Constipation; Why it happens, how to prevent it, and why you should be concerned about it.
What is Constipation?
Most people will experience some form of constipation from time to time. Constipation is not just the inability to have a bowel movement, but it also includes the difficult passage of stools, such as hard stools, having to strain to have a bowel movement, or the feeling of incomplete evacuation. This is usually short term, lasting a day or two, and is due to travel, changes to routine, diet, dehydration, medications, stress, hormonal changes or inactivity. It can generally be managed by increasing water and fibre in a person’s diet, and occasionally the use of over the counter laxatives.
However, constipation that is occurring regularly or that is on-going, lasting several weeks or more is considered chronic constipation. Chronic constipation is classified as infrequent bowel movements or the difficult passage of stools that persists for several weeks or longer. Constipation is generally described as having fewer than three bowel movements a week, however, if an individual is used to having one or more bowel movements per day, this person may be deemed to have constipation if they are only having a bowel movement every second or third day.(1) Therefore, it is important to look at the individuals history of bowel movements when making a classification of constipation.
“Constipation is not just the inability to have a bowel movement, but it also includes the difficult passage of stools, such as hard stools, having to strain to have a bowel movement, or the feeling of incomplete evacuation.”
What is the Criteria for Constipation?
Functional Constipation can be classified by the presence of two or more of the following features: (1)
• Straining
• Lumpy or hard stools
• Sensation of incomplete evacuation
• Sensation of anorectal obstruction/ blockage
• Manual manoeuvres needed to facilitate defecations (e.g, digital evacuation, support of the pelvic floor)
• Fewer than 3 defecations per week
If you have concerns, please speak to a healthcare professional.
How often Should I have a bowel movement?
Ideally you would have one to three bowel movements daily, however, normal bowel function is different for everyone. More than three times daily could be considered too frequent, while less than one bowel movement every two or three days could be considered too infrequent. This means that some people have a bowel movement every day or multiple times per day while others can skip an entire day, and both cases are considered normal. If you find yourself having a bowel movement more than three times daily or less than three times per week it is worth getting this looked into further by a healthcare professional.(1)
"Normal bowel function is different for everyone. It should be assessed on an individual basis"
What Should a normal stool look like?
The Britstol Stool chart is used to assess what ‘normal stools’ should look like. Ideally they should fall on the scale of type 3 or type 4 on the chart. (2) This can be described as “like a sausage but with cracks on the surface” or “like a sausage or snake, smooth and soft”. Ideal stools are easy to pass and don’t require any straining or pushing.
" Ideal stools are easy to pass and don’t require any straining or pushing."
Figure 1: Bristol Stool Chart. Medical aid designed to classify stools into seven different groups.(2)
What causes constipation?
Constipation can be caused by a number of different reasons such as: (3,4)
• Changes in your diet (type of foods or timing of food intake)
• Low Fibre Diet
• Reduced food intake (low calorie diets)
• Diet high in refined and packaged foods
• Dehydration
• Changes in your daily routine
• Travel
• Physical Inactivity
• Stress
• Anxiety or depression
• Hormonal Changes
• Ignoring the urge to pass stools
• Medication (over-the-counter or prescribed) e.g. opiates, pain-killers (especially those containing codeine), antacids, antidepressants, some blood pressure medications, regular laxative use (especially stimulant laxatives)
• Impaired coordination of Pelvic Floor or abdominal muscles
• Medical Conditions e.g. diabetes, Parkinson’s disease, anorexia, hypothyroidism
• Pregnancy
Why should I care about being constipated?
"Constipation can have an effect on both your physical and mental health."
Constipation can have an effect on both your physical and mental health. Not only does it leave you feeling uncomfortable, bloated and is potentially painful, but it can also make you feel depressed and stressed.
Constipation can also have other health complications such as: (3,4)
• Haemorrhoids (piles)
• Rectal bleeding, pain, itch or swelling (due to straining and passing of hard stools)
• Faecal impaction (where dry, hard stools collect in the rectum and can make constipation worse)
• Rectal Prolapse (due to excessive straining during defication)
• Bowel Incontinence (the leakage of liquid stools)
• Colorectal Cancer
How to Prevent Constipation?
• Reduce refined foods, high sugar foods and packaged foods
• Increase fibre intake (fruits, vegetables, wholegrains, flaxseeds, soaked chiaseeds)
• Increase fluid intake
• Increase physical activity
• Ensuring the diet provides enough residue (small food intake can cause constipation)
• Develop a daily routine
• Make time to relax and de-stress
• Don’t ignore the urge to the toilet
How to treat Constipation?
Short term use of laxatives can be used. However, long term use of laxatives especially stimulant laxatives, can be damaging, as the body can become reliant on them and become unable to function efficiently without them. Stimulant or fast acting laxatives (such as dulcolax and Senokot) irritate the intestinal wall.
Therefore a more natural approach such as improving dietary and fluid intake as well as concentrating on lifestyle habits is a far better approach to treating constipation. By following the tips on “how to prevent constipation” above, these tips can also be used to treat constipation.
Magnesium supplementation can be used to help treat and prevent constipation. It is a natural osmotic laxative, which means it relaxes your bowels and pulls water into your intestine. 5 The water helps to soften and bulk the stools which prevents them becoming dry and hard and makes them easier to pass. Magnesium also helps to relax the intestinal muscles which can help with constipation caused by stress.
Colonic hydrotherapy is also a good way of treating constipation as it aids in clearing the large intestine, removing old impacted faecal matter. As well as this, the water that enters the bowel during a colonic helps to exercise the intestinal muscles and stimulate peristalsis which can help them to function better on their own post treatment.
"Colon Hydrotherapy helps to exercise the intestinal muscles and stimulate peristalsis which can help them to function better on their own post treatment."
References:
1. Talley NJ. Differentiating functional constipation from constipation-predominant irritable bowel syndrome: management implications. Rev Gastroenterol Disord. 2005 Winter;5(1):1-9. PMID: 15741927.
2. Heaton, K W & Lewis, S J 1997, 'Stool form scale as a useful guide to intestinal transit time'. Scandinavian Journal of Gastroenterology, vol.32, no.9, pp.920 - 924. Retrieved on 2/3/2007.
3. Talley NJ. Definitions, epidemiology, and impact of chronic constipation. Rev Gastroenterol Disord. 2004;4 Suppl 2:S3-S10. PMID: 15184814.
4. Nhsinform.scot. 2020. Constipation Symptoms And Treatments. [online] Available at: <https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/constipation#complications-of-constipation> .
5. Beckstrand, R. and Pickens, J., 2011. Beneficial Effects of Magnesium Supplementation. Journal of Evidence-Based Complementary & Alternative Medicine, 16(3), pp.181-189.