Constipation: chronic and common

Four things that can help keep you regular

CLARE COLLINS

CHRONIC constipation is incredibly common: about one in four people worldwide report symptoms.

Lots of things can trigger constipation: being out of your usual routine (think holidays, illness or injury), inactivity, having a low fibre intake and not drinking enough water.

Certain medications can also cause constipation, including iron supplements, painkillers, diuretics (to help you get rid of sodium and water), and other drugs to treat heart disease, mental health conditions and allergies.

Constipation is more common in older adults and in women, due to hormonal changes that slow bowel motility – the time it takes for your body to digest food and expel the waste products (stools). Pregnant women are particularly prone.

How do you know you’re constipated?

Symptoms include:

Lumpy or hard stools. Feeling that your bowels haven’t emptied completely or your anus is blocked.

Straining to pass a bowel motion, manipulating your body position to try to pass a motion. Having fewer than three bowel motions a week.

If over a three-month period you answer yes to two or more of these symptoms most weeks, you have “constipation”.

The good news is it can be treated and then prevented.

If your bowels are so packed you can’t pass any bowel motions at all, see your GP. You may need treatment with specific laxatives to clear your bowels before you can start a prevention plan.

Here are four things research shows improve bowel function: the time it takes for food to move through your digestive system and be expelled, the frequency and volume of bowel motions, and stool consistency.

1. High-fibre foods

Dietary fibres are complex carbohydrates that aren’t digested or absorbed in the gut. Different types of dietary fibres improve bowel function through the following processes:

The fermentation of fibre in the colon produces water and other molecules. These make stools softer and easier to pass.

Absorption of water into stools stimulates the gut to contract and makes bowel motions softer.

A higher fibre intake creates bigger stools, which pass more quickly, resulting in more regular motions.

A good source of fibre is psyllium. It forms a viscous gel, which gets fermented in the colon, leading to softer bowel motions. A review comparing the effect of psyllium with wheat bran in people with chronic constipation found psyllium was 3.4 times more effective at increasing the amount passed.

This is important because having a bigger bowel motion waiting in the colon to be passed sends signals to your gut that it’s time to expel the stool – and helps the gut contract to do just that.

The review found psyllium and coarse wheat bran had a stool-softening effect, but finely ground wheat bran had a stoolhardening effect.

Other foods rich in fermentable carbohydrates include dark rye bread and legumes (chickpeas, lentils, red kidney beans, baked beans); while wholemeal and wholegrain breads and cereals are high in different types of dietary fibres.

2. Kiwi fruit

Kiwi fruit fibre absorbs about three times its weight in water. This means it helps make stools softer and boosts volume by increasing the amount of water retained in bowel motions. This stimulates the gut to contract and moves the bowel motions along the gut to the anus.

Kiwi fruit are also rich in the complex carbohydrate inulin, a type of fructan. Fructans are a prebiotic fibre, meaning they encourage growth of healthy bacteria in the colon.

But fructans can also aggravate symptoms in some people with irritable bowel syndrome (IBS). If you have IBS and constipation, check with your GP before upping your fructan intake.

If you don’t like kiwi fruit, other vegetables and fruit high in fructans include spring onions, artichokes, shallots, leeks, onions (brown, white and Spanish), beetroot, Brussels sprouts, white peaches, watermelon, honeydew melon and nectarines.

3. Prunes

Prunes are dried plums. They contain a large amount of sorbitol, a complex carbohydrate that passes undigested into the colon where

bacteria ferment it. This produces gas and water, which triggers an increase in bowel movements.

Eating prunes is even more effective than psyllium in improving stool frequency and consistency.

One study compared adults eating 100 grams (about10) prunes a day for three weeks with those who ate psyllium. The prune group passed an average of 3.5 separate bowel motions a week compared with 2.8 in the psyllium group.

The prune group’s stools were also softer. They rated, on average, 3.2 on the Bristol stool chart, compared with 2.8 for the psyllium group, meaning their bowel motions were more towards smooth to cracked sausage-shaped motions rather than lumpy ones.

Other foods that contain sorbitol include apples, pears, cherries, apricots, plums and “sugar-free” chewing gum or lollies.

4. Water

Not drinking enough water is the strongest predictor of constipation. When your body is a bit dehydrated, there’s less water for the fibre in your colon to absorb, meaning your bowel motions also become dehydrated and harder to pass. Aim for arbout 1.5 to 2 litres of fluid a day, which can include liquids such as tea, coffee, soup, juice, and even jelly and the liquid from stewed fruit.

Putting it all together

Start by increasing the amount of water or other liquids you drink. You should be drinking enough that your urine is the colour of straw.

Next, add in psyllium. Start with a tablespoon once a day with breakfast cereal.

Psyllium forms a gel as soon as it comes into contact with liquids, so to make psyllium more palatable. Mix it with a small amount of stewed fruit or yoghurt and eat it straight away.

If needed, increase psyllium to twice a day.

At least once a day, have some prunes (either dried or canned) or kiwi fruit, and a variety of other foods high in fibre, fructans, sorbitol and fermentable carbohydrate.

If your bowel habits don’t improve, see your GP. |