• Defecation should be unhurried, with enough time to ensure that defecation is complete.
• Attempt defecation first thing in the morning, or about 30 minutes after a meal. This may require some planning and time management.
• Respond immediately to the sensation of needing to defecate.
• Inadequate (auditory or visual) privacy can contribute to constipation.
• When mobility is limited, for example in people who are frail or who have dementia, it is important for carers to see that they not only have sufficient help to get to the toilet at the time they need to go, but also have a regular, unhurried toilet routine, with privacy.
• Supported seating can help if the person is unsteady on the toilet.

These recommendations are largely based on expert opinion [Hsieh, 2005; Wilson, 2005; Emly and Rochester, 2006; Ginsberg et al, 2007].

• Occasional 'mass movements' propel the contents of the bowel through the colon. Propulsion of colonic contents is significantly increased in the mornings and after meals — the gastro-colic reflex. Activity of the colon is at a minimum in the late afternoon and at night. In people who are resting, colonic intraluminal pressure activity rises markedly during and after food, but this increase is rarely associated with the propulsive activity found in physically active people.
• The optimal times to have a bowel movement are typically soon after waking and after meals, when colonic activity is greatest.
• Evidence that bowel movements are more likely after awakening in the morning and after meals, and that bowel movements are less likely at night and while at rest, was found in studies of colon activity in healthy volunteers [Bassotti and Gaburri, 1988] and in people with irritable colon syndrome [Holdstock et al, 1970].