If you suffer from constipation, Clarice Hebblethwaite offers some relief at last.
How often do your bowels move? It’s hardly a discussion you have at work, or over coffee with your friends! And that’s the trouble, as it leaves people not knowing what a normal bowel habit is and what counts as constipation.
A common problem
Constipation is common and almost one in five people over the age of 30 has constipation at some stage during their life, according to The Gut Foundation.
Sometimes, people will only learn they have constipation when talking with their doctor. Up to that point they thought having a bowel motion once a week was normal and ‘just like everyone else’.
Ideally, your bowel will move once or twice a day, most days of the week. It should move easily without you straining to go and the motion will be soft and bulky. See ‘What’s normal, what’s not’, (below), for what a normal stool (bowel motion) looks like.
If you ask the general public what constipation is, most will say it is straining or hard, pellet-like stools, not being able to go when you feel the need, or not going often. But typically, chronic constipation is diagnosed when a person has bowel motions twice a week or less. This is especially if there are other symptoms as well, such as straining to pass a bowel motion, abdominal discomfort, or a sensation of not emptying the bowel completely.
How it affects your health
Often, people who are living with constipation have no idea it’s affecting their health in other ways, such as making them feel tired and lethargic.
This is because we naturally produce lots of waste every day. Most of this is packaged into safe compounds by the liver, then emptied into the digestive tract (colon). It travels through the colon before leaving the body in the bowel motions.
Build-up of toxic waste
There are billions of bacteria in the gut which are vital for our health. The problem comes when waste products sit in the colon for too long. Then the bacteria can start to un-package these waste products, which then re-enter the blood stream, circulating back around the body. The result can be symptoms like a feeling of tiredness, ‘foggy brain’ and skin acne.
Constipation often creates bloating, which can feel uncomfortable, and wind, which can be quite smelly. This is due to food waste building up in the day by walking, running, dancing or doing Thai Chi or yoga.
What can you do?
Constipation is increasing with our modern ways of living. Here’s how you can improve your regularity.
Activity makes a difference
We sit around for hours at work, but a healthy gut likes activity - if you move, then your gut moves too. Keep active each day by walking, running, dancing or doing Thai Chi or yoga.
The importance of water
Many of us drink less water than we should. Fluid is essential to soften stools and keep them moving. Most adults need about 1.5-2 litres of fluid each day.
Fluid helps the fibre you eat soften and swell, creating a bigger, bulkier bowel motion. In fact, a study recently found fluid was the most important determinant of constipation levels in 8000 US adults. Those who drank the most fluid were significantly less likely to suffer from constipation compared to those who drank the least.
So, stay hydrated by enjoying water, herbal tea, soup, vegetable juice as well as tea and coffee throughout the day.
Drink enough so you don’t get a dry mouth, thirst or dehydration headaches. Another good sign you’re drinking enough is the colour of your urine. It should look like a pale straw colour, rather than dark yellow!
You’ll need to drink more fluid on days when you’re active, sweating more, in air conditioned buildings or at home with the heater going.
The power of high-fibre foods
Our diets are often filled with refined foods containing very little fibre.
Eating more fibre can make the stool bigger and bulkier and speed up transit time through the gut. A bigger, bulkier motion also makes the digestive tract muscles squeeze, giving you the urge to go to the toilet.
Fibre is found in vegetables, grains, fruit, nuts, seeds and legumes, such as lentils, beans and chickpeas. (See ‘Getting more fibre’ below.)
It’s important to increase the fibre in your diet gradually to give your gut time to get used to the change. If you suddenly increase the amount of fibre you eat, you may find you suffer from bloating.
Heed your body’s signals
Many people ignore the need to go to the toilet. They are too busy at work, don’t like to use public toilets or are embarrassed to go at work in case they make a noise or smell.
If you frequently don’t make the time to go when the urge arises, the bowel can stop giving you the message.
So, respond to the urge to go to the toilet. Often, the best time for the bowel to move is in the first two hours after waking or breakfast. Sometimes having a hot drink is enough to get you going! Make sure you allow time to respond to this urge rather than ignoring it.
The impact of medication
Many medications can have constipation as a side effect. Ask your GP for advice if you are taking any medications.
But I’ve done all that and I’m STILL constipated
In some cases, doing all of these things doesn’t improve constipation. So the next step could be to try a fibre-bulking supplement, a laxative or a probiotic.
Usually, people start with a fibre-bulking supplement like Benefiber, Metamucil, Normafibe or psyllium husks. These are concentrated forms of fibre from plants that are dried and ground up into a powder or granules.
Follow the recommended dosage on the pack and slowly build up the dose. Make sure you drink a good couple more glasses of fluid than usual if you’re taking a bulking fibre supplement.
