Constipation

Constipation occurs when food moves too slowly through the digestive tract and as a consequence, stools become more solid and increasingly difficult to pass. It is one of the most common conditions affecting the digestive system.

In the developed world, up to 25% of people are said to suffer constipation symptoms, probably because of a more refined diet.

Most of us will know about or have experienced the symptom. However, defining constipation is not always easy. How often do you really need to move your bowels? 

Some people open their bowels 2 to 3 times a day, others no more than once per week.

Doctors define constipation as:

• When you open your bowels less than three times a week
• Having to strain excessively when you do
• Or if you have hard pellet-like stools, sometimes described as rabbit droppings.

Naturopaths however believe that you need to open your bowels at least once a day and that if you do so less frequently it means you are constipated.

Women tend to be more constipated than men and the condition is more frequently encountered with increasing age.

So, if there is no agreement on how often we need to open our bowels, how would one know if one is constipated? Again, this is a not always an easy question to answer.

Doctors look for other symptoms, known as the Rome III criteria, to define constipation. Apart from those already mentioned, symptoms include: 

• a feeling that your bowel is obstructed at its outlet or
• a feeling that you have not finished defecating.

Other symptoms which may indicate that you are constipated include experiencing flatulence or a bloated feeling due to excessive wind in your tummy.

For the majority of people experiencing constipation, no specific cause can be found. However, a number of factors are known to contribute to constipation and for each individual, it is likely that a number of these will be involved.

The most common factors leading to constipation are:

• Dietary - Not eating enough fruit, vegetables, wholegrain, pulses or other food groups rich in fibre
• A change in personal circumstances, lifestyle or eating habits
• Stress at work or at home
• Other mood disorders such as anxiety, feeling low in mood or depression
• Certain medicines, most commonly pain-killing medicines based on codeine or morphine.

It is vitally important that food is chewed in the mouth, commencing the digestion process correctly. The act of chewing starts to break the food down. If your food isn’t chewed in your mouth, it certainly won’t be anywhere else. Food that isn’t properly broken down is likely to cause digestive pain as it moves on.

Once in the stomach the food is worked on by the digestive juices, with protein being broken down, and bugs that might have entered with the food being destroyed. The production of digestive juices in the stomach stimulates the rest of the digestive tract to produce digestive secretions.

The stomach contents now enter the small intestine where absorption of food constituents into the bloodstream takes place.

The small intestine meets the large intestine (or colon) at the right hand side of the lower abdomen and the food residues now journey up the ascending colon. As this part of the passage is working against gravity it can be a tricky area; people often get pain up the right hand side of their abdomen where food residues have stuck.

The main function of the colon is to absorb water from the food residues, which are pretty sloppy at this stage. The longer the bowel contents hang around, the more water is absorbed and the harder and drier they become.

• Dry, compacted faeces are much harder for the bowel to grip and move along, so the bowel movements become slower and less effective.
• Moreover, when the intestinal contents are moist and bulky, they fill the space inside the bowel and press on the bowel wall, sending a message to the brain that the bowels need to evacuate. Hard, dry faeces can’t do this.

Waste products that are left sitting in the colon dry out and fester and so they breed germs and kick up a stink. The bowel wall is absorbent: water and vitamins are supposed to be absorbed through it into the bloodstream. However, toxins from stagnant waste products may also be re-absorbed through the bowel wall into the bloodstream instead of leaving the body.

No wonder you feel irritated, lethargic and low. Many people’s diarrhoea is caused by their long term constipation, little though they might suspect it. The gut wall becomes inflamed by the wastes that are hanging around there, and new food arriving irritates the inflamed area, triggering diarrhoea.

Flatulence arises from the bowel contents sitting stewing instead of moving on. It can also be caused by under-secretion of digestive enzymes, which leaves partially digested foodstuffs fermenting as they travel through the gut.

Poor gallbladder function can be spotted by the faeces appearing chalky instead of brown. Diverticulitis comes about when small, impacted faeces force the muscles of the colon to push much harder to grip the bowel contents.

This intense pressure on the intestinal wall finally causes the muscle to sag, creating pockets that can fill with impacted faeces, creating inflammation and further weakening the tone of the gut wall. The weakened wall can bleed if impacted matter later breaks away.

If you suffer from constipation, first, take a look at your diet. Make sure that you have a daily intake of fruit, vegetables (aim for more than 5 per day) and other foods with high fibre content such as bran. 

Certain fruit such as prunes (either whole or in juice), plums and kiwi fruit can be specifically helpful for some people suffering constipation.

In addition, regular exercise improves the way the digestive system works, so a daily 15 or 30 minute walk each day will do both your heart and bowels some good.

Make sure that you give yourself plenty of time in the toilet. Banish all thoughts of embarrassment, relax and give your bowel a chance to do its work. It is also helpful to do this at a fixed time each day – 15 minutes after breakfast works well for many. 

If a change of diet and lifestyle are not sufficient to sort out your constipation, you might want to turn to laxatives as a temporary solution to kick-start the process, and then rely on your diet to prevent further episodes. 

Herbal laxatives are amongst man’s oldest medicines and work in two ways:

Bulking agents. A good example is linseed which swells when in contact with water. This increases the bulk and volume of your stools, making them softer and easier to pass

Stimulating agents. The most commonly used are senna and frangula. This type of medicine stimulates the muscles in your bowel to contract, pushing stools further towards the exit

If you habitually consume vast quantities of coffee, non-herbal tea, dairy products, wheat, chocolate and red meat, you will be much more likely to have bowel problems than someone eating heaps of fresh vegetables, fresh fruit, wholegrains and dried fruit.

A sufficient supply of water is particularly important for the bowel! Without sufficient water the bowel contents soon dry up. The lining of the colon also changes, becoming thicker and stickier rather than providing a smooth lubricant for the passage of the faeces.

Exercise regularly, if only gently, as this stimulates muscle activity and assists peristalsis. Yoga is a good idea as it strengthens muscles and increases mobility without being beyond anyone’s ability. To give your bowel more individual attention, massage gently in a clockwise circle around your belly, going up the right hand side and down the left, gently but firmly.

See your doctor if:

• You notice any unexplained bleeding from your back passage
• You have unexplained or unusually severe tummy pain
• Your constipation develops suddenly and / or is accompanied by vomiting.
• Lastly, if you do use laxatives to treat constipation, make sure that you do not become dependent on them. Using laxatives too frequently can make your bowel ‘lazy’.