Manage Constipation in 4 Steps

Have you ever had trouble having a bowel movement or experienced constipation? If you answered yes, then you definitely know what it feels like when your gut is giving you the silent treatment!


Some quick facts about constipation;

  • It affects 1 in 10 children and is responsible for 3-5% of all visits to a paediatrician.

  • 1 in 5 adults experience constipation.

  • It affects both men and women but is more of a common complaint in women.

  • The likelihood of experiencing constipation increases as we get older, particularly once we are over the age of 65 years.

What is Constipation?

Constipation is a common medical concern in both Australia and other developed countries. Constipation is defined as when a person is unable to empty their bowels, finding it more difficult to have a bowel movement or having more infrequent bowel movements than what is normal for them.


Constipation can be described as being either acute or chronic. So, what’s the difference?


Acute constipation: This usually lasts for a short period of time and occurs infrequently. It is likely related to changes to dietary habits, such as not eating enough fibre, changes to routine or short-term use of certain medications (I will talk more about this later!)


Chronic constipation: This means that you have been experiencing difficulty with having a bowel movement for a long period of time. Whilst this can also be related to dietary habits, particular medical conditions can also play a role (I will also talk more about this later!) If constipation has been experienced for a long period of time, it can sometimes be referred to as “functional”.


What is Functional Constipation?

What this means is that there is not a physical or physiological cause for your constipation. A person may be otherwise healthy, however despite this, is still having trouble with experiencing a normal bowel movement. This condition can often run in families and studies have shown that 1/3 of people with functional constipation will have family members with similar bowel issues.


Once other conditions have been ruled out a set of diagnostic criteria called the Rome IV Criteria for Diagnosing Functional Constipation will be used to confirm if you have this. This includes whether you have been experiencing 2 or more of the following, for the last 3 months with symptoms starting at least 6 months before diagnosis;

  • Straining during more than ¼ (25%) of bowel movements.

  • Lumpy or hard stools more than ¼ (25%) of bowel movements.

  • Sensation of incomplete evacuation more than ¼ (25%) of bowel movements.

  • Sensation of anal or rectal obstruction/blockage more than ¼ (25%) of bowel movements.

  • Manual manoeuvres to facilitate more than ¼ (25%) of bowel movements (such as digital evacuation, or support of the pelvic floor).

  • Fewer than 3 spontaneous bowel movements per week.

You must also have both of the following;

  • Loose stools rarely present without the use of laxatives.

  • Do not meet the ROME IV criteria for the diagnosis of irritable bowel syndrome (IBS).

How Often Should I Have a Bowel Movement?

This is a question that I get asked quiet frequently by my clients. What is considered normal can be different from person to person as everyone’s gut and lifestyles are different, but it can range from multiple times per day to three times per week.


What’s important to remember is that having less frequent bowel movements does not mean that you are constipated, as long as you are not experiencing any pain and are following your usual bowel habits. You only need to keep an on eye out for it if you start experiencing changes to your bowel habits. As I have mentioned, everyone is different, so if you have been having less than what’s “normal” for you, it may mean that you are constipated.


Tips to help determine if your bowel motions are regular enough;

1. Aim for a bowel movement every 1-2 days that is soft and easy to pass.

2. If you are not sure, you may find keeping a bowel diary helpful.

  • You can record how often you are having a bowel movement.

  • The type (for example, whether it is hard or soft).

  • How easy it is to pass (did you need to strain excessively?)

  • Have you been experiencing any other symptoms (such as wind, bloating or stomach pain).

3. Keep in mind, that if you are eating less than usual for any reason, you should still be having regular bowel movements.


Symptoms of Constipation

There are so many different symptoms that can be experienced with constipation and it’s important to remember that these will vary from person to person.

Some common signs and symptoms can include;

  • Stomach pain, bloating and discomfort

  • Wind

  • Feeling tired and fatigued

  • A decrease in appetite

  • Feeling full quickly after meals

  • Bowel obstruction or blockage

  • Excessive straining or difficulty having a bowel movement

  • A feeling of not being completely empty

  • Passing hard or lumpy stools

  • Infrequent bowel movements

  • Worsening of IBS symptoms, such as abdominal pain, excessive wind, bloating and/or distension.

