Dietitian Clarice Hebblethwaite discusses a topic most of us don’t like to talk about — and offers solutions to get you moving.
How often do your bowels move? It’s hardly a discussion you have at work or over coffee with your friends! And that’s the trouble, as it leaves us not knowing what’s a normal bowel habit and what is constipation.
Sometimes a person only learns they have constipation when talking with their doctor. Up to that point they may have thought having a bowel motion once a week was normal and ‘just like everyone else’.
If asked, most people would say constipation is straining, hard pellet–like stools (bowel motions), not being able to go when you feel the need, or not going often.
But clinically, chronic constipation is diagnosed when a person has bowel motions twice a week or less. This is reinforced when there are other features as well, such as straining to pass a bowel motion, abdominal discomfort, and a sensation of not emptying the bowel completely.
How it affects your health
Often people who are living with constipation have no idea it is affecting their health in other ways, such as making them feel tired.
Why is this? We eat and produce lots of waste every day. Most of this is packaged into safe compounds by the liver and emptied into the digestive tract to leave the body in bowel motions. In the lower digestive tract (colon) are billions of bacteria, which are vital for our health. The problem comes when waste products sit in the colon for days rather than a few hours. When this happens the bacteria can start to unpackage these waste products, which then re-enter the blood stream to circulate back around the body. The result can be a feeling of tiredness, ‘foggy brain’ and skin problems such as acne.
Constipation often creates bloating and wind which feels uncomfortable. For many people there is nothing more frustrating than clothes feeling tighter as the day goes on.
How often should I go?
Ideally your bowel will move once or twice a day, most days of the week. It will move easily without you straining to go and the motion will be soft and bulky.
How can I get things moving again?
Listen to your body
We may ignore the need to go to the toilet if we are too busy at work, don’t like the public toilets or are embarrassed to go at work in case we make a noise or smell. But If you frequently don’t make the time to go when the urge arises, the bowel can stop giving you the message.
Respond to the urge to go to the toilet. Often the best time for the bowel to move is in the first two hours after waking or breakfast. Sometimes having a hot drink is enough to result in an urge. Make sure you allow time to respond to this urge rather than ignoring it.
Eating more fibre can make the bowel motion bigger and bulkier. A bigger, bulky motion increases bowel pressure, which makes the digestive tract muscles squeeze, giving you the urge to go to the toilet. Fibre is in vegetables, grains, fruit, nuts, seeds and legumes and pulses such as lentils and chickpeas. See ‘Getting more fibre’ below, for 30 ways to get more into your day.
Drink plenty of fluid
Most adults need about two litres of fluid each day. Fluid helps the fibre soften and swell, creating a bigger and bulkier bowel motion. Enjoy water, herbal tea, fruit tea, soup, vegetable juice as well as tea and coffee. Drink enough that you don’t get a dry mouth, thirst or dehydration headaches. Another good sign that you are drinking enough is the colour of your urine. It should look like pale lemon juice rather than whisky! You will need to drink more fluid on days when you are active, sweating more, in air conditioned buildings and at home with the heat pump going.
Move your body
Keep active each day with activities such as walking, running, dancing, Thai chi and yoga.
I’m doing all that and still feel constipated!
In some cases, eating a high fibre diet doesn’t improve the constipation. The next step you can try is taking a laxative. There are different types to take. Some laxatives work by bulking the motion, others by drawing water into the colon, or stimulating the colon muscles to squeeze. Ideally it is best to discuss the choice of laxative with your doctor and rule out any underlying disease or more serious causes.
Bulking fibre supplements are concentrated forms of fibre from plants that are dried and ground up into a powder, or granules. Follow the recommended dosage on the product and slowly build up the dose over two weeks, as bloating can occur. Do drink a couple more glasses of fluid than usual if you are taking a bulking fibre supplement.
Another group of commonly used laxatives are based on fruits containing enzymes or certain sugars, such as kiwifruit (available in Kiwicrush and Phloe products), prunes or rhubarb.
Looking after your colonic bacteria can also help keep your bowel healthy and regular. There are about 3kg of bacteria living in our colon. Much of the bowel motion is formed from bacteria that have finished their work and are ready to be eliminated.
Probiotics are strains of healthy bacteria that can help balance out the ‘good’ and ‘bad’ bacteria in the colon. One particular strain called Lactobacillus casei Shirota has been shown to help constipation. This strain is present in Yalkult drinks (available in the supermarket chiller).
If trialling a probiotic, take it for a month to see if it makes a difference to your health symptoms. If helpful, then continue as a daily treatment for three to six months.
For a healthy bowel it is certainly worthwhile including naturally fermented foods in your daily diet, such as bio-live yoghurts, kimchi, unