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.
Symptoms of Constipation
You may be suffering from constipation if you are:
- 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 disease, stroke etc which affect the nerves that cause muscles in the colon and rectum to contract.
Constipation Weight Gain
The state of the gut has been linked via research to a person’s ability to lose or gain weight. Constipation is a major sign that the bacteria residing in the gut or the microbiota are not very happy. The mix of bacteria we have housed in our gut has a major influence on how we metabolise food. Sudden constipation accompanied by weight gain can signal a shift in the microbiome (you may have recently had surgery or a round of antibiotics) and a change in the way you store and burn fat. Working on improving the gut bacteria may play a major factor in your long term weight loss goals
Causes of Constipation
From a nutrition point of view, there are a few factors that cause constipation:
High Fibre Foods for Constipation
There are two types of 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 system. 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 bowel, but rather by the gut bacteria housed in our large intestine so it keeps the gut bugs happy too. Fibre can be quite controversial as I have lots of gut clients who react quite badly to fibre (i.e. pain, bloating), which can be high in FODMAPs and high fibre foods tend to be high carbohydrate foods which may encourage weight gain. Also, adding gluten grains into an inflamed gut is never a wise move. These are issues I always consider when increasing fibre in a client’s diet.
Foods that cause constipation
If you have been diagnosed with irritable bowel syndrome (IBS), there will be some foods that trigger symptoms such as constipation. These foods triggers will most likely be high in FODMAPs, which are poorly digested and ferment in the large intestine, causing symptoms like bloating, constipation, diarrhoea and stomach pain.
People with gluten-related conditions such as coeliac, wheat allergy or non-coeliac gluten sensitivity may find gluten-containing foods cause GI upset and constipation or diarrhoea.
Alcohol can be a big driver of gastrointestinal issues such as constipation. Drinking alcohol causes poor hydration due to not drinking enough water as well as losing more water than usual through urine.
A diet high in red meat can also contribute towards constipation. Red meat is low in fibre and may replace high-fibre foods on your plate. It is also high in saturated fat, which takes longer for our body to digest and can increase the risk of constipation further.
Constipation and 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. Aim for 2L per day.
Do Antibiotics Make You Constipated?
Antibiotics are absolutely necessary for bacterial infections and during surgery. However, they don’t just kill of pathogenic bacteria. They can also destroy many of the beneficial gut bugs that live mostly in our large intestine. Many of my gut clients notice symptoms such as constipation after a round of antibiotics for completely unrelated conditions such as an ear infection. Long term antibiotics for issues such as acne can have a serious impact on the microbiome on an ongoing basis. I always recommend that my clients take microbiome protectors such as saccharomyces boulardii while taking antibiotics, and we work on adding in lots of prebiotic fibres to help beneficial bugs to thrive post treatment. This helps to keep pathogenic bacteria at bay and bacteria that encourage healthy bowel movements to return to healthy populations.
Other Causes of Constipation
- 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. 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.
- 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.
- Many chronic health conditions can cause constipation such as multiple sclerosis, Parkinson’s disease, stroke, diverticular disease, diabetes, lupus, scleroder
I have helped many clients relieve the discomfort and pain associated with constipation through diet and lifestyle changes.
Magnesium for Constipation
Magnesium is a muscle relaxant and the gastrointestinal tract is a very large muscle. Therefore, Magnesium supplements can often be helpful for constipation. I often combine Magnesium and vitamin C (a natural laxative) together for my constipated clients. On the other hand, iron supplements can have the opposite effect and can either be the complete cause of constipation or make it worse.
Foods to Eat When Constipated
When you are constipated it is important to increase your fibre intake slowly, to not overwhelm the gut. Make sure you’re including plenty of fruits and vegetables in your meals (half a plate with every meal), along with adequate amounts of water (aim for around 2L per day). Sometimes increasing fibre alone can solve the problem.
In other situations, treatment for constipation can be a bit more complicated than just eat more fibre. If increasing your fibre intake isn’t solving your constipation or if it’s making the problem worse, it’s better to come and see a qualified nutritionist for an expert look at the problem. I routinely run food allergy and intolerance testing and microbiome testing for my constipated clients and these often pick up reactive foods and gut bacteria issues. 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 and lifestyle changes play a huge part in bringing you back to optimal health.