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Improving constipation – what you can do

There are four main ways of dealing with constipation:

  • change your diet
  • avoid dehydration
  • take more exercise
  • use a laxative.

Change your diet

Diet is very individual and what works for one person may not work for another. There is no one diet that suits everyone and it is not uncommon for people to find that they cannot tolerate certain foods. This does not often amount to an allergy but rather an intolerance. Keeping a food diary can sometimes help.

Increasing your fibre intake can sometimes (but not always) be effective in constipation. 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. There are two kinds of fibre: soluble and insoluble. Soluble fibre, as its name suggests, dissolves in water; insoluble fibre does not. Soluble fibre forms a gel whilst insoluble fibres absorb water and form bulk. Both forms of fibre ferment and produce gas, which can cause bloating and/or pain. Insoluble fibre is found in whole wheat, whole grains, wheat bran, corn bran, seeds, nuts, barley, couscous, brown rice, bulgur, courgettes, celery, broccoli, cabbage, onions, tomatoes, carrots, cucumbers, green beans, dark leafy vegetables, raisins, grapes, fruit, and root vegetable skins. Soluble fibre is found in oatmeal, oat cereal, lentils, apples, oranges, pears, oat bran, strawberries, nuts, flax seeds, beans, dried peas, blueberries, psyllium, cucumbers, celery and carrots.

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 several weeks, to allow your gut to adjust to the new diet. Some people find increasing their fibre causes more tummy pain, bloating and wind. 
 
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 yoghurt.
Fibre checklist

Fibre content (in grams)

High-fibre foods  
Bowl of All Bran 9.8
Bowl of muesli 6.2
Bowl of Bran Flakes 5.2
2 slices of wholemeal bread 4.1
1/2 large can of red kidney beans 12.4
1/2 large can of baked beans 7.6
Medium jacket potato 4.2
4 tablespoons of 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 of ordinary brown bread 2.5
2 slices of white bread 1.1
3 tablespoons of cooked sprouts 3.1
2 tablespoons of cooked broccoli 2.3
3 tablespoons of cooked carrots 1.9 
1/2 avocado 3.4
Apple (with skin) 3.1
Orange 2.7
Banana 2.2
1 tablespoon of peanuts 1.6 
1 tablespoon of mixed nuts and raisins 1.1 
 
Source: MeRec Bulletin 1999;10 (No 9).
 
Increase the amount of fibre gradually. 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. Some people find that high-fibre worsens bloating without improving constipation.

Avoid dehydration

Increasing your fluid intake will not always improve constipation. In the past, doctors advised drinking lots of water to help constipation. Research has now shown this will not help (Prescriber 2010;21(11):24–9). Also, if you have a medical condition, such as heart failure, it may not be advisable to take too much fluid. Check with your doctor.

Think about your lifestyle

Inactivity can make the bowels sluggish, and doing more exercise can help to relieve constipation, especially if you are elderly. 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)

The problem with ignoring the urge to defecate 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 faeces. This increases the likelihood of piles or painful anal cracks (anal 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.

Do you need a laxative?

Laxatives should be a last resort and are often not necessary, as most episodes of constipation are short lived and will resolve on their own. 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. 
 
You may find that a laxative becomes less effective the longer you use it, so if you really need a laxative it is best to find two or three different ones that work for you, and rotate them. Keep the dosage to the minimum that is effective.
 
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.

Osmotic laxatives retain fluid in the bowel, which then softens the faeces. They may take several days to work. Examples of this type of laxative are: milk of magnesia, which is magnesium hydroxide; Epsom salts or Andrews Liver salts, which are magnesium sulphate; and laxatives containing polyethylene glycol. If you have kidney or heart failure problems talk to your doctor before taking this type of laxative, as they may not be suitable.

Stimulant laxatives (such as senna, bisacodyl) work by increasing contractions of the bowel, and so they can cause tummy cramps. The effect occurs within a few 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.
 
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 sodium ducosate or ‘liquid paraffin’ from a pharmacy, lubricate and soften the faeces. Sodium ducosate encourages water into the faeces, whereas liquid paraffin probably acts by lining the bowel with a film of oil that stops water being absorbed into the body from the faeces. Liquid paraffin is also a mild stimulant. Faecal incontinence (soiling) can occur with this type of laxative. These laxatives are not suitable for long-term use. 

If laxatives don't work

If laxatives do not relieve the constipation, your doctor may consider other treatments. Biofeedback is one possibility. 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.
 
Your doctor may suggest a medication called prucalopride. This is not a laxative but works by increasing the muscle contractions of the bowel and decreasing the time it takes for faeces to move along the colon. It is licensed only for use in women in whom laxatives have not worked. It is normally only suggested for use by a hospital specialist for severe cases of constipation. It can have side effects – headache (in 11%), nausea (in 95%), tummy pain (in 7%) and diarrhoea (in 6%), although these often settle down during the first few weeks of use (Prescriber 2010;21(11):24–9).
 

Written by: Mr Andrew Ramwell
Edited by: Mr Andrew Ramwell
Last updated: Thursday, November 7th 2013

 


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Comments on this article

Posted by muscleshine on 11/04/2017 at 06:54

very helpful article

Posted by Sybil on 26/09/2015 at 07:11

I am finding it very difficult to pass motion everyday, and consume good food. Please help me to get regular and normal motion without facing any difficulty.

Posted by Melissa on 09/12/2014 at 03:19

I've tried laxatives, coffee, veggies & fruit & still haven't had a bowel movement in a week

Posted by sarina on 24/09/2014 at 03:04

I've been in bed with pain and back in forth to the emergency for abdominal severe pain. Vomiting and trying to past stool at the same time. They can't seem to be able to get my pain regulated until they use I.V medication Ik

Posted by Optional on 16/08/2014 at 02:00

Does talking to many laxatives weaking your pelvic muscles, as I cough I wet myself a little.

Posted by Optional on 14/12/2011 at 07:54, United States

I'm sure this is TMI, but I'm not the most "regular" gal on the block. As a gastric bypass surgery patient, I am prone to constipation. I also take iron and calcium supplements which exacerbate things quite a bit. When I mentioned this to one of my doctor's nurses, she recommended the Fiber Cleanse from Lady Soma products. It was very easy to use; I just take with a glass of water once a day. Most importantly, this stuff works!! I find it's better to take it on a regular basis, rather than waiting to get constipated and then taking it. I feel good taking it every day because I know it is all natural, and it keeps me nice and regular.

Posted by Optional on 14/04/2011 at 09:21, United Kingdom

Million thanks for this article, it is a life saver!

Posted by Puri on 30/10/2009 at 06:44, Bangladesh

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, Australia

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.

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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 the 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

Defecation 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 defecating. This is probably why it is even quicker when we are frightened

In the USA, more than $800 million is spent on laxatives each year

Constipation results in more than 2–5 million visits to doctors in the USA each year

About 4,500,000 people in the USA say they are constipated most or all of the time (National Health Interview Survey)

In a UK survey, 6% of people said they had suffered from constipation in the past year, 13% had some difficulty in passing their faeces at least once a month, and 19% took laxatives at some time

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