Diet And Constipation

Constipation is a common and distressing condition which means different things to different people. Some feel constipated if they don’t open their bowels every day, while for others it’s normal to go just three times a week. In fact, it’s a myth that you need to open your bowels on a daily basis. Most people skip a day or two every now and then, depending on factors such as fibre and fluid intake, activity level and hormone balance.

The good news is that many constipation problems can be overcome naturally with diet and lifestyle changes, food supplements, and a simple device that lets you adopt a more natural squatting position on the loo. The following are the best natural constipation cures I’ve found in clinical practice.

Constipation causes

Constipation affects between 5% and 20% of people, depending on how it is defined.

A team of gastroenterologists from Bristol have drawn up a stool classification scale which describes 7 different types of bowel motion, of which types 1 and 2 occur with constipation.

Women are twice as likely to experience constipation as men, due to the effects of the female hormone, progesterone. This slows the speed at which contents pass through the bowel (bowel transit time) and makes constipation a significant problem during pregnancy.

Bowel transit time also slows with age due to changes in muscle strength, so that older people are five times more likely to have troublesome constipation than younger adults.

Constipation can occur when cutting back on food intake to lose weight, or as part of another condition such as irritable bowel syndrome (IBS), depression, underactive thyroid, neurological conditions (eg multiple sclerosis) or as a side effect of medication. Opiate painkillers (eg codeine phosphate, dihydrocodeine) are the most common culprits, but other classes of drug such as diuretics, antispasmodics, antidepressants, calcium-channel blockers and even antihistamines can also cause constipation in some people. Check the patient information leaflet that comes with your medication and, if constipation is a known side effect, your doctor may be able to suggest an alternative.

Often there is no obvious cause for your constipation, in which cause it is referred to as ‘idiopathic’ constipation (which basically means of unknown cause) and, if it fits the criteria above, is diagnosed as functional constipation.

Magnesium deficiency causes constipation

Lack of magnesium is one of the most common causes of constipation in people who follow a low-fibre, processed diet, but magnesium deficiency often goes unrecognised.

A study involving 3835 female dietetic students (aged 18-20 years) found that, even in this knowledgeable group, as many as 26% had functional constipation. No associations were found between their symptoms and their dietary fibre intake or fluid intake, but low magnesium intake was associated with increasing prevalence of constipation. Those with the lowest magnesium intakes were 30% more likely to experience functional constipation than those with the highest intakes.

Magnesium is an effective laxative, used over the years in the form of Epsom salts. High dose magnesium citrate is also used medically to cleanse the bowel before gastroenterology procedures. Magnesium works as an osmotic laxative which draws water into the intestines to make the contents more fluid. It may also stimulate release of intestinal hormones (eg cholecystokinin), or activate enzymes (eg nitric oxide synthase) that regulate bowel function. Magnesium is also needed for muscles to relax and contract properly.

If you take a magnesium supplement at night, you are likely to have a regular bowel movement or ‘magnesium moment’ in the morning – especially after eating.

I recommend that you have a cup of coffee in the morning, as this helps to stimulate bowel opening, too.

Does a change of water cause constipation?

Although it sounds like an old-wives tale, constipation often occurs when you visit a different area for more than a week or two. A change in drinking water may well play a part. How? Because drinking water in some areas contains good amounts of magnesium which is needed for bowel muscles to contract, and which draws fluid into the bowels to help maintain normal bowel function.

If you travel from a hard-water areas to a soft-water area, your magnesium intake may plummet to cause constipation. Other factors such as change in diet and lifestyle may also play a role, of course.

Constipation can result from dehydration, which prevents the bowel secreting sufficient fluid to keep things moving. Drink sufficient fluids (especially water) to maintain pale-coloured urine (usually 2-3 litres water per day is needed).

Coconut water, herbal teas, soups and juices all count, too.

Hygiene and comfort are vital when your bowels are playing up, and if you haven’t yet discovered wet toilet wipes, they are an absolute must. A new toilet tissue spritz, FreshX, is also available (currently only in Sainsbury’s) which transforms normal toilet tissue into a moist, soothing, refreshing wipe.

Constipation symptoms

When constipation occurs in its own right, it is known as functional constipation. The new Rome IV criteria define functional constipation as a bowel disorder whose predominant symptoms are difficult, infrequent or incomplete defecation. These constipation symptoms must have occurred for at least 6 months before diagnosis, and remained present during the last 3 months. Although abdominal and or bloating may occur, if these predominate then the correct diagnosis is irritable bowel syndrome.

