A 2019 UK report showed that 1 in 7 adults and 1 in 3 children have constipation. Between 2017 and 2108 196 people a day were admitted to hospital with constipation. Yet in another study that interviewed 2352 adults with constipation, over half of them said they managed constipation themselves and didn’t consider it a big deal. Why is it that we think minor digestive problems are not a big deal? 

So what is constipation? 

Constipation occurs when the food waste that is left travels down into the large intestine where it would be normally fermented by the gut bacteria and then removed when we poo. If it doesn’t travel on and out then the longer it stays the more water gets reabsorbed and the drier and harder it gets and the more difficult it is to pass it out. 

Think about a wilting lettuce – soak it in water and your salad will be be crispy after an hour or so – water flows into the lettuce because there is more salt and sugar in the cells of the lettuce than in the water (osmosis). Water leaves the ‘poo’ and goes into the rest of the body, (some laxatives work by picking up water on there way down to the colon so the ‘poo’ isn’t so dry and easier to pass. 

Constipation can look like:

• Chronic straining and hard to pass
• Feeling like you haven’t fully evacuated, 
• Hard, lumpy ball like ‘maltesers’ or long and lumpy stools, 
• Fewer than 3 stools/week.
• #1 – 3 on a Bristol Stool Chart

Who is more likely to become constipated?

Certain people are more likely to become constipated, including

• women, during pregnancy or after giving birth
• older adults
• people who eat little fibre
• people who take certain medicines (e.g. pain killers) or supplements (e.g. iron)
• people with certain health conditions such as inflammatory bowel disease, diabetes, hypothyroid…SIBO and IBS.

There are lots of reasons why you might get constipated and sometimes taking a laxative isn’t always the answer. 

Causes

Let’s be clear we all might be temporarily constipated now and again – We might experience FOOT (fear of other toilets), or ‘not my loo’ syndrome when traveling, or through illness and stress. 

It’s very common when you travel to a new place  – the gut likes everything to be the same – the nerves of our gut remember the kind of food we like and what time we eat, what time we usually go to the toilet and what time of the day or night it is. When we travel this can change,  we might get more dehydrated and our gut, bless it, gets confused and puts the brake on until it recognises ‘normal’ and then it resumes pooing again.  

Reasons for more chronic constipation include:

1. Not drinking enough water
2. Diet – highly refined/processed foods/meat based diet – little fibre and plant foods
3. SIBO 
4. Carbohydrate intolerance
5. Hormones
6. Dysbiosis (IBS)
7. Rectal outlet dysfunction/structural damage
8. Inflammatory Bowel Disease
9. Pelvic floor dysfunction
10. Stress and emotional reasons

It’s really important to find the cause of the constipation.

My tips if you have constipation are:

1. Look at your diet –  whether you need to increase your fibre or pull back a little for the time being. We should be eating about 30g/day. The best way to do it is to increase your veggies  until you are getting about 7-9 serves/day. Fibre is also found in wholegrains and legumes. Fruit are also a good form of fibre and we should aim for 1-2 pieces of fruit/day.  We also need to be reducing constipating foods and drink such as alcohol which is dehydrating, processed grains (‘white foods’), red meat and junk foods (high in salt and low in fibre).
2. Look at whether you need to increase your water intake to 1.5 – 2L/day (you might need more if flying).
3. Ask your GP or health practitioner whether it could be the medicines or supplements that are causing your constipation – e.g. NSAIDS (ibuprofen), opioid pain killers such as codeine, tramadol, morphine,  Iron supplementation, some anti-depressants e.g. amitriptyline, blood pressure medications, anti-histamines… 
4. See a women’s health physio to assess your pelvic floor function or osteopath or chiropractic to check for structural reasons. 
5. Get checked for underlying causes (oestrogen, progesterone or thyroid imbalances, bacterial overgrowth or even physical blockages).  

• • Oestrogen and progesterone both affect motility – common to be constipated before menses.   Studies are contradictory – high progesterone levels have been associated with constipation because it inhibits motility – although high oestrogen in mice did the same.  However some studies show that low oestrogen and progesterone also do the same.  We do know that oestrogen keeps cortisol in check so when oestrogen declines, cortisol increases and that can cause constipation by slowing down digestion in general. 
  • Low thyroid hormone levels can create constipation because everything slows down. Diabetes is also associated with constipation. 
  • Physical blockages – compacted stools – partial blockages due to inflammation and damage to the gut lining and adhesions can also cause constipation (common in inflammatory bowel disease. 
  • SIBO – small intestinal bacterial overgrowth – the wrong type and amounts of bacteria reside in the small intestine and some bacteria can create methane gas and that causes constipation. This needs testing and specific treatment.
  • LIBO – large intestinal bacterial overgrowth can also create specific gases that cause constipation. This is usually rectified with a healthy dose of fibre and a greater variety of plant foods.

Other things to consider: 

1. Red Flags – If you have blood in your stools, unexplained weight loss and persistent tiredness alongside the constipation or the constipation is chronic then you MUST go to your GP. 
2. Consider stress – how can you reduce your stress load and manage your resilience – breathing techniques, mindfulness practices, yoga, massage, cold showers, taking mini-moments of peace and/or joy,  Reflect on your emotions – are you ‘holding on to something? Is there something that you can’t ‘let go of?’  – person, experience, past memory… 
3. Intolerances  – a sensitivity to certain foods can also cause constipation. Foods such as gluten and/or wheat rich foods and dairy (protein more than lactose).  Complete a diet symptom diary in case it is due to an intolerance – complete a elimination/challenge diet to find out what specific foods could be causing you problems. Come and join my ‘Reduce the Reactivity Reset’ to test for food intolerances (3 month programme where we remove the food you might be reacting to and then test them). 
4. Make an appointment with a naturopath, nutritionist or ME and we can come up with an individualised plan to get you pooping again.
5. Simple remedies can include: Try magnesium oxide or citrate 500-2000mg 2 hours before bedtime and away from food – start slowly and work your way up until it works;  You can also try a warm glass of water on waking that you ‘chew’ add a squirt of lemon juice or a lemon slice to improve bile flow which can work as a natural laxative.  ‘Phloe’ can also be helpful or try 2 kiwifruit/day, psyllium husks, Metamucil,  prunes or stewed apples.  Can use probiotics and prebiotics (partially hydrolysed guar gum [PHGG]) but it is best to get guidance because if you have SIBO then probiotics and prebiotics can make your constipation worse.
6. Laxatives and stool softeners – ‘3 day rule’ – if you take a strong laxative it will likely clear your whole large intestine out.  Our colon has 3 sections and usually when we poo we usually only empty the last section of our colon, then it gets filled up with the next lot of poo. If we clear the whole colon out with a laxative then it can take 3 days before the colon is full again and ready to go. So once the laxative has worked – it can take another 3 days to have a bowel motion so please don’t don’t take the laxative before that.
7. Move your booty – walking, gentle exercise can get things moving downwards again.
8. Bowel is primed to poo before 10am – due to the natural peak of cortisol – wakes up your colon – coffee can give your colon a bit of oomph!  Have it 1 hour after breakfast rather than on waking (especially if you have reflux).
9. Look at how you sit – rock gently, raise your legs up or get a ‘squatty potty’. This opens up your pelvis, puts it in the correct position, allows for more space for flow and can prevent straining.  

 

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