CONSTIPATION
Constipation is a disorder of the lower gastrointestinal tract marked by a decrease in the frequency of stools, difficulty defecating, and/or the passage of dry, hard stools. Most people experience an occasional change in bowel habits; when it is persistent, it is referred to as chronic constipation.
During the digestive process, food passes from the stomach to the intestine where nutrients and water are absorbed into the body. The waste products of digestion create a stool, which travels through the intestines with muscle contractions. It normally takes six to 24 hours to pass a stool. Anything that slows the passage of stools through the intestines or increases the amount of water absorbed by the body—such as a lack of fibre, fluids, or physical activity; medication; or ignoring the urge to defecate—can lead to constipation.
Chronic constipation affects 31 percent of people between 19 and 65 years, and approximately 45 percent of people over 65 years. This can be a debilitating and uncomfortable problem, but there are a number of lifestyle recommendations that can help.
SIGNS & SYMPTOMS
• Abdominal pain, bloating, and gas
• Bowel movements less than three times a week
• Passing hard stools
• Straining during a bowel movement
Chronic constipation can also cause bad breath, headache, fatigue, hemorrhoids (due to straining), and worsen varicose veins.
Severe constipation may cause fecal impaction, a mass of hardened stool. This can be dangerous and may require removal by a doctor.
Note: See your doctor if you notice blood in your stool or have black stools, as this could signify a serious problem.
RISK FACTORS
Age (more common in older adults)
Diet (lack of fibre and/or fluids)
Health conditions (irritable bowel, celiac disease, colon cancer, liver disease, and low thyroid)
Lack of activity (sedentary or bedridden)
Medications (sedatives, narcotics [codeine], chemotherapy, blood pressure drugs, Parkinson’s drugs, and iron supplements)
Pregnancy (causes hormonal changes)
Stress (reduces intestinal motility)
DOCTOR’S ORDERS
Lifestyle approaches, such as increasing fibre and water intake and regular exercise, should be tried first. If this is not successful, your doctor may recommend drug therapy.
Stimulant laxatives irritate the colon wall to stimulate a bowel movement. Examples include Dulcolax (bisacodyl), Senokot (senna), castor oil, and cascara. These drugs work quickly (overnight), but may cause abdominal cramping and are recommended for short-term (a few days) use only. When taken regularly, they can cause dependence and other problems (see below).
Bulk-forming laxatives add bulk and water to the stools, which improves passage through the intestines. They are taken daily with plenty of fluids, and it may take a week to notice benefits. Side effects include temporary gas and bloating. Examples include bran, Metamucil (psyllium), and Benefibre (guar gum).
Stool softeners, such as Colace (docusate) cause water and fats to penetrate the stool, easing movement through intestines. They may cause tolerance and become ineffective with prolonged use. Mineral oil makes the stool slippery to facilitate passage; however, it should not be used regularly, as it can reduce the absorption of fat-soluble vitamins (A, D, E, and K).
CAUTION: DO NOT OVERUSE LAXATIVES
Overuse of laxatives may cause dependence (lazy bowel syndrome), poor absorption of vitamins and nutrients (particularly potassium), dehydration, damage to the intestinal tract, and worsened constipation. Those who take laxatives for a long time may need to go off them slowly to allow the bowels to return to normal function.
Dietary Recommendations
Foods to include:
• High-fibre foods improve bowel regularity. Eat whole-grain breads and cereals (made with wheat bran, whole oats, rye, and flaxseed), fresh fruits (especially strawberries, apples, and rhubarb), dried fruits, vegetables, and legumes.
• Broccoli, spinach, and kale contain magnesium, which improves gut motility.
• Aim for 25-35 g of fibre daily.
• Drink plenty of fluids—water is best, but pure fruit and vegetable juices and herbal teas are also fine.
Foods to avoid:
• Refined and processed foods are high in sugar and contain little fibre.
• Mucus-forming foods (dairy) slow the transit time of waste and can be constipating.
• Caffeine and alcohol are dehydrating and should be minimized.
Lifestyle Suggestions
• Increase physical activity, as exercise helps stimulate intestinal and bowel contractions. Try walking, biking, or swimming.
• Set aside time to have a bowel movement, such as after breakfast.
• Don’t resist the urge. The longer you delay going to the toilet once you feel the urge, the more water that is absorbed from the stool and the harder it becomes.
• Acupuncture, massage, and reflexology may help by improving intestinal motility
• Detoxification, a short-term cleanse or juice fast along with fibre supplements (psyllium, flaxseed), allows the body to focus on removal of waste. This is particularly helpful for chronic constipation.
Top Recommended Supplements
Fibre supplements: Products containing psyllium husks, flaxseed, oat bran, guar gum, glucommannan, and fenugreek are effective and can be taken regularly. Take with plenty of water. Start with a small amount (one tablespoonful daily) and gradually increase to allow your bowels to adjust.
Probiotics: Supplements containing these «friendly bacteria» help to restore the normal gut flora and have been shown in studies to relieve constipation. Look for Kyo-Dophilus. Take one to three capsules daily.
Complementary Supplements
Aloe vera juice: Aids bowel movements by working as a stimulant and improving intestinal contractions. For short-term use only. Dosage: 65 ml_ twice daily.
Magnesium: Aids intestinal function and helps stool retain water; may be deficient in those with constipation. Dosage: 200 mg twice daily.
FINAL THOUGHTS
To prevent constipation and optimize bowel function:
1. Consume 25-35 g of fibre daily. Best sources are whole grains, vegetables, fruits, and legumes.
2. Drink lots of fluids, especially after exercising.
3. Get regular physical activity to stimulate intestinal contractions.
4. Take a fibre supplement if your diet is lacking.
5. Probiotics can help restore intestinal function.
