Constipation – Dr Vivien Rolfe

In the first article I introduced the topic of constipation as it is something I experience. I wrote about the importance of diet, and how certain foods like the fibre in bran or soft fruit are important to prevent constipation, or can be introduced if we are struggling. In this article we’ll look at other things we can try day to day.

Exercise

Doing exercise at a moderate-intensity like walking and cycling is helpful for various gut disorders including irritable bowel syndrome, inflammation and constipation. A brisk walk each morning could be something to try as it will improve motility which is the muscular contractions in the bowel, and exercise can also reduce inflammation which could ease the stress on the bowel. In one big review of exercise and digestion – high intensity exercise like running was less helpful to the bowel, as was prolonged exercise. So moderate exercise might be the way to go if you are experiencing constipation.

Lovely mind-body activities like yoga, Qigong and Tai Chi can be helpful. In yoga, the twisting poses can help massage the abdomen. Sit on a dining room chair facing forward. Twist to the right gently…then to the left. You can also sit on the floor with your legs stretched out in front and twist in the same way.

These activities are doubly helpful as they will also be relaxing and this too is healthy for the gut. We know our gut and mind is connected through the “gut-brain axis”, and these mind-body movements can therefore be doubly helpful. There are some lovely yoga poses here on Healthline.

Hydration

Staying hydrated is very important. One of the roles of the large intestine is to conserve water and it absorbs it back into the blood stream. So if we are dehydrated, it will extract water from the poo leaving it even harder and possibly more malteser-like. Having a couple of glasses of water would be something to do immediately if you are struggling. Sometimes if we’ve had a busy day and reached for the coffee, or if we’ve drunk alcohol the day before, we may well be dehydrated.

Stress and anxiety

Stress and anxiety can disrupt the bowel. Your sympathetic nervous system will be placing you in fight, fright or flight mode and you’ll be feeling pretty rotten. It will be overriding the parasympathetic nerves which control our rest and digest functions, so as that suggests, this will impair the working of our digestive system. Indeed stress can upset our guts – sometimes we may experience diarrhoea instead of constipation. It would be worth thinking what is going on for you in your life that might be stressing you. Then head for something relaxing.

Coffee

Coffee can stimulate bowel motility so a strong cup might be something to try. But not late on in the day as it might keep you awake.

Gentle ways to go with foods and herbs

I started to mention the importance of soluble and insoluble fibre in the first article, although to note that some people with irritable bowel syndrome may be sensitive to soluble fibre such as that found in soft fruits and onions, and be using a FODMAP diet There are other plant-based foods that can bulk the poo out and help. For breakfast try psyllium husks or linseed (flaxseed) on your cereal or porridge. These help soften the poo and make it easier to pass. You can take a little of these foods each day and see how you go.

The herbal formula Triphala which means three fruits is available in capsules and is an Ayurvedic remedy comprising three plants – Amla, Haritaki and Bibitaki. These are the fruits of the trees that are then dried and powdered. Triphala is best take as a dried powder in a capsule as it does taste bitter, but I find a couple of capsules in some warm water before bed a soothing way to go. This usually has its effects the following day.

Fennel is also a nice soothing herb on the gut and can relieve spasms and bloating. It might not be the strongest remedy for constipation, but it is delicious in a tea.

Laxative products

If you feel that the diet and exercise advice is not helping, then you should speak with your Pharmacist about using a laxative.

You can purchase fibre supplements that are bulk-forming like Fybogel or Psyllium. It is suggested that 10g a day is helpful. Other laxatives work in different ways and some are more stimulating like the plant senna. Your pharmacist will advice, but ideally you should not reach for these regularly as they can impair bowel function long term and slow things down altogether.