Other symptoms can include;

  • Anal fissure. This is when trying to pass large, hard stools can cause a small tear in the lining of the anus. It can cause pain, stinging and bright red blood, which is often noticed in the toilet or on toilet paper.

  • Faecal overflow or incontinence. This occurs mainly in children and the elderly who have been experiencing chronic constipation. This leads to a loss of awareness of needing to have a bowel movement and unintentional soiling of underwear.

Causes of Constipation

As mentioned above, constipation may have no underlying cause, such as in those with functional constipation, or can be the result of another cause. This can sometimes be referred to as secondary constipation.


Medical causes of constipation include;

  • Pain relief medications

  • Codeine

  • Oxycodone

  • Morphine

  • Anti-nausea medications

  • Ondansetron

  • Other drugs or medications

  • Anti-depressants

  • Chemotherapy

  • Some nutritional supplements

  • Iron supplements

  • Calcium supplements

  • Excessive laxative use

  • Hormonal and metabolic conditions

  • Underactive thyroid

  • Diabetes

  • Some medical conditions

  • Coeliac disease

  • IBS

  • Haemorrhoids

  • Diverticulitis

  • Certain diseases

  • Colorectal cancer

  • Metastatic stomach cancer

  • Neurological disorders

  • Parkinson’s disease

  • Stroke

  • Cow’s milk allergy

  • Studies have shown that this can cause severe constipation in some infants and children.

  • Pregnancy

  • Menstruation

  • This may be due to changes in hormones that can affect bowel habits.

  • Slow gut motility

Lifestyle factors that can cause constipation;

  • Not drinking enough fluid or dehydration

  • Decreased mobility

  • Inadequate fibre intake

  • Physical inactivity

  • Ignoring the urge to have a bowel motion

  • Sedentary lifestyle

  • Stress

  • Changes to your daily routine

My Expert Tips to Help You Manage Constipation


1. Increase Your Intake of High Fibre Foods Fibre helps to keep our stools soft by absorbing water throughout our gut. This assists with preventing constipation and keeping our bowel movements regular. So, high fibre foods help improve constipation by holding liquid in the stools and keeping them soft. It also helps to keep us fuller for longer and supports keeping our gut microbiome happy and healthy.


In Australia, it is currently recommended we consume;

  • 14-22g per day for children.

  • 25g per day for women.

  • 30g per day for men.

However, despite all the benefits of adequate fibre intakes, most Australians currently do not consume enough fibre.


The easiest way to make sure that you are getting enough fibre each day is by eating a healthy balanced diet with a wide variety of foods. This is easily achieved by ensuring that you eat foods from each of the 5 food groups. These are grains (cereals), meat and/or alternatives, fruit, vegetables and dairy and/or alternatives.


My expert tips for increasing your fibre intake are;

  1. Include at least 1-1.5 cups of vegetables with your lunch.

  2. Include at least 1.5-2 cups of vegetables with your dinner.

  3. Include vegetables as snacks.

  4. Choose wholegrain and/or high fibre breads, cereals, pastas and rice instead of refined or white versions of these foods.

  5. Eat at least 2 pieces of fruit each day.

  6. Use fruit for snacks and desserts.

  7. Add fruit to your breakfast cereal, smoothies or yoghurt.

  8. Keep edible skins on your fruit and vegetables.

  9. Try having a small handful of nuts or seeds as snacks.

  10. Add legumes such as beans or lentils to your meals.

  11. Add high fibre foods slowly to your diet to avoid getting symptoms such as wind, bloating, cramps and diarrhoea.

2. Eat 2 Kiwifruit Each Day

Eating kiwifruit regularly has been shown to help relieve the symptoms on constipation. It is a simple, natural and budget friendly strategy to help with improving your bowel movements. Studies have shown it to be a safe alternative to other strategies as it seems to have very little, if any, side effects.


Eating 2 kiwifruit each day helps to increase how often you have a bowel movement and improves laxation, which means it makes it easier to have a bowel movement. However, keep in mind that improvements in your bowel movements will only be seen while you are regularly eating kiwifruit and will decrease if you stop eating them.


So how does the humble kiwifruit do all this?


This is thought to be because of the fibre content in kiwifruit as it helps with absorbing water throughout your gut, which bulks up your stools and improves laxation. It also contains an enzyme called actinase which is believed to also help with laxation by making it easier for the contents of your gut to move through it.


