Improving
constipation
There
are three main ways of dealing with constipation:
- eat
more fibre (see table below)
- drink
more fluid
- take
more exercise.
Your
diet
The best way to deal with constipation is to eat plenty of fibre and drink
plenty of fluid – about 8–10 mugs a day (i.e. 2 litres or 4 pints).
Fibre is not digested and absorbed in the intestines, so the stools are softer
and more bulky, and it is easier for the bowel muscles to push them along.
You may think you have a high-fibre diet, but in reality you may not be taking
enough. In the UK, 100 years ago, we each consumed about 40 grams of fibre
a day, but most of us now have less than 15–20 grams a day. Traditional
African diets contain 50–150 grams of fibre a day.
Aim for
at least 30 grams of fibre a day, which really means eating
one fibre-rich food at every meal. If you suddenly increase
the amount of fibre you eat, you may notice wind and bloating,
so increase the amount slowly, over about 2 weeks, to allow
your gut to adjust to the new diet.
A simple
way of increasing fibre in your diet is to:
- change
to wholemeal bread, and eat 2–4 extra slices a
day
- eat
2–3 extra helpings of fruit and vegetables a day
- change
to a wholewheat cereal (the packet will tell you)
- add
some raw bran to your cereal or yogurt.
|
|
Fibre
content (in grams)
|
| High-fibre
foods |
| Bowl
of All Bran |
9.8
|
| Bowl
of Bran Buds |
8.0
|
| Bowl
of muesli |
6.2
|
| Bowl
of Bran Flakes |
5.2
|
| 2
slices wholemeal bread |
4.1
|
| 1/2
large can red kidney beans |
12.4
|
| 1/2
large can baked beans |
7.6
|
| Medium
jacket potato |
4.2
|
| 4
tablespoons peas |
4.1
|
| 5
dried apricots |
5.8
|
| 5
prunes |
4.9
|
| 100
g of Quorn |
4.8
|
| Medium-fibre
foods |
| 2
Weetabix |
3.9
|
| Bowl
of Fruit’n Fibre |
2.8
|
| 2
slices ordinary brown bread |
2.5
|
| 2
slices white bread |
1.1
|
| 3
tablespoons cooked sprouts |
3.1
|
| 2
tablespoons cooked broccoli |
2.3
|
| 3
tablespoons cooked carrots |
1.9
|
| 1/2
avocado |
3.4
|
| Apple
(with skin) |
3.1
|
| Orange |
2.7
|
| Banana |
2.2
|
| 1
tablespoon peanuts |
1.6
|
| 1
tablespoon mixed nuts and raisins |
1.1
|
|
Source:
MeRec Bulletin 1999;10 (No 9).
|
A high-fibre
diet is healthy for most people, but if you are elderly
and not very mobile it can make the constipation worse,
so check with your doctor. And some people find that high-fibre
worsens bloating without improving constipation. And if
you have a medical condition, such as heart failure, it
may not be advisable to take so much fluid. Again, check
with your doctor.
Think
about your lifestyle
Exercise is important. Inactivity can make the bowels sluggish, so be as active
as possible. Changing patterns of shift work can upset the rhythm of your bowels.
Similarly, it is quite common to be constipated at the beginning of a foreign
holiday, especially if you have crossed time zones and are also eating foods
that are different from your normal diet.
Toilet
training (for adults)
Another reason for constipation is what doctors call ‘poor bowel habit’.
This means ignoring the urge to have your bowels open, perhaps because you
are too busy or you dislike using a lavatory away from home or near other people.
The problem
with is that, after a while, you stop feeling the urge.
So don’t ignore it when your body tells you that
you’re due to have your bowels open. And give yourself
enough time for an undisturbed visit to the lavatory, preferably
half an hour after breakfast.
Humans
are probably meant to have our bowels open in a squatting
posture – sitting on a lavatory is not the optimum
posture. So, when you sit on the lavatory, prop your feet
up on a footstool.
Don’t
push and strain to pass a stool. This increases the likelihood
of piles or painful anal cracks (fissure), and can be dangerous
if you have high blood pressure. If nothing has happened
after 10 or 15 minutes, go away and do something else,
and try again later.
Dealing
with painful anal conditions
If you have a painful anal condition, look at our sections on anal
pain, piles (haemorrhoids) and anal
fissure.
Do
you need a laxative?
Laxatives should be a last resort; they are usually not necessary and can be
habit-forming. Dozens of laxatives are available from pharmacies without a
prescription, so if you have tried changing your diet and it hasn’t worked
you may be tempted to try one. Before doing so, see your doctor. This is because
constipation in most people is dealt with by increasing the fibre in the diet
as above, by increasing the amount of fluid you drink and by taking more exercise.
If this has not worked for you, there could be a more serious reason, which
your doctor needs to sort out.
If your
doctor decides there is nothing seriously wrong, a laxative
might be appropriate, particularly if:
- you
have piles, and they bleed if you strain to pass faeces
- you
have bad angina, and your doctor has told you to avoid
straining to pass faeces
- you
are elderly, and your tummy and pelvic muscles are weak,
so passing faeces is difficult.
Types
of laxative
Bulk
laxatives (such
as psyllium husk from health-food stores, bran,
ispaghula husk, methylcellulose, sterculia) provide
fibre in a concentrated form. They have to be
taken with plenty of water, and it can be several
days before they have an effect. They are the
best type of laxative for long-term use.
Stimulant
laxatives (such as senna, bisacodyl)
work by increasing contractions of the bowel,
and so they can cause tummy cramps. The effect
occurs in about 6–12 hours, so they are
taken at night to produce a morning bowel action.
Some experts think that if you use these regularly
for years, the contractions of the large bowel
(colon) may eventually become weakened, making
the problem much worse than before, so this type
of laxative is inadvisable for long-term use.
Glycerol suppositories that you insert into the
back passage (rectum) act as a stimulant because
they are slightly irritant to the bowel.
Osmotic
laxatives retain fluid in the bowel,
which then softens the faeces. Examples of this
type of laxative are: Cream of Magnesia, which
is magnesium hydroxide; Epsom salts or Andrews
Liver salts, which are magnesium sulphate; and
Movicol.
Lactulose
and lactitol are types of sugars that
the body cannot digest, so they remain in the
bowel where they act partly like fibre and partly
like an osmotic laxative. They often cause bloating,
wind and tummy cramps and have to be taken regularly
for up to 3 days before having an effect.
Faecal
softeners, such as ‘liquid paraffin’ from
a pharmacy, lubricate and soften the stool. They
probably act by lining the bowel with a film
of oil that stops water being absorbed into the
body from the stool. Liquid paraffin is also
a mild stimulant. It is not suitable for long-term
use.
|
Biofeedback
Some people, most often young women, have a problem coordinating the muscles
of the bowel, anus and pelvic floor. For example, when they are trying
to pass faeces, they contract the anus muscle instead of relaxing it. Special
feedback training can overcome the problem. This treatment is available
in only a few specialist hospitals, and is reserved for people with a severe
constipation problem.
