When eating fibre can make you even MORE bunged up

SWeATInG profusely and crippled with excruciating stomach pains, Tammie Cherry feared she was seriously ill and took herself to A&e. As well as the stomach pains, her lower back hurt and she felt sick.

‘My stomach was so bloated I looked pregnant,’ says Tammie, 41.

Initially, doctors thought she had appendicitis, but a scan revealed the real cause: Tammie is one of the two million Britons who suffer with severe constipation — they have fewer than three bowel movements a week or difficulty passing stools.

And the condition’s not just about a bit of discomfort — in 2014, 666,287 people ended up in hospital.

‘I was just sent home and told to eat more fruit and high-fibre foods — the same old advice I’d been getting for years,’ says Tammie, a former nursery nurse from Gravesend, Kent. ‘Unfortunately, it didn’t work.’

For many people, an occasional bout of constipation can be cleared this way — by eating more fibre, drinking more fluids, taking more exercise or trying the odd laxative.

But for others this won’t help and can actually make things worse. An estimated 15 to 30 per cent of cases of long-term constipation stem not from a low-fibre diet, but from having a slow transit time — which means their gut pushes food and waste along too slowly.

As a result, their problems stubbornly persist, even if they use laxatives to try to soften or bulk out their stools.

And rather than improving the problem, extra fibre can actually congest the bowel further.

Yet experts say this condition can be missed and patients are often repeatedly advised to top up their fibre intake when they really require very different treatments. ‘GPs may not always be aware that constipation can be caused by slow transit,’ says Professor Julian Walters, a consultant gastroenterologist at Imperial College Healthcare.

‘Fibre may soften the stools — by absorbing water and making them easier to pass — but it won’t always result in passing them more frequently, as this is governed by the speed of gut transit, so waste may build up in the bowel and cause pain and bloating.

‘Bran in particular is a poorly tolerated source of fibre and can make pain and bloating worse in some constipated people.’

There are various reasons why people may have a sluggish gut. One is a shortage of chemical messengers such as serotonin, that act on receptors in the gut wall and stimulate the muscular contractions that propel food and waste through the body.

As a result, their gut contractions are too weak to push waste along as normal.

OTHer causes include taking drugs such as opioid painkillers (codeine, co-codamol, tramadol), which not only bind to receptors in the central nervous system but also to receptors in the gut, slowing movement, and hypothyroidism (underactive thyroid), an autoimmune disease that slows down bodily processes.

‘Stopping these medications or prescribing thyroxine for hypothyroidism would solve the problem in these cases,’ says Professor Walters.

Constipation problems often start in childhood — this can be because of slow transit or poor diet and lack of fluid. Dr Anne Wright, a consultant paediatrician who runs bowel and bladder clinics at the evelina London Children’s Hospital, says chronic constipation is increasingly common in children but is ‘a real taboo subject’.

‘There’s a perception that constipation isn’t that serious and that children will grow out of it, but we know from studies that some don’t,’ she says.

Tammie’s problem started at age ten; she had only one bowel movement a week.

‘I ate loads of bran, porridge and brown bread, but it made things a lot worse,’ she says.

‘I didn’t go any more frequently and the bran made me bloated and caused pain.’

By 16, Tammie was having a bowel movement only once every three weeks.

‘I felt constantly bloated and nauseous and my stomach would stick out.’

Her GP diagnosed irritable bowel syndrome (IBS), an umbrella term for a range of bowel symptoms including constipation and diarrhoea.

Tammie was told to eat more bran and was prescribed Fybogel, a bulk-forming laxative that softens stools, and senna, a laxative that works by irritating the lining of the bowel.

But she was still often constipated, and visits to the GP always yielded the same advice: eat more fibre.

As a result, she gave up on doctors until her hospital admission two years ago.

Weeks after her visit to A&e, Tammie started passing blood and feared it was bowel cancer — a condition her father had been diagnosed with at age 13.

Her GP sent her for a transit study, which measures the speed at which food and waste travels through the body.

‘I had to swallow plastic capsules — they didn’t come through me for nearly two weeks,’ she says.

‘The consultant diagnosed me with slow transit, but his attitude was that I’d have to learn to live with it.’

Professor Walters says if a patient has tried standard advice (such as laxatives and altering diet) and the constipation persists, slow transit is likely.

‘Unfortunately, I see people who have been told to eat more fibre for years,’ he says. ‘If they had been referred earlier, they could have had a transit study done and got the right treatment.’

Treatments include a drug called prucalopride (brand name resolor) that stimulates cells in the intestine that contain serotonin receptors.

If this doesn’t work, the patient may be offered biofeedback.

THIS is a combination of targeted physical exercises — such as the brace technique, where the patient sits on the loo with elbows on their knees and knees above their hips and leans forward, bracing their abdominal muscles — and psychological therapies to reduce anxiety and aid relaxation.

Biofeedback aims to retrain bowel and bladder muscles, and proved a breakthrough for Tammie. She heard about it a year ago when she was taking her father to an appointment at St Mark’s Hospital in Harrow, Middlesex, a specialist bowel disease centre. She asked her GP to refer her there, too.

Specialist nurse Brigitte Collins, the leader of St Mark’s biofeedback team, says their unit’s approach has an 84 per cent success rate.

‘Some people have had slow transit for so long, they no longer recognise the sensation that tells them they need to open their bowels and have to relearn these feelings,’ she says.

Usually a patient has four to six sessions. Tammie had three and now has bowel movements five days out of seven.

But she says the most useful advice was to eat less fibre.

‘I eat white bread, rice and pasta and stay away from bran,’ says Tammie. ‘I also remove the skin and pips from fruit, avoid seeds and nuts, as they clump together and can block the intestine in people with slow transit, and limit vegetables to two portions a day.

‘My advice to anyone in the same position is: Don’t let doctors fob you off. High-fibre foods aren’t always good for you.’