Business as usual is best for your bowels
Warning – this is probably not an article you want to read over breakfast! If you’re interested, I’d suggest you put down the paper, go and eat some high fibre cereal or whole grain toast, with a big glass of water, and come back to it later.
Constipation can be surprisingly difficult to define, as what constitutes ‘‘normal’’ toilet habits varies hugely for us all. What is important when it comes to bowel issues of any kind, is to understand what your usual ‘‘routine’’ is – so if you normally go to the toilet to defecate twice a week, but your stool is soft and isn’t painful to pass, then that’s fine. If you go to the toilet twice a day, and there is no diarrhoea, blood, mucus or pain then that’s also fine… it is a change in your normal that is important to note.
If you think of it in that way, then constipation is any reduction in your normal habit – so going less often than usual, or passing stools that are harder, smaller or painful. It affects around 14 per cent of us, so is common, and for most people will be transient and pretty mild. However for some people constipation is an ongoing, lifelong issue, that can cause significant discomfort and impact on quality of life.
Constipation is more common in women than men, and also more common in people who have a lower income, presumably partly because a healthy diet is often hard to afford. It is also common in children, especially around the toilettraining age.
Most often the cause is ‘‘lifestyle’’ related, but other causes exist too:
Diet
A diet that doesn’t contain adequate fibre will lead to constipation. The recommended intake of fibre per day is around 18 grams, but many of us don’t eat anything like this amount. Fibre is the part of food that isn’t digested by the body, so remains in the gut, with the purpose of adding ‘‘bulk’’ to our stools and stimulating the pushing movement of our bowels (known as peristalsis). It is found in fresh fruit and vegetables, and wholegrains such as wheat and bran.
Fluid intake
Drinking two litres of water a day helps keep your stools soft so they can pass easily through your bowels. If you are chronically dehydrated, or drink lots of ‘‘diuretic’’ drinks such as coffee, you will be more likely to suffer from constipation.
Immobility
Elderly people, those who are bed-bound or immobile due to disability or illness, and people who don’t exercise or have very sedentary jobs are also more at risk. Regular movement enables your gut to do its job.
Situational
This may sound crazy, but I know plenty of people who can’t ‘‘do their business’’ when they are away from home. This can be even worse if you are in hospital, for example, and are expected to use a bedpan.
Medication
Lots of medicines can cause constipation but the chief culprits are any pain-reliever containing codeine or morphine, iron tablets, and some olderfashioned types of antidepressants.
Anal fissures
Painful fissures around the anus (often caused by having to pass a really hard, big stool) can make it so sore that you inadvertently ‘‘hold on’’ to your bowel motions, leading to ongoing constipation.
Imbalances of hormones or salts
Thyroid problems, too much calcium or not enough potassium in the blood can cause constipation.
Obstructions’’
Anything that causes a physical barrier to the passage of stools will also lead to constipation. This can be something within the bowel like a tumour, lump, or narrowing (known as a stricture), or something outside, like a growth in the womb or pregnancy.
Nerve problems
The bowel depends on a good nerve supply to keep it stimulated and moving. For people with nerve damage (for example, through injury, diabetes, or other conditions), constipation can be an awful, ongoing issue.
Other causes
There are other, rarer causes of constipation, and sometimes it can be a sign of something more serious. However, there are also people who we know have fantastic, fibre-rich diets, exercise regularly, drink plenty of fluid, yet still suffer from chronic constipation, and have nothing serious underlying it – presumably these people naturally have a ‘‘sluggish’’ gut, and need to work harder than the rest of us to achieve ‘‘regularity’’.
So if you do find yourself suffering from constipation, what should you do?
❚ Firstly, don’t panic – it is unlikely that this is because of anything serious, and will probably pass with a few adjustments to your diet and lifestyle.
However, if you have never had constipation before, are over 40, have a strong family history of bowel disease, or there are any other symptoms such as bleeding, malaise or weight loss, you should book a doctor’s appointment to get some basic tests done.
❚ Secondly, have a good look at the factors that may be contributing and make some changes. Increase your fibre intake – switch to brown bread, pasta and rice, and eat at least five portions of fruit and vege a day (kiwifruit is a winner).
Make sure you drink plenty of water, and get active. Another tip is to try to optimise your ‘‘toilet posture’’ – our western toilets are a really bad way to encourage defecation. Squatting is a better position for our bowels. So put a small footstool under your feet (or a couple of bulky books), and lean over with your forearms on your thighs – it is surprisingly effective.
❚ If none of these work, you can buy a ‘‘bulker’’ from the pharmacy. These products simply work by increasing the size of your stool, which stimulates the bowel wall to move more, pushing your faeces through more easily. Anything that includes bran, isphagula husk, methylcellulose or sterculia should be effective.
❚ If none of these work, book to see your doctor. They will be able to help you work out why this is going on, and will be able to provide some short term medication in the form of either laxatives, softeners or enemas.
For more information, visit healthnavigator.org.nz