Painful feces, motions, poop and poo. Dealing with Constipation.

Constipation is a problem more common than you might imagine.  Our culture doesn’t welcome discussion about bowel habits, so often people worry for no reason or don’t seek help when they should.

There is a range of ‘normal’ bowel habits between individuals.  Some people pass stools (faeces/poo) 2 or 3 times a day and for others 2 or 3 times a week is normal.  The key is to know what’s normal for you and then you’ll know that a change from your pattern may mean you’re constipated.

In this article we’re going to look at constipation, what it is and what can be done to treat it.

What is constipation?

Constipation is the symptom of:

  • Stools (faeces/poo) becoming hard which makes them uncomfortable, painful and/or difficult to pass.
  • Going to the toilet less often than usual.
  • You may have a pain or ache in the lower belly if you’re constipated, and you may feel bloated or sick.

What causes constipation?

There are a number of causes, any one or a combination of which can cause constipation.

  • Not having enough fibre/ roughage in the diet.  Roughage such as bran, whole wheat cereals, fruit and vegetables help the contents of the gut move along and make sure the bowel works well.
  • Not drinking enough will also cause constipation or make it worse if you’re prone to it.  The lower bowel (see the diagram) re-absorbs a lot of water as part of its normal process.  If you’re dehydrated then it will try to get more water from the stool as it passes through which will dry out the stool.  This makes is more difficult to pass.
  • Some medications cause constipation.  Painkillers with codeine or morphine in them, some antacids, iron tablets and some antidepressants can cause constipation.  If you’re struggling with constipation and are taking any medications, then talk to a pharmacist will be able to tell if you constipation is a side effect.
  • Pregnancy can cause constipation because of the changes in hormone levels. I in 5 pregnant women have problems with constipation (source patient.co.uk).
  • Having an underactive thyroid has many symptoms and constipation is one of them.  For more details on this condition, read this article on the symptoms of an underactive thyroid.
  • Not exercising can also cause constipation or make it worse.  A very sedentary lifestyle, along with a poor, low fibre diet, can mean that the gut doesn’t get the help it needs to keep moving its contents along.
  • Irritable Bowel Syndrome is a condition which causes the bowel to work erratically.  It has other symptoms and some people have diarrhoea rather than constipation, but constipation with IBS is more common in women.  Read this article about the symptoms of IBS.
  • Taking too many laxatives can make the bowel lazy and cause constipation when you don’t use them.
  • Some specific diseases such as Multiple Sclerosis, Parkinson’s Disease, stroke and spinal cord injuries, diabetes, lupus and scleroderma are all conditions where constipation is not uncommon.
  • Unknown cause (idiopathic). Some people do all the right things with their diet, fluids and exercise but still suffer with constipation.  The bowel is underactive and doctors sometimes call this functional constipation or primary constipation; the bowel is healthy but not working effectively.  It’s more common in women and can start in childhood and persists into adulthood, throughout life.

Tests for constipation.

Tests aren’t usually needed as the description of the symptoms is enough to diagnose it.

However if this is a change to your usual bowel habit and you can’t think of a reason for it – no change in diet, lifestyle, medication or your overall health – then talk to your doctor if it lasts for more than 6 weeks.  He may run some tests to get to the root of the problem.

Talk to your doctor if it’s very severe and laxatives don’t help. There’s an article on laxatives for constipation here.

Talk to your doctor if you have other indicators such as feeling the cold and feeling sluggish or other unexplained symptoms; passing blood in the stools (this can be caused by piles or haemorrhoids which are made worse by constipation, but can also be a sign of other health problems); if you have a family history of colon cancer or inflammatory bowel disease.

Treatment for constipation.

The best constipation remedy is with the diet, which will both treat and prevent it.  Foods for constipation will help in the long term, however if you’re suffering with constipation now, then look at this article on over-the-counter laxatives as remedies for constipation.

  1. Eat plenty of roughage.  Government guidelines are for at least 5 portions of fruit and vegetables each day.  1 portion is:
  • 1 large fruit (an apple, banana, pear, orange, large slice or pineapple etc)
  • 2 smaller fruits (satsumas, plums etc)
  • 1 small (100ml) glass of fruit juice.  This is not a high fibre item but the fluid will help with your constipation.
  • A cup full of smaller fruits such as raspberries, strawberries, blueberries, cherries etc
  • 1 tablespoon of dried fruit such as currants, dried apricots, prunes etc.  Dried fruits are very good for constipation as they contain a high concentration of sorbitol, a sugar that draws water into the gut and softens the stools, making them easier to pass.
  • 1 dessert bowl of salad
  • 1 portion of vegetables is said to be about 2 tablespoons full.  Vegetables include any green leafy vegetable, sweetcorn, tomatoes, parsnips, sweet potatoes, carrots etc, also beans but not potatoes.
  • Fruit and vegetables can be fresh, frozen or tinned.  If you’re having tinned fruit then look for those in fruit juice rather than syrup.
  1. Whole wheat cereals (check the labelling on the packet) and muesli are high in fibre, so add these to your diet.
  2. Wheat bran can be bought at health food stores and added to porridge (oats are another source of fibre) and soups.
  3. Replace white pasta, bread and rice with wholemeal varieties.  These should be available in most supermarkets, but if you can’t find them then health food outlets sell them.

