Giulia Enders, the author of GUT, describes constipation beautifully in that you wait on the toilet for something that just won’t come, using a lot of force, but in return you get no more than what looks like raisins. You just don’t get that feeling of being empty and feel disappointed.
Here in the UK, we are not great at openly discussing bowel motions with one another, but in private my clients often ask me how often they should poo and how much they should pass. Luckily for you I love talking about it. After all, it’s something we all do!
In terms of frequency, on average, normal bowel movements can be anywhere between 3 times a day and 3 times a week and, in general, normal motions are accepted to look like types 3 and 4 on the Bristol Stool Chart. In other words, normal motions look something akin to the texture of a sausage with cracks in it or smooth like a banana.
Constipation is classically diagnosed when you have:
- A bowel movement less than 3 times a week.
- You pass hard motions for more than a third of the time and they tend to look like pellets.
- The motions are difficult and awkward to pass without the help of medication.
What happens in the bowel?
The disconnection with bowel actions tends to happen in the large bowel where most of the waste that reaches the large bowel is in a liquid state. The large bowel’s job is to reabsorb water and salts and eliminate waste material and indigestible foods, such as ﬁbre.
How common is constipation?
Constipation is a common condition. In fact, it’s estimated that around 1 in 7 adults and up to 1 in 3 children in the UK has constipation at any one time. It can occur in all age groups but affects twice as many women as men and is more common in older adults and during pregnancy.
IBS sufferers can often have constipation, diarrhoea or even a mixture of both. I know from experience that it can be frustrating for clients with IBS to ﬁnd a happy medium sometimes with their bowel movements.
There are 2 types of constipation:
- Temporary constipation (which can be caused by illness, travel or periods of stress).
- And chronic constipation (which can be due to dietary restrictions, medication, medical issues like MS, Parkinson’s, MND, structural issues, pelvic ﬂoor issues, immobility etc).
Constipation and Travel:
I don’t know about you, but I always become constipated when I travel. Here are some of the things which cause this:
- When we travel on aeroplanes, we lose ﬂuid from our body due to the altitude. Also, many of us don’t like using the tiny toilets on the plane, so we drink less water or have a few alcoholic drinks which makes the situation worse by causing dehydration.
- Our eating habits are often out of sync because we have had to get up unusually early, missed a meal or have eaten differently than we normally would, such as having a full cooked breakfast at the airport (which has very little ﬁbre compared to, say, a normal breakfast of whole grain cereal and fruit).
- Travel can also be stressful and this can disrupt the communication between your brain and gut and even the blood circulation to the gut, causing a natural slowing of the transit time of food throughout your digestive system.
- If you’re planning on getting jet-set this summer and want to avoid the frustrations of constipation, sip water throughout your ﬂight and try to avoid drinks that may dehydrate you before and during the ﬂight!
Constipation and stress:
Stress can affect constipation because it causes the body to divert blood ﬂow from the intestines toward vital organs, such as the heart, lungs, and brain to help prepare your body to react to the stressful event. This creates an issue however, because quite often the stress is not caused by a physical situation.
Stress can manifest itself as a result of a distressing email or an upsetting situation or event, but our bodies continue to react with a physical response. As a result, intestinal movement slows down and constipation can occur.
Constipation caused by stress can be difficult to manage because it involves addressing both the physical symptom of constipation and the underlying stress that is contributing to it. By practicing deep breathing techniques and participating in relaxing methods of physical activity such as yoga, we can tackle both sides of the issue. However, it is important to consider speaking with a therapist or mental health professional if the stress is too much to handle on your own.
Dietary advice for constipation:
- Start to record your dietary intake using a food diary, such as Nutracheck or MyFitnessPal, where you can clearly see how much ﬁbre you have in your diet. Try to aim for at least 30g of ﬁbre daily because, sadly, the average female tends to only eat 17g of ﬁbre a day and males 20g.
- Try to eat at least 5 x 80g portions of fruit and vegetables per day.
- Eat only wholegrain carbohydrates. If you are constipated there is no point in eating white bread, rice, pasta etc.
- Add seeds into your diet. Chia seeds and crushed linseeds are your friends! Start off with 1 tbsp. of them added into your cereal, soup, oats or salad and then build up to a maximum of 3 tbsp. daily if needed.
