Combat constipation

Constipation is one of the most common digestive complaints and it can affect people of all ages. It can be very uncomfortable to live with and is thought to affect 1 in 7 of adults, more common in women than men. It is normal to have short bouts of constipation from time to time. However, chronic constipation can be more serious when it lasts for more than 3 months.

There is no formal agreed definition of constipation but among healthcare professionals it is often considered when you pass fewer than three bowel movements per week. Clients often focus on the frequency of their bowel movements with many assuming they are not constipated if they pass a bowel movement daily or are constipated if they do not open their bowels daily. These assumptions are not always true as the stool quality or consistency is equally important. You might pass a bowel movement daily but if the bowel is not emptied sufficiently this can be classed as constipation; conversely someone might open their bowels every second day without any discomfort or straining and this can be classed as a normal stool. Aside from stool consistency and frequency; on an individual level people describe the following symptoms which cause them discomfort and affect their quality of life: having difficulty passing a bowel movement and the need to strain, having stools that are hard and dry and painful to pass, feeling that not all your stools have been passed, “incomplete evacuation” and having to use fingers to remove stool during a bowel movement.

What causes constipation?

There are many possible causes of constipation and whilst this is not an exhaustive list, some of the causes include:

 

  • Lack of fibre in the diet
  • Not drinking enough
  • Being inactive or increased sedentary behaviour
  • Ignoring the urge to poop
  • Side effect of certain medications such as iron supplements or codeine for pain management
  • Stress, anxiety or depression
  • Poor pelvic floor muscles often due to surgery, injury or child birth

Alterations in the gut microbiota also play a role. Gas produced during microbial fermentation of foods can alter bowel movements e.g. elevations in methane are associated with slower transit time.

Combat constipation Image

Below are some tips to help you manage constipation.

 

Prioritise your pooping position!

 

How and when we poop is important to support a successful evacuation as incomplete evacuation can contribute to constipation and cramping.

 

Key things to remember when sitting on the toilet are to put your feet up on a stool to ensure your knees are higher than your hips, lean forward slightly resting your forearms on your thighs and take some deep abdominal breaths.

 

Also try not to put off going to the toilet when you feel the urge as “holding your poo in” and delaying your bowel movement can contribute to constipation. Water is reabsorbed back into the body in the colon so the longer the stool remains, the more water is reabsorbed resulting in a hard drier and likely difficult stool to pass.

Combat constipation Image

Exercise to evacuate!

Exercise does more than just raise your heart rate! Exercise helps stimulate bowel contractions and can help speed up the movement of food through your gut. Additionally it is well recognised exercise is a great way to manage stress; and stress is linked to functional disorders such as constipation.

 

This does not mean you have to join a gym, start a formal exercise class but it does mean trying to limit the amount of sedentary time i.e. time spent sitting down. Try going for a walk, taking the stairs instead of the lift or escalator, start dancing lessons, take up yoga – find some movement that you enjoy and enjoy it regularly, as any little bit of physical activity will help.

Focus on fibre.

Increasing fibre intake is often recommended as a first step to address constipation as fibre can help add bulk and softness to a stool to ensure easier passage through your gut to support a regular bowel movement. Recommendations are to aim for 18-130g fibre per day in adults; 25g in children of secondary school age and children in primary school should aim to have 20g per day.

 

If you feel you need to increase your fibre intake, do so gradually to allow your digestive tract to adapt to this higher fibre intake and ensure you increase your fluid intake also.

 

Simple changes to boost your fibre intake include:

  • Include more oats in your diet e.g. overnight oats, porridge oats, granola with greek yogurt or milk instead of your usual cereal, replace your digestive with a ginger or chocolate oatcake.
  • Pimp up your eggs on toast with a side order of wilted spinach, pan fried mushrooms or tomatoes.
  • Add extra fruit to your meals where possible e.g. fruit with your yogurt pot, add some blueberries to your salad, sliced banana to peanut butter on toast, top your bowl of porridge with berries or sliced apple.
  • Evidence suggests 2 kiwis per day can help with stool consistency and increased gut motility. Similarly 50g prunes in a recent study has been shown to help with stool consistency and frequency, however for some people prunes might exacerbate persistent bloating or wind
  • Increase your intake of pulses e.g. add red lentils to your shepherds pie mix or chickpeas to your chicken curry.
  • Try incorporating more wholegrain foods in your diet e.g. using brown and white rice or wholegrain seeded bread/oat based breads
  • Swap your jam on toast for peanut butter
  • Add chopped nuts or seeds to your yogurt, bowel cereal or sprinkle some over your salads
  • Next time you reach for a bag of crisps try grabbing a handful of nuts instead
Combat constipation Image

Eat Regular Meals.

You might have been told to cut back on food whilst constipated to help “clear out” your colon but this will have the opposite effect!

 

Firstly if you are not eating there is less food waste to create a bowel movement, and secondly eating stimulates the gastro-colic reflex which in turn stimulates intestinal contractions to help the movement of food through your digestive tract and thus reduce constipation. This not mean you need to start grazing and eating more food, but try to avoid missing meals and aim for 3 meals per day.

Fill up your fluids!

 

Fluids are important to soften your poo, making it easier to pass. If you don’t have enough water in your body, the colon reabsorbs water from your food waste, aka your poo and  this results in hard dry stools that are difficult and painful to pass. Simply increasing your fluid intake can help to keep your stools soft and a general rule of thumb is:

  • <60years of age – aim for 35mls/kg/d
  • >60 years of age – aim for 30mls/kg/d

Fluids to include in your calculation are water, tea, coffee, squash, herbal tea, milk, dairy free milk alternatives, coconut water and fruit juice (consider limiting to 150mls if you suffer with bloating and excessive wind). Consider limiting caffeinated drinks such as tea and coffee to 2 cups per day.

 

When increasing your fibre intake be sure to increase your fluids also. Soluble fibre such as oats and linseeds soak up water to create a soft gel and therefore it is important to ensure you drink enough fluids to make this fluid available.


Lets talk!

No one likes talking about poo and bowel habits (unless you are a gastro dietitian like me!).. However if you are suffering with constipation and would like more help to manage your bowel habits contact me and I would love to help you.

 

Alternatively this constipation guide from The Guts Charity is a great read: Constipation 

 

more resources.

Exploring your values can help you finally dodge diet culture

Read more

Caffeine and IBS – what you need to know?

Read more

Is weight loss possible whilst eating intuitively?

Read more