You may find that as you introduce more fibre to your diet that you get more bloating and gas in the digestive system.  This will ease over time (a few weeks) as the gut gets used to the different food you’re giving it.  For more information about farts, flatulence and gas, read this article.

  1. Drink plenty of non-alcoholic beverages.  This will help the stools stay soft in the lower bowel and easier to pass.  It will also help lubricate the roughage.  Aim for about 2 litres each day – about 8-10 cups – but if this seems daunting if you don’t already know how much you drink, then start by adding 3-4 more cups to your regular intake.  Guidance changes on whether tea and coffee count as ‘cups of fluid’ so have some variety in what you drink – some tea/coffee, fruit tea, juice, water, cordial, milkshakes etc.
  2. Don’t ignore the need to go.  If you’re busy it can be just more convenient to ‘hold it in’ but this can make the faeces more difficult to pass later as they dry out in the lower bowel.  Try going in the morning or about 20-30 minutes after a meal.  The waves of peristalsis that move the food through the gut are greatest at these times and will make it easier to go.
  3. Sit right when you go.  Squatting is the best position but that’s not usually possible with Western-style toilets.  So you could put a pile of magazines or a small foot-stool under your feet which will raise your legs and knees; lean forward, elbows on your thighs and try to relax.  Focus on your breathing to help with relaxing; try not to strain or hold your breath.  The picture demonstrates this.

    Picture source MSTrust.org.uk

  4. Take more exercise.  Just a 20 minute walk each day may be enough to get things moving.  Being upright (not just sitting up) means that gravity will help the bowel move its contents along properly.  Walking about, taking some exercise on a bike, dancing or walking up and down stairs engages the abdominal muscles to a greater or lesser extent and the bowel benefits from this.  Look at little ways that you can put some more oomph into your day.

Some ideas for easily getting more foods for constipation and fluid into the diet.

Think about your usual diet – what you eat and when.  You may not want to radically change your lifestyle but if you’re reading this then constipation is obviously causing enough problems that you want to change something to deal with it.

The easiest way to add more fibre to your diet is by adding snacks and replacing a few things.  Here are a few things to try:

  • Replace white pasta, bread, rice etc with wholemeal.  Wholemeal pasta and rice takes a little longer to cook but the flavour is very similar (slightly ‘nuttier’ and delicious).
  • If you’re in the car a lot then have a bag of dried fruit to hand – dates, prunes, apricots, currants etc are a nice sweet snack.  Remember to keep a bottle of water/juice handy too.
  • If you’re at home and want a larger snack or small meal then try a bowl of porridge – ¼ cup of rolled oats and ¼ cup of wheat bran, with milk to cover.  Put it in the microwave for about 2-3 minutes and serve to your taste with fruit, (jam, sugar or a little salt are the low fibre flavour options).
  • Choose whole wheat cereals and serve with a topping of fruit such as banana or fruit compote. To make a fruit compote, take dried fruits of your choice and soak them in fruit juice.  Store in the refrigerator.
  • Replace sweet snacks with fresh fruit during the day.
  • If you like pizza then buy plain margarita pizzas and load your own toppings – sweetcorn, pineapple, mushrooms, onion and any other vegetable toppings you like.  Have your pizza with a dessert bowl of salad (1 portion) and/or some fresh or frozen vegetables (peas or beans for example).
  • Make a batch of vegetable soup and store in the refrigerator so that you can have it for your lunches if you’re at home or take it in a flask if you have a microwave at the office.  Add beans and pulses to the soup for extra fibre.
  • Make your own lunch salads loaded with tomatoes, beans, sweetcorn, onion, carrot, lettuce etc.  They can be taken to work in a plastic container.
  • Drink a glass of water/juice etc with each meal and have a cup of tea or coffee after.

Fruit and fruit juices contain sugars that can damage the teeth.  Counter this by having a glass of water after you eat fruit or drink fruit juice, or chew sugar-free gum, which helps your own saliva protect your teeth.

If you’re worried about your symptoms or medical problem but don’t want to seek professional help because you feel embarrassed, silly or that it’s your fault, read this page now:  How to talk to a doctor about an embarrassing problem.

Elspeth Raisbeck

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