripped fat loss down to the essentials. No gimmicks, no extremes, just the basics that actually work and stick.

If you're trying to simplify your approach and see results, this one's worth your time. Go to aom. Is/fatloss. Again, that's aom.is/fatloss. It's episode number 7 67.

Hope you enjoy it.