Finally

If you are a fellow sufferer, there may be some dietary advice, herbs, exercise or other tips that are helpful here. Some people also find relief from squatting more naturally, and there’s the elegantly named squatty potty that you can try. As I’ve said already, if you need an over-the-counter remedy then do speak with your Pharmacist and they’ll be super helpful. If you are worried about your symptoms then do see your Doctor straight away. Do check the NHS website for advice for yourself, and particularly if you are worried about a child.

Constipation – what is it?

I always put being constipated down to hormones as for me it always connected with my monthly cycle. But now I’m through the menopause it still appears from time to time. The pain can be excruciating with soreness for days. What’s going on?

First of all, people are diagnosed with chronic constipation if it has persisted for three months or more. There can be underlying medical conditions causing this. We now know that constipation can go hand in hand with depression, as both may be caused by an unhealthy gut microbiota. These are the trillions of microbes that live in our large intestine and help with many of the functions we’re describing in this article.

What I’m considering here is the occasional bout of constipation that we may be able to care for ourselves. If your symptoms have gone on for weeks then see your Doctor. Our occasional constipation can be defined as passing small hard poos and/or not going very frequently, so perhaps not having gone for a few days.

How do I know what’s good or bad bowel movement?

I suspect you know how often you do a poo so know what is healthy for you. Some people are mightily regular and go once or twice a day. So what is healthy for one person might be different for someone else. For constipation when I experience it, I can go several days without a poo.

You can also tell by looking at the poo shape. The wonderful city of Bristol gave us the Bristol stool chart. It classifies seven types of poo by its shape. Types 1 and Two are constipation. Here is what they describe for constipation:

Type 1: Separate hard lumps, like nuts. hard to pass (indicates severe constipation)
Type 2: Sausage-shaped but lumpy (constipation).

I’m Type 1 a lot of the time – what I’d describe as a bag of maltesers. And sometimes it does not shift at all. Ouch.

Various lifestyle things can affect this and whilst I’m always trying to work out what is best for me, here is what I have read in the science papers. There are the obvious things like diet and exercise that can effect us here.

Dietary fibre is important

Dietary fibre is the most important food component when we are thinking about bowel health. Fibre is the cellulose component of plants that our bodies cannot digest. Fibre in the diet from oat bran or jacket potato skins are valuable for the gut as the fibre bulks out the digestive contents and helps form larger poo. If we have low levels of fibre in our diet which may be the case if we eat quite a lot of prepared meals or processed food – this can cause constipation, but it is not the only cause.

The fibre gives the walls of the large intestine something to move against – a bit like being able to flex muscles – and it helps the bowel keep in shape. The added roughage should aid going to the toilet. Foods containing this bulking fibre or we call it insoluble fibre include oats, bran, wholesome cereals and jacket potato skins.

Another type of fibre found in fruits like prunes, figs and apricots is called soluble fibre. These are less-bulking but are great as the gut bacteria ferment them and produce helpful short-chain fatty acids. These are fats that keep the bowel wall healthy and can regulate motility. These gorgeous sticky fruits also contain sugars that can help water be retained in the poo and so soften it. This can help lubricate and move things along. Some people are sensitive to soluble fibre though – so do make any diet changes slowly if this is you.

Linseed (same as flax seeds) can be soaked in water to become more gel-like and used on morning cereals or in yoghurt. They can also help lubricate and provide a soft bulk to the poo.

It is surprising though that many healthy diets like the Mediterranean diet although intuitively should be healthy for the bowels, there haven’t been many studies looking at the diet as a remedy for constipation. I’d say I have a healthy and vegetable-full diet and I still suffer. Maybe I’m not eating enough bran and fruit – I think sometimes we think we are healthy but we may let things slip for a few days.

In a review of research by the British Dietetic Association, they summarised that dietary fibre was the most important thing to supplement, particularly psyllium, followed by probiotics, magnesium, kiwi fruit, rye bread and mineral water.

In the next blog post on the topic, we’ll explore other things we can do to help ease constipation.

Tag: Constipation

Constipation – lifestyle changes that may help

Constipation – background and causes