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.
Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated:
Wednesday, February 24th 2010
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Comments on this article
Posted by Puri on 30/10/2009 at 06:44:00 am
My 2 year child constipated for long time. He passes small amount stool once in 15 days. He has symptoms loose of appetite and his intestines expanded to an extraordinary size We use to bowel him with glycerin suppository.
Posted by Anonymous on 09/10/2009 at 08:40:00 am
I had terrible constipation for a year before doing much about it. I was only able to pass a small amount every week and my intestines expanded to an extraordinary size.. Now fortunately my situation is improving with doses of parrafin oil daily. If wind and other IBS symptoms are also present, see a doctor as you may have fructose malabsorption. (I have it) ***beware of fibre supplements. mainly eat a very fibrous diet as fibre supplements merely add to the blockage (they bulk the faeces). eat a lot of vegetables and 2 pieces of fruit.
Posted by palfiova on 14/08/2009 at 07:46:00 pm
I am constipated for long time. I pass the stool once in three weeks. I have symptoms :passing slime from back passage ,bloated tammy,loose of appetite.
Posted by Diana on 06/05/2009 at 09:41:00 pm
I find that i am constipated for up to 10 days before my period is due is this normal, when my periods come i can have a bowel movement.
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Fascinating facts
An average person on a typical Western diet passes about 150 g (5 oz) of faeces each day. Faeces consist of about one-third solids and two-thirds water
The solid matter in faeces is cellulose from vegetables, dead cells cast off from the lining of the gut, bacteria, some salts and pigment from bile (which gives them their brown colour)
Most of the waste matter from food is passed out in the faeces within 72 hours, but in healthy people up to 30% may remain in the colon for a week or more
We think one stool a day is healthy, but this is because of the way we have trained ourselves - our bodies are designed to pass faeces more often. Other primates (such as chimps and monkeys) pass soft stools several times a day
Defaecation is a very efficient process, normally taking only 10 seconds. Presumably it has to be quick - animals (and primitive man) cannot run from a predator easily if they are in the middle of passing a stool. This is probably why it is even quicker when we are frightened
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