Constipation

Many people suffer with chronic constipation due to the taboo nature of the subject, combined with a lack of understanding of the issue. It can affect people both physically and mentally, as well as having a large economic burden on the NHS. £162m was spent by the NHS England on treating constipation between 2017-18.

Whilst you may associate constipation with not being able to poop, it is also associated with not being able to empty your bowels completely and the consistency of your poop. There are three main subtypes of constipation:

  1. Slow transit constipation - this is when your poop takes a long time to move through the large intestines. This slow movement means there is more time for the water to be absorbed, leaving you with hard, dry poop. It also creates an unfavourable environment for your gut microbiome.
  2. Evacuation disorder - this is when you have difficulties with the final 'evacuation' of your poop, resulting in constipation. This can be due to a dysregulating of bowel movements involved in pooping including the intestine, anal trapdoor and pelvic-floor muscles. This means that whilst your poop is able to move through your intestines, it is doing it in an uncoordinated way.
  3. Constipation-predominant Irritable bowel syndrome - There are four types of IBS and one of them is constipation dominant. By following the lifestyle and dietary advice to manage constipation, you can improve a number of your IBS symptoms.

Potential causes of constipation

  • Constipation does not have one cause but can be caused by a number of factors including diet, lifestyle and medication. Including:
  • Low levels of activity - this can decrease stimulation of the gut muscles
  • Not eating enough whole grain fibre - fibre helps add bulk to our stools, help food move through your intestines
  • Dehydration - a lack of hydration will leave you with hard, dry poop that can be difficult to pass
  • Stress, anxiety or depression - this can affect your gut-brain axis
  • Medication - certain medication can disrupt your gut-muscle movements or increase fluid absorption
  • Pregnancy - both from the change in hormones as well as the physical compression from pregnancy
  • Changes in routine - changing factors like what we eat, when we eat or sleeping can impact our normal pooping routine
  • Ignoring the urge to go - this allows more time for water to be absorbed, resulting in hard, dry poop that can be difficult to pass
  • History of physical or psychological trauma - trauma can impact the function of the muscles involved in pooping via the gut-brain axis

Managing Constipation

Depending on the cause of your constipation, your management strategies will differ. Therefore, it is important to understand the underlying cause of your constipation. Keeping a food and symptom diary may help identify your cause.

Management of constipation can be separated into three categories: diet, physical activity and toilet habits.

 

  1. Diet - make sure you are drinking at least 2L of water per day and are eating plenty of wholegrain fibre. The recommended amount of fibre in the UK is 30g however, most people do not reach this. Sources of fibre include wholegrain bread, brown pasta and rice, beans and pulses, fruits and vegetables and nuts and seeds.
    • Certain foods can also be consumed to help relieve constipation
      • Prunes
      • Kiwis
      • Psyllium husk or flaxseed
      • Friendly bacteria (either as supplements or fermented foods) can also help manage constipation by helping to regulate bowel moments and aid in the digestion of food

 

  1. Physical activity - Aim to be physically active each day for at least 20 minutes. Physical activity doesn't just mean going to the gym, going for a walk, gardening or going dancing all count!

 

  1. Toilet habits - When you have the urge to go, go! Holding it in can cause constipation. Try establishing a routine with this, give yourself 5-10 minutes to sit and relax on your toilet. Even if you don't poop, it can help establish your routine. It is important to ensure you are relaxed at this time, you might find that listening to music or deep breathing can help!

 

If you are concerned about your constipation or if the management strategies are not working, we recommend visiting your GP.