What you need to know about motility and IBS

Bowel transit time is an indicator of the health of the digestive track. It measures the speed food moves through the digestive tract. There’s a lot of confusion about motility and bowel transit among my clients. And you have to understand the problem before you can properly address it.

Many people with IBS have transit time that are too slow (constipation) or too fast (diarrhea), and this blog post clarifies how to measure transit time, and the difference between bowel transit and motility.

There is a lot of confusion between the two and they require different interventions. So it’s important to understand the difference.

Small intestinal motility refers to the small intestinal contractions that move food and debris downward. It also refers to the cleansing waves of the small intestine, when it is empty. Food passing through the stomach and small intestine can take 6 to 8 hours on average (though it can vary between 4 and 11 hours).

Bowel transit time measures the speed that food moves through the whole system. And large bowel transit is the speed that food moves through the large intestine.

When small intestinal motility is sluggish it can lead to small intestinal bacterial overgrowth (SIBO) and when the large intestinal transit time is sluggish it can cause constipation (IBS-C) and inflammation.

So to sum up: Motility refers to the speed of the contractions that move food and bacteria down and out of the small intestine, including the cleansing waves of the migrating motor complex. Bowel transit time refers to food moving through the whole system. Large bowel transit time refers to the speed that food moves through the large intestine.

Bowel transit home test

It’s easy to test your bowel transit time at home. All you need is a tablespoon of sesame seeds or some other hard to digest seed or food (like corn) that shows up undigested in the stool. Beets are also good because they turn your stool red. Notice when the stool starts to change color and how long it stays that color.

Doing the transit test is very easy. Just swallow a tablespoon of sesame seeds (or other food) with a glass of water and note the time and day you took it. Then note how long it takes for it to come out the other end.

An average, healthy transit time is between 30 and 50 hours but it could take as long as 72 hours. It will vary by individual and also change from day to day.

Anything over 72 hours is considered sluggish bowel transit and means things are stagnating in the gut. We want our digestion to be like a rushing river versus a stagnant pond, which allows slimy things to grow on top. Stagnation increases the chances for overgrowth and inflammation in our digestive tract.

We also don’t want things to move too quickly through the system because nutrients won’t be absorbed. This is an indication that the body is trying to detox something it is sensitive to. It could also be caused by anxiety and stress, which speeds up the system.

Here are ways to support healthy motility and bowel transit.

More about motility and transit time

When we support healthy motility in the small intestine and healthy bowel transit in the large intestine we minimize bacterial overgrowth and inflammation.

Large Bowel transit time can have a “chicken and egg” effect. Slow transit can be caused by inflammation and can also cause it. Constipation can result.

When inflammation is the cause of constipation, the standard medical advice of eating fiber and drinking water won’t help. The cause of bowel inflammation (such as infections, overgrowths, food reactivity, inflammatory diet) needs to be addressed first.

If inflammation is not the root cause, a diet rich in plant fiber and water is supportive of overall bowel transit time. Foods high in fat and protein, like meat, slow it down. And remember not to drink water with meals, but rather between meals, as it can lower stomach acid.

Not everyone does well with fiber. Below I discuss supplements that can help support transit and motility in these cases.

The speed of motility in the small intestine depends on the how well the cleansing contractions of the migrating motor complex (MMC) are working. The MMC works best when the small intestine is empty so it is best for motility to not eat or snack too frequently. Leave 3 to 4 hours minimum between meals. If you have blood sugar issues you may have to adjust your eating schedule to keep your blood sugar stable.

SIBO is caused by a slow or malfunctioning MMC, which leaves food to ferment in the small intestine to cause gas, bloating or reflux. When they stagnate in the small intestine, carbs tend to ferment and cause gas, protein putrifies, and fat turns rancid.

There is no home test for small intestinal motility specifically but a SIBO lactulose breath test is the gold standard test that will tell you if you have SIBO. Everyone with SIBO has slow or dysfunctional motility. Even when there is diarrhea.

If you’re taking the SIBO test for the first time, it’s helpful to know your overall bowel transit time because if it’s extremely slow (over 96 hours) that may require a two-day SIBO prep diet instead of a standard one-day prep diet to get accurate results.

You can get more tips like this in the SIBO Rescue Guide.

Supporting motility & transit time

The small intestine requires different support than the large intestine.

For the small intestine, herbal or pharmaceutical prokinetic agents are used. Prokinetics speed the cleansing waves of the MMC. Motil pro is one of my favorite and consists mainly of ginger, 5 HTP and zinc l-carnosine. There’s also Iberogast and Motility activator.

Prescription prokinetics are much stronger but must be prescribed by a doctor. They are low dose Erythromycin or Prucalopride. Low dose naltrexone is also a prescription prokinetic but not as strong as the first two.

And remember to leave 3 to 4 hours between meals and finishing eating up to 4 hours before bed.

It is also very helpful for the MMC to calm the nervous system by promoting feelings of calm or safety. This is often the missing piece (I go over this in detail in my guide). There are many ways to do this but deep breathing or meditation are common solutions. Having fun or enjoying a deep rest are also effective.

For the large intestine, the gentlest ways to support bowel transit is with magnesium. Magnesium citrate is the gentlest version and Magnesium oxide is the strongest.

Another tip to ease constipation is to change the angle of your legs when sitting on the toilet. This lines up the angle of the colon to let gravity assist with transit time.

You can buy a toilet footstool like a squatty potty, or use two yoga blocks to prop up your feet (like I do).

Another cause of slowed transit it holding in a bowel movement when you have the urge to go. This trains your bowels to hold it. Listen to your body and go when you have the urge.

Lastly, movement will speed digestion and thus the movement of food through your system. You don’t need to do anything vigorous (which may cause more inflammation), walking after a meal is one of the best things you can go for transit time.

Finding the cause of poor motility

Stress, infections and inflammation can all slow transit time, but there are other root causes to investigate. Nervous system dysfunction can be a root cause, so using somatic therapy or hypnosis to release stress and trauma can help regulate motility.

A slow thyroid can slow down motility in the small intestine. So can a traumatic fall or surgery, by causing intestinal adhesions which block movement.

When things move too quickly through the system it is best to find the root cause. This is typically a cleansing reaction to something the body is sensitive too. Or a reaction to an overgrowth, infection or inflammation.

The most common causes of diarrhea I see in my health coaching practice are h. pylori (the GI Map is the best test for this as many other tests produce false negatives), a parasite called blastocystis hominis and hydrogen SIBO. The GI Map test for the first two and the SIBO breath test can find hydrogen gas.

Understanding is power

With a better understanding of motility and bowel transit you know how to spot it and support it. And now you understand why increasing fiber and water intake will make no difference. Look at infections, food sensitivities or the nervous system to correct this issue.

Magnesium, prokinetics, trauma therapy/ nervous system regulation, intermittent fasting/ specific eating schedule can help address the symptoms that slow or fast transit time or motility causes.

Keeping everything moving at the right pace will restore gut health faster.