3. Increase Your Fluid Intake

When you increase your intake of fibre it is important that you also make sure that you are drinking enough water throughout the day. As mentioned above, fibre absorbs water in your gut to assist with keeping your stools soft and preventing constipation. Not drinking enough fluid can result in fluid not being absorbed from your gut into your stools. This can result in harder stools and cause stomach pain or discomfort and constipation.


You may have heard a lot about how much water we should drink, such as 8 cups or 2 litres per day, however as we are all different, there is no one amount that is recommended for everyone. The best way to judge if you are drinking enough water is by looking at the colour of your urine. This may sound strange, I know! Dark urine likely means that you may be dehydrated and have not had enough fluid, while clear urine means you may be drinking too much. Aim for a pale-yellow colour as this is likely to indicate you are well hydrated.


4. Increase Your Physical Activity

Being physically active every day and decreasing the amount of time you spend engaging in sedentary behaviour is not only important for improving constipation but is also vital for your overall health and wellbeing.


My expert tips for increasing your physical activity are;

1. Be sure to include regular activity in your day. Australia’s Physical Activity and Sedentary Behaviour Guidelines are a really good starting point.


2. Doing any type physical activity is better than not doing any.

  • Find an activity that you enjoy doing and start with 5-10 minutes and gradually build up to the recommended amount.

3. Be active on most, preferably all, days of the week.


4. Add 2½ to 5 hours of moderate or 1¼ to 2½ minutes of vigorous intensity physical activity each week.

  • This can be included as 30-60 minutes of moderate intensity activity (such as brisk walking or gardening) per day OR

  • 75 to 150 minutes of vigorous intensity activity (such as swimming or running) each week.

5. Do muscle strengthening activities on at least 2 days each week.


6. Sit less, move more.


7. Limit the amount of time you spend sitting for long periods of time.


8. Break up long periods of sitting as often as you possibly can.

  • This can include getting up from your desk once an hour and going for a short walk.

If you would like some support to take control of your IBS, click here to watch my program video to learn how I can help you eliminate your bloating, constipation and diarrhoea WITHOUT feeling confused or overwhelmed.

References

  1. Australian Government: Department of Health. Australia’s Physical Activity and Sedentary Behaviour Guidelines [Internet]. Cited 2019 November 30. Available from:https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines#npa1864

  2. Barbara G, Fukudo S, Drummond L, et al (2018). Tu1644 – Green Kiwifruit Compared to Psyllium for the Relief of Constipation and Improving Digestive Comfort in Patients with Functional Constipation and Constipation Predominant Irritable Bowel Syndrome — Analysis of Three International Trial Centres. Gastroenterology. 154:S-979-S-980.

  3. Beck DE (2008). Evaluation and Management of Constipation. The Ochsner Journal. 8:25–31.

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  5. Bijkerk CJ, Muris JWM, Knottnerus JA, et al (2004). Systematic review:the role of different types of fibre in the treatment of irritable bowel syndrome. Alimentary Pharmacology & Therapeutics. 19:245–51.

  6. Brandt LJ, Prather CM, Quigley EM, Schiller LR, Schoenfeld P & Talley NJ (2005). Systematic review on the management of chronic constipation in North America. The American Journal of Gastroenterology. 100(suppl 1):S5–S21.

  7. Chan AO, Leung G, Tong T, et al (2007). Increasing dietary fiber intake in terms of kiwifruit improves constipation in Chinese patients. World Journal of Gastroenterology. 13:4771-5.

  8. Chang CC, Lin YT, Lu YT, et al (2010). Kiwifruit improves bowel function in patients with irritable bowel syndrome with constipation. Asia Pacific Journal of Clinical Nutrition. 19:451-7.

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  11. Gastroenterological Society of Australia (GESA), Digestive Health Foundation. (2010). Constipation Information Sheet.

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  20. Suares NC & Ford AC (2011). Systematic review: the effects of fibre in the management of chronic idiopathic constipation. Alimentary Pharmacology & Therapeutics. 33:895–901.

  21. Tack, J et al (2006). Functional gastroduodenal disorders. Gastroenterology. 130, 1466-1479.

  22. Tucker DM, Sandstead HH, Logan GMJr, et al (1981). Dietary fibre and personality factors as determinants of stool output. Gastroenterology. 81:879–83.

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