Constipation means not being able to empty your bowel as regularly or as completely as usual, and straining to pass hard or lumpy stools, which can be painful and uncomfortable.
Most of the time it’s nothing to worry about and your symptoms may last for a few days or so. If, however, your symptoms last for more than a week, you’re classed as having chronic constipation. In many of these long-term cases, constipation can cause significant discomfort and affect sufferers’ day-to-day lives.
What causes constipation in one person may vary from what causes it in another. However there are several likely triggers, including the following:
Around two in every five women are believed to have constipation to some degree or other while they’re pregnant, says the NHS. That’s because during pregnancy, your body produces higher levels than usual of a hormone called progesterone. This hormone relaxes the muscles, which means the muscles in your digestive system may also become less efficient, leading to a backed-up bowel.
The majority of cases of constipation during pregnancy are affected during the earlier stages. But many women also find that as their baby starts to grow, it puts more and more pressure on their bowel, which can also cause the symptoms of constipation.
A change in your diet may play a part in constipation during pregnancy too, especially if you experience food cravings or aversions to foods you used to eat without any problem. And if you’re diagnosed with iron-deficiency anemia while you’re expecting, taking a course of iron supplements may also cause constipation symptoms.
When it comes to constipation, the good news is there’s lots you can do to treat and prevent it by making a few simple lifestyle changes. In fact, many people find improving their diet and lifestyle means they don’t need any other type of treatment for constipation.
Eat more fibre
If you aim to eat at least 18g of fibre every day, you’ll be well on your way to preventing constipation (the NHS recommends between 18-30g of fibre daily). That’s because a high-fibre diet keeps your bowel healthy and helps with the process of waste products passing out of your body. Foods rich in fibre include fruit, vegetables, wholegrains (wholemealbread, pasta, rice etc), beans, seeds, nuts and oats. If you’re watching your weight, this has an added benefit, as foods high in fibre help keep you feeling full for longer, which may help to prevent snacking and overeating.
However, eating more fibre isn’t always the answer, as some people with severe constipation find it can make their symptoms worse. So find out the level of fibre intake your body needs to stay regular.
Always have breakfast
It’s important to have something to eat when you get up because it gets your digestive system working after the previous night’s rest. If you’re affected by constipation and skip breakfast on a regular basis, it could well be making your symptoms worse.
Drink plenty of water
If you don’t drink enough fluids it can lead to dehydration, and one of the symptoms of dehydration can be constipation. So make sure you drink plenty of water – or, if you prefer, juices and herbal tea. Even a few cups of ordinary tea and coffee can help you stay hydrated, but because they contain caffeine (which is thought to be dehydrating), try to limit the amount you drink a day. Eating lots of fruit and veg will help, as they contain water too.
Be active every day
Taking regular exercise can help keep your digestive system in good working order because when your body is active, it helps your gut to work more effectively. That’s why people who are bed-bound – from having an illness, for example – are often susceptible to constipation.
Aim for at least 150 minutes of moderate-intensity exercise each week (break it down into 30-minute sessions on five days of the week). Moderate-intensity exercise means working hard enough to increase your heart rate and break into a mild sweat, but at the same time you should also be able to carry on a conversation.
Eat more sorbitol
Sorbitol is a natural substance found in fruits such as prunes, pears, apples, grapes, raspberries, strawberries and apricots that has a laxative effect. Because sorbitol isn’t easily digested, it absorbs and retains water in the digestive system, which helps to soften your stools. For an even bettereffect, choose dried or semi-dried fruits, which contain higher amounts of sorbitol than fresh fruits.
Manage stress levels
Being under too much stress can have an effect your bowel, so look for ways of coping with stress more effectively. Try to find more time for relaxation, even if it’s just 10 minutes a day. For instance, put on a CD, make yourself a cup of tea and sit back and enjoy the calming effect it can have on your brain. If you have more time, taking a short catnap of 15-30 minutes may help you feel refreshed afterwards.