There are different types of laxatives - some work by drawing water into the colon or stimulating the colon muscles to squeeze. Speak to your GP or pharmacist about the best use of laxatives for you.
Probiotics are strains of healthy bacteria that can help balance out ‘good’ and ‘bad’ bacteria in the gut. One particular strain, Lactobacillus Casei Shirota, has been shown to help constipation. This is present in Yakult drinks (available in the supermarket fridge). If you’re trialing a probiotic, take it for a month to see if it improves your symptoms. If it’s helpful, then continue as a daily treatment for three to six months.
If, despite your efforts, constipation still persists, see your doctor. And, if you have symptoms of blood loss in your bowel motions (like black stools) or unexpected weight loss it’s especially important to consult your doctor.
What if my habits change?
A change in bowel habit with bloating or wind could be due to Irritable Bowel syndrome (IBS) or something more sinister, like an underactive thyroid, endometriosis or even bowel cancer, so it’s important to talk to your doctor.
Dietary changes can help IBS. An Accredited Practising Dietitian working in the area of digestive health and food intolerance, such as with the low-FODMAP diet, can be of help. To find a dietitian go to daa.asn.au. For more information on constipation and IBS, visit gutfoundation.com.
A windy problem
Passing wind is normal. Gas is a natural bi-product of the digestive process. According to The Gut Foundation, the average number of emissions per day for men is 12 and women seven, depending on the person and the quality of their diet. Sometimes the smell can be strong. In some instances, this is caused by food (e.g. garlic, onions, spices and carbonated drinks, including beer). Constipation itself can also play a major role.
What’s normal, what’s not
Download the PDF (above-right) for a guide that's based on the Bristol Stool Chart. The foods shown represent the shapes and textures of different stools, so you can compare yours.
Getting more fibre
It’s easy to eat more fibre. Slowly try to add these higher-fibre options into your day.
Add 1 to 2 tablespoons of bran to high-fibre breakfast cereal*. Some people find bloating worsens with wheat bran, so try oat bran or rice bran.
Add 1 to 2 tablespoons of linseed (also called flaxseed) to cereal, or to vegetable juice or a smoothie. You can buy it ground or whole.
In sandwiches, add some extra salad, or try having a couple of handfuls of vegie sticks as a side.
Eat fresh or cooked fruit with peels left on, such as apples or pears rather than canned fruit.
Add vegies to eggs on toast - try rocket, spinach leaves, mushrooms and tomatoes. Top with a sprinkle of sunflower and pumpkin seeds.
Snack on raw nuts, sunflower seeds, pumpkin seeds or sesame seeds.
Choose grainy, high-fibre bread made with wholemeal flour (look on the nutritional info panel of the pack for bread with more than 5g fibre per 100g).
Add a handful of green leaves to smoothies including spinach, silverbeet leaves, rocket or kale.
Choose grainy, high-fibre crackers or biscuits made with oats, oat bran, dried fruit, linseed, wholemeal flour, nuts, pumpkin seeds or sunflower seeds.
Make meals that let you add lots of vegies - soups, stir-fries, salads or bakes. Enjoy hommous and salad as a high-fibre filling in your sandwich.
*Choose high-fibre breakfast cereals (eg. oats, Weet-Bix, muesli), which contain more than 5g fibre per 100g.
Take our fibre quiz
Q: Do you include half a cup of legumes (eg. baked beans, lentils, chickpeas) barley or potato salad in your diet?
B. 3-4 times a week
C. Every day
Q: How often do you eat 2 slices of wholegrain bread (eg. multigrain, wholemeal or rye) or a cup of brown rice or pasta?
B. 3-4 times a week
C. 2 or more times a day
Q: How often do you have at least 2 pieces of fresh, unpeeled fruit and at least 5 serves (2 1/2 cups) of vegetables a day?
B. 3-4 times a week
C. Every day
Q: How often do you eat a cup of high fibre breakfast cereal, eg. wholegrain flake biscuits, bran flakes, or half a cup of muesli or oats etc?
B. 3-4 times a week
C. Every day
Your fibre profile – how you scored
Tally your answers to the questions above.
Your total intake and mix of fibres is likely to be low. Check the advice here and aim to gradually increase your fibre intake from a variety of sources.
You’re on the right track to eating enough fibre. Check out different sources of fibre and aim for a variety of these foods each week.
You're an absolute ‘fibre star’! You should already be getting enough total fibre and mix of fibres in your diet.
Quiz courtesy of The Gut Foundation
Did you know?
Almost one in five of us has constipation at some stage.
Chronic constipation is when a person has bowel motions twice a week or less.
If you suddenly increase the amount of fibre you eat, you may find you suffer bloating, so take it slow.
Have an iPhone? Try the free Kellogg's All-Bran Fibre Tracker, to keep a tally of your daily fibre intake.