- Get into a rhythm and try to eat at the same time every day. Our guts love regularity!
- Be patient and give these changes a few days to work.
- Remember how important ﬂuids and hydration are to the digestive system.
- Try a bulking laxative, such as psyllium husk, as this draws water into your digestive system and makes your motions bigger, softer and easier to pass.
- Take some time to relax by trying some calming apps like Nerva or Buddhify to start to reconnect the gut-brain axis again.
My top tips for improving constipation:
- Start to look closely at the way you eat and the timing of your eating. Our guts perform better with small regular meals rather than large infrequent meals. This is due to messages being sent from your jaw to your brain to stimulate your gut to move food through your digestive system to make room for a new ‘delivery’ of food arriving.
- Chew, chew and chew again! The more you chew the easier it is for the food you eat to be digested. Properly chewing your food mixes it with lots of saliva which helps begin to break it down. Also, chewing properly stimulates the movement of food already in your digestive system. (I like to think of the digestive system as a mechanical pencil in that, as you push the new lead in, another piece of lead comes out the bottom.)
- Drink plenty of ﬂuids. Water comprises one of the key components of our waste, so if you’re dehydrated your bowel movements can be drier and harder and therefore, more difficult to pass. However, there is also the question of how and what we drink too. If most of your ﬂuid comes from caffeinated drinks like tea, coffee and ﬁzzy drinks and you’re not drinking enough water then this is something to address. I advise sipping ﬂuids throughout the day as this has a better effect on your digestive system and is more likely to hydrate you rather than downing lots of water at one time. As a rule of thumb, aim for 30ml per kg of body weight, but if you are exercising or are in a hot country or working environment you will need to add more to compensate for the loss of water through sweat.
- Your pooing position on the toilet can have a massive impact on your ability (or inability) to pass a motion. Within the digestive system the last part of the colon is angled straight down. As a result, when we sit on the toilet to empty our bowel this forms a slight bend in the colon and anus which can make it more difficult to evacuate the bowel. To alleviate this issue, I recommend that clients slightly raise their knees when on the toilet as this has the effect of straightening the colon and anus which makes it easier to pass a motion.
- Try not to delay emptying your bowels or holding in the movement when you need to poo. If you regularly hold in a bowel motion this trains the muscle to operate in reverse and makes it harder to move them. Also, the longer the poo stays in your gut the more water is withdrawn from it which makes passing it even harder, so don’t ignore the urge to go when you need to.
- The rocking technique is also very effective, where you:
- Sit on the toilet.
- Bend your upper body as far as possible to your thighs.
- Then straighten up into the sitting position.
- Repeat this a few times and this should help move things along.
- Move more! It may be a simple suggestion, but the more you stand and move, the bigger effect gravity has on our bodies in helping to move things through our digestive system. I often ﬁnd that when a client has had quite an active job, but then changes to a more sedentary position this can slow down the transit time of motions.
What type of treatments are available?
If you have incorporated some of the above tips to no avail, have no fear, there are several over-the-counter treatments available which can temporarily lift the burden of constipation. These include:
- Bulk-forming agents or ﬁbre supplements such as psyllium husk.
- Stimulant laxatives such as senna (Senokot).
- Osmotic laxatives such as lactulose (Duphalac or Lactugal).
- Lubricant laxatives such as arachis oil.
It is important to consult a pharmacist or your GP before taking any of the above- mentioned over-the-counter treatments to make usure it is safe and appropriate for your situation.
When should I contact my doctor?
Whilst constipation can generally be dealt with at home – if you have made lifestyle changes, and tried over-the-counter treatments but are still experiencing issues with constipation and have any of the following symptoms, you should get in touch with your GP as soon as possible:
- Passing blood with your bowel movements or bleeding from rectum
- Unintentional weight loss
- Constant bloating or abdominal pain
- Fatigue and/or weakness
- Lower back pain
If you have any questions about the above information or want to speak to me regarding any gut issues/IBS symptoms you may be experiencing then please get in touch here
 https://www.webmd.com/digestive-disorders/poop-chart-bristol-stool-scale. Accessed 03.21.
 https://www.monashfodmap.com/blog/managing-constipation-ibs/. Accessed 03.21.
 https://www.nhs.uk/conditions/constipation/. Accessed 03.21.