Getting into a regular toilet routine can also be beneficial, so try to set aside a sufficient amount of time every day – preferably in the morning when the lower bowel is most active. Also, avoid putting off going to the toilet when you feel the urge to avoid your bowel becoming backed up.
Constipation is common during pregnancy, but there are various health conditions associated with it too, including the following:
Irritable bowel syndrome
Constipation is one of the main symptoms of IBS, which is thought to affect up to one in five people in the UK at some point in their life. Other symptoms include abdominal pain, diarrhoea, stomach bloating and excessive wind.
When the thyroid gland doesn’t make enough thyroid hormone, the condition is known as hypothyroidism (or underactive thyroid). Constipation is one of the common causes, along with tiredness, feeling cold all the time, weight gain, depression and muscle aches and cramps.
Neurological conditions such as diabetes, Parkinson’s disease and multiple sclerosis can cause nerve damage, which can have a knock-on effect on the digestive system, making it more difficult for food to be digested.
Inflammatory bowel disease
People with Crohn’s disease and ulcerative colitis can also suffer from constipation, though chronic diarrhea is a more common symptom.
Constipation can also be a side effect of certain medicines, including:
If increasing the amount of fibre in your diet and making other positive lifestyle changes don’t relieve or prevent constipation completely, there are some gentle remedies you can take that may help.
Natural bacteria boosters
There is some evidence that food products and supplements containing live bacteria such as L acidophilus, L Casei and B Bifidus may improve constipation in both adults and children (i). Combining live bacteria with soluble fibre such as fructo-oligiosaccharides (FOS) and inulin has also produced encouraging results in some trials (ii). Both live bacteria and soluble fibre supplements are thought to help increase the amount of beneficial bacteria in the bowel.
You can also try taking laxatives for short amounts of time until your constipation improves. There are three main types of laxatives, each of which works in a different way:
In most mild cases of constipation, the first laxative to try is a bulk-forming one, then if that doesn’t clear your constipation you could try lactulose, the osmotic laxative (or a combination of lactulose and a fibre supplement). A stimulant laxative is often recommended if your stools aren’t hard, but you’re having difficulties passing them. Macrogols-type stimulant laxatives, on the other hand, are usually reserved for more severe cases of constipation.
Most mild cases of constipation don’t cause any problems in the long term. But if you’re affected by regular bouts of constipation – or chronic constipation – you may have a higher-than-normal risk for one or more of the following complications:
Regular exercise and a diet including plenty of fibre and fluids are vital for a healthy digestive system, and should keep bowel movements regular. For the occasional times when the body may need some assistance, natural supplements can be gentle and effective remedies.
See your doctor …
If you notice an abrupt change in your bowel habits.
If symptoms of constipation persist for two weeks or longer, despite self-care measures, or is persistent constipation is accompanied by unexplained weight loss.
If fever or abdominal pain accompanied constipation.
If cramping or pain is severe or disrupts your daily routine.
If you notice blood in the stool.
If the constipation develops into diarrhoea or vomiting.
If you have recently started taking medication that may be causing constipation.
Reminder: If you have a medical condition, consult your doctor before taking supplements.
(i) De Paula JA, Carmuega E, Weill R. Effect of the ingestion of a symbiotic yogurt on the bowel habits of women with functional constipation. ActaGastroenterolLatinoam. 2008;38:16-25. Bekkali N, Bongers ME, Van den Berg MM, et al. The role of a probiotics mixture in the treatment of childhood constipation: a pilot study. Nutr J. 2007 Aug 4.
(ii) Zunft HJ, Hanisch C, Mueller S, et al. Symbiotic containing Bifidobacteriumanimalis and inulin increases stool frequency in elderly healthy people. Asia Pac J ClinNutr. 2004;13(suppl):S112.
LAMBERTS The practitioner’s Guide to Supplements (Resumen). Is published by “The Reader’s Digest Association Limited, London on behalf of Lamberts Healthcare.Reprinted with amendments 2005.