Constipation has affected most of us at some point in life. It can be transient, cyclical or a long term issue. Being constipated is essentially different for different people. For some it means reduction in number of times of passing stool, while for others it might be passing stool that is hard and difficult to pass or a feeling of incomplete evacuation. Constipation can be primary, when it is linked with the function of the large gut or secondary, when it is a consequence of something. This can range from quality of diet, lifestyle, change in diet, change in environment, conditions affecting balance of the gut flora, certain diseases such as diabetes and medication. Stress and functional conditions of the gut such as IBS can also cause constipation. As there are different reasons, the generic advice to increase dietary fibre, have more water and be more active might not be useful to all sufferers and frustrates those who already have these elements in their diet and lifestyle. I find it very useful to explore the reasons that might be responsible for a person feeling constipated before a solution is offered.
Diet and lifestyle have a very important role to play and this blog aims to briefly explain the main elements involved.
- Soluble fibre (also known as fermentable fibre)
- Insoluble fibre (partially fermentable fibre)
- Fibre supplements
- In summary
Conventional advice is to increase fibre to help constipation, so sufferers with bunged up bowels head to switch to wholemeal bread, pasta, brown bread, bran etc. However it is important to know that fibre is not one entity and increasing it too quickly can have a negative effect on symptoms. There are two types of fibre, soluble and insoluble, and these act differently on the gut and its function, hence choosing the right type of fibre for your symptoms is an important consideration. Although most carbohydrates have both type of fibre, some have higher proportion of soluble fibre and others have more insoluble fibre. It would be rare to find a natural source that has either soluble or insoluble fibre.
is found in grains such as oats, barley and rye, fruit, beans and pulses and root vegetables such as carrots and sweet potatoes.
Soluble fibre dissolves in water, it attracts water and forms a mushy gel in the gut. It helps to keep stools soft, making them easier to pass, which may help prevent or treat constipation.
is found in cereal foods like high fibre breakfast cereal, wholemeal breads and pasta, brown rice and other wholegrain, fruit, vegetables such potatoes with skins, nuts and seeds. Insoluble fibre does not dissolve in water and adds bulk to stool.
If you are going down the route of taking fibre supplements such as psyllium seed husk, bran, and methylcellulose, these products increase stool weight and have a laxative effect. Be sure to drink a lot of water when taking any of these products, as they can clog up the gut and cause constipation.
Most carbohydrates have a mixture of both types of fibre in different ratios. Generally fruit and vegetables are seen as a source of soluble fibre and helps maintain a thriving gut microbiome in form of gut bacteria. Insoluble fibre, whole meal bread or pasta, add bulk to stool and the weight of the stool propels it forward though the large gut. Although both types of fibre are generally advised to help with constipation, this can sometimes be unhelpful as too much or the wrong type of fibre can make matters worse. One of the by-products of fibre fermentation is gas and this can cause flatulence and stomach discomfort, especially if people are not used to eating a lot of fibre.
intolerance to certain fermentable carbohydrates can cause bloating and constipation. A diet that is manipulates these highly fermentable carbohydrates (low FODMAPs diet) under supervision of a specialist dietitian can be very effective in management of constipation.
Having water is a very important part in management of constipation. The body has a intelligent system of fluid regulation. The natural instinct of the body is to conserve water and when we don’t drink enough the body will draw out water from the stool and this makes it hard. The harder the stool becomes, more difficult it is to pass, the longer it stays in the large gut, the harder it gets. Drinking water is important but there is no one amount that is right for everyone and the right amount depends a number of factors including age and activity levels.
being active has a positive effect on bowel health. Regular exercise of any type can help keep bowels regular. There are some specific yoga poses and targeted exercises that can help relieve constipation.
Constipation is disruption in normal bowel routine. This can be due to many factors such as diet and lifestyle that lack the elements that promote regular bowel movement, some diseases or medications or change in number of gut bacteria. Majority of times constipation is transient and can be helped by following dietary and lifestyle changes. Sometimes constipation can be quite refractory to treatment and the above measures don’t help. If possible seeking advice from a gastroenterologist, arranging a hydrogen/methane breath test to check if there is imbalance of bacteria can help pinpoint specific reason behind constipation. If there is imbalance of bacteria or the constipation is a part conditions such as irritable bowel syndrome (IBS) or small intestinal bacterial overgrowth (SIBO), an exclusion diet such as low FODMAPs under guidance of a specialist Dietitian can be very effective.
To arrange an appointment with Consultant Dietitian Dr. Nicky Saini please contact The Functional Gut Clinic on 0161 302 7777