Doctors diagnose functional constipation if you have at least 2 of the following:

  • Straining during more than a quarter of defecations
  • Lumpy or hard stools on more than a quarter of defecations (Bristol types 1 and 2)
  • A sensation of incomplete emptying of the bowels on more than a quarter of defecations
  • A sensation of rectal obstruction or blockage on more than a quarter of occasions
  • Having to take manual measures (digital evacuation or support of the pelvic floor) on more than a quarter of occasions.
  • Fewer than 3 spontaneous bowel movements per week.

In addition, loose stools must only rarely occur without using laxatives, and there must be insufficient criteria (pain or bloating) to diagnosis irritable bowel syndrome.

NB Always see your doctor if you experience a change in bowel habit – don’t diagnose this yourself as you may need investigations to rule out other bowel conditions.

Fibre for constipation

Usual advice is to gradually increase your intake of fibre-rich foods. Don’t increase your fibre intake too quickly or you may experience bloating and abdominal pain. Increase your fluid intake if you are increasing your fibre intake, so the fibre doesn’t dry out and make your constipation worse.

Research shows that a daily fibre intake of 25 g can increase stool frequency in people with chronic functional constipation, and this effect is significantly improved by increasing fluid intake to 1.5 to 2 litres a day.

Natural fibre supplements can help to maintain bowel regularity by bulking up motions and retain fluid within the motions so they are easier to pass. To give you an idea of how effective these are, every additional 1 gram of fibre you consume can bulk up your bowel motions by an additional 5g in weight!

Natural sources of fibre include wholegrains, fruit, vegetables, beans, salads, nuts and seeds (eg chia, flaxseed).

Sorbitol, a sweetener has a natural laxative action, and is found in apples, apricots, gooseberries, grapes, raisins, peaches, pears, plums, prunes, raspberries and strawberries, so include some of these in your daily diet along with other fibre-rich foods’.

NB Some products also contain senna leaves (a stimulant laxative, see below) so double-check you are getting the product you prefer.

Prunes for constipation

Prunes (dried varieties of plum) are an excellent source of soluble fibre, which fuels the growth of beneficial, probiotic bowel bacteria. But the real secret for why prunes overcome constipation is that they contain a natural laxative called hydroxyphenylisatin. This natural laxative is present in both prune juice and whole prunes, and stimulates secretion of fluid into the bowel. It also stimulates intestinal contractions to get things moving. As a bonus, eating prunes may reduce your risk of bowel cancer, too.

Try prunes soaked in water or cold tea overnight and eaten for breakfast, served with natural bio yoghurt and a handful of seeds for extra fibre.

Psyllium seeds and husks for constipation

Psyllium seeds and husks (also known as ispaghula) are a highly effective, natural and gentle fibre source. Psyllium contains soluble fibre and mucilage which swells to between and 8 and 14 times its original volume when mixed with water. In the intestines, psyllium forms a bulk laxative that acts rather like a sponge, gently cleansing your bowel by absorbing toxins and excess fats. It is particularly helpful for people who cannot tolerate other forms of fibre such as bran. As a bonus, psyllium helps to lower cholesterol levels, too.

Always take psyllium with plenty of water. Mix each serving with at least 250ml water or juice, stir and drink immediately. Add more liquid if necessary to obtain the right consistency. Drink another glass of water after each dose, too.

Chia seeds for constipation

Chia seeds are an excellent source of both protein and fibre. When mixed with water or milk and left for 15 minutes, the mixture thickens to a texture that reduces hunger and which helps to promote bowel regularity. If you don’t like this texture, then consume the mixture earlier before it has thickened. The chia seeds will continue to swell and expand in your digestive tract as they absorb fluid to act as a gentle, natural laxative.

Probiotics for constipation

Probiotic bacteria include strains of Lactobacillus and Bifidobacterium, which produce lactic acid and enzymes to aid digestion, and suppress the growth of less acid-tolerant, gas-forming microbes. Ideally, you want at least 70% of the trillions of bacteria in your gut to consist of probiotic strains, but the balance is often reduced by previous antibiotic treatment, poor diet choices, stress, smoking and alcohol consumption.

Having insufficient levels of probiotic bacteria increases the chance of developing constipation and is associated with irritable bowel syndrome and diverticular disease (outpouchings in the lining of the large bowel from straining with constipation).

Probiotics for constipation in pregnancy: Eating yoghurt is a relatively simple and pleasant way to solve the problem. A study involving 60 pregnant women with constipation found that when they ate 300g yogurt per day, for 4 weeks, the frequency of defecation increased from 2 times per week to 8 times per week, with significant improvements in stool consistency, symptoms of straining, sensations of obstruction, and the need to manually assist defecation.

Probiotics for constipation in irritable bowel syndrome: Probiotic supplements provide a higher dose of probiotic bacteria and multi-strain products have been shown to significantly improve constipation associated with irritable bowel syndrome.

Probiotics for functional constipation: Results from 14 clinical trials, involving 1182 people found that probiotic supplements were significantly more effective than placebo. Overall, probiotics speed up the gut to reduce transit time by over 12 hours, improved stool consistency and increased stool frequency by 1.3 bowel movements per week.

To maintain colonisation of these bacteria in the bowel, it’s best to replenish levels on most days, which usually means taking a probiotic supplement.

Select a probiotic supplement supplying a known quantity of probiotic bacteria such as 20 billion colony forming units (CFU) per dose.

Check the shelf life of the supplement – those close to their expiry date will contain fewer live probiotic bacteria than those with a longer shelf life. Also check whether or not your chosen supplement needs refrigeration.

Prebiotics for constipation 

Prebiotics is the term for non-digestible fibres that act as a food source for probiotic bacteria in the bowel and help to maintain their presence in useful numbers. Prebiotics include fructo-oligosaccharides (FOS) which are found in some foods such as oats, barley, wheat, garlic, onions, bananas, honey and tomatoes.

FOS are sometimes added to health foods as a natural sweetener. Inulin is found in both globe artichoke and Jerusalem artichokes.  Prebiotic supplements are also available. NB Prebiotics can make you a bit windy if you consume too many.

Is a Squatty Potty the answer?

Our ancestors didn’t sit on a toilet seat, but hovered over a hole or behind a bush to do their business. Squatting provides the ideal, natural angle for emptying your bowels as it relaxes your puborectalis muscle and aligns the pelvis and rectum to promote an easier and more complete evacuation.

Squatty Potty fits around the base of your toilet so you can put your feet on it to achieve an optimal squatting position without sacrificing the comfort of your sit-down loo. It raises your feet so your knees are positioned above your hips. This takes you straight into ‘elimination mode’, helping things move naturally without straining.

Beginners may prefer a 7″ Squatty Potty, while more experienced squatters will find the 9″ size works best.

 Laxatives for constipation

Laxatives fall into four main groups depending on how they work.

Bulking agents (eg psillium/ispaghula, sterculia, methyl cellulose) contain indigestible plant fibre that, when taken with water or sprinkled onto food, increase the volume of bowel motions by absorbing water, softening the motions and helping bowel walls get a better grip for propelling motions downwards. Methyl cellulose also acts as a faecal softener. Onset of action may take several days.

Faecal softeners  (liquid paraffin, arachis oil enemas) increase the penetration of water and fats into solid bowel motions. This softens faeces, eases straining and is useful for painful conditions such as anal fissure and haemorrhoids. Onset of action: 24 – 48 hours.

Stimulants (senna, bisocodyl, dantron, docusate sodium, glycerol, sodium picosulfate) stimulate increased colonic motility. Onset of action is usually rapid,  within 6 – 12 hours. Best taken when you go to bed, to get working over night. Some people experience abdominal cramps if they are very constipated.

Osmotic agents (eg lactulose, lactitol, macrogols, magnesium salts) draw fluid into the bowel to soften stools and provide lubrication to ease constipation. Their onset of action is rapid and usually work within 24 – 48 hours after the first dose.

NB If you are pregnant or breast-feeding, check with a pharmacist or doctor before taking any laxative, as these can affect the baby’s bowel, too.

How your doctor can help with constipation

Your doctor can help diagnose any underlying medical causes of constipation and rule out drug side effects, and conditions that need further investigation. You may need a blood test to check for anaemia and an underactive thyroid gland, for example.

Those with red-flag symptoms such as sudden change in bowel habit after the age of 50, a family history of bowel cancer, blood in the motions, weight loss or anaemia are usually referred for hospital tests such as colonoscopy (telescopic examination of the lining of the large bowel).

Your doctor can prescribe a laxative, stool softener or a suppository (which helps to stimulate a bowel movement). If these aren’t effective, do go back and let your doctor know, as prescription-only treatments are available.

In Conclusion

If your bowels aren’t working properly, increasing your intakes of magnesium, fibre-rich foods, probiotics and drinking sufficient water will often solve the problems. Always tell your doctor if a change in bowel habit lasts longer than a week or two. Don’t be embarrassed – GPs deal with bowel problems on a daily basis and will almost certainly have experienced a few themselves!

I hope you’ve found this helpful. Please leave any questions or comments in the comment box below. Thanks.

Image credits: pixabay;  cabot-health/wikimedia;

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