Constipation is an incredibly common condition that may be transient or could have been part of a person’s entire life. It involves infrequent bowel movements or difficult to pass stools that persist for weeks or longer. I often see clients who have been constipated for decades. A bit of constipation every now and again can be a challenge but chronic, persistent constipation can be extremely uncomfortable and may interfere with a person’s ability to go about their daily tasks. You may be suffering from chronic constipation if you are:
CHRONIC CONSTIPATION SYMPTOMS
- Passing less than 3 stools per week
- Have hard or lumpy stools
- Persistently strain when having a bowel movement
- Feel that there is a blockage and find it hard to pass
- Feel like you need the toilet even though you have just been
- Need help to empty your rectum e.g. with a finger.
Chronic constipation should be investigated (especially if it is of a sudden onset) as it may be caused by a blockage in the intestine, anal fissures (tiny tears in the skin around the anus), colon or rectal cancer, bowel narrowing etc, and can also be caused by other chronic conditions such as multiple sclerosis, Parkinson’s diease, stroke etc which affect the nerves that cause muscles in the colon and rectum to contract.
WHAT CAUSES CONSTIPATION
From a nutrition point of view, there are a few factors that cause constipation:
- a lack of fibre in the diet. There are 2 types of dietary fibre – insoluble and soluble. Insoluble fibre (found in wheat bran, and wholegrains) adds bulk to the stool and helps it move more quickly through the digestive tract. Soluble fibre (found in legumes, fruits and vegetables) helps to soften the stool so it is easier to pass. Fibre is not digested by our own digestion, but rather by the gut bacteria housed in our large intestine so it keeps them happy too. Fibre can be quite controversial as I have lots of gut clients who react quite badly to fibre, which can be FODMAP foods (ie. Pain, bloating etc.) and high fibre foods tend to be high carbohydrate foods so they may encourage weight gain. Also, adding gluten grains into an enflamed gut is never a wise move. These are issues that I always take into account when increasing fibre in the diet.
- Dehydration. Not drinking enough water can also have a major impact on constipation. You will only get the benefit from your fibre intake if it is adequately hydrated with sufficient water. Increasing fibre and not increasing water can have the opposite effect and make you even more blocked up.
- Lack of exercise. Stool moves through the digestive tract via the process of peristalsis, a series of muscle contractions that push the stool through the bowel. Exercise can encourage these muscle contractions so if you are leading a sedentary life, this may be contributing to your constipation.
- A change of routine. Our bowels love routine and if you change it, they may not be very happy. Working nightshift, jet lag, change of diet etc can all lead to constipation.
- A tendency to put off going to the toilet. Many occupations such as teachers and nurses, can’t get to the toilet when they feel they need to go. Holding on a little bit longer can mean that water is absorbed from the stool and makes them more challenging to pass. Our body also becomes less sensitive to normal signals to go to the toilet.
- Pregnancy. Hormones, reduced activity and the pressure of a growing uterus against the intestines can increase the prevalence of constipation in pregnancy.
- Advancing age. As we age, our internal muscles become weaker, we may move less and we may be more reliant on medications that may lead to constipation.
- Medications. There is barely a drug on the market that does not have gastrointestinal side effects. Many medications such as narcotics (e.g. Codeine, antidepressants, iron supplements, calcium channel blockers (antihypertensives) and antacids can contribute to constipation.
- Irritable bowel syndrome (IBS). You can have diarrhoea or constipation-based IBS, or a mixture of the two. My goal is to get the root cause of IBS and treat it accordingly.
- Hypothyroidism. A lack of the thyroid hormone, can cause everything to slow down, including the bowel.
CHRONIC CONSTIPATION TREATMENT
As you can see, treatment for constipation is a bit more complicated than just eat more fibre (although that alone often solves the problem). I routinely run food allergy and intolerance testing for my constipated clients and these often pick up reactive foods. Omitting these foods from the diet can help with solving the problem. However, I am also looking at many aspects of my client’s health to get to the root cause of the problem. Chronic constipation can be very uncomfortable and even debilitating. Diet plays a huge part in bringing you back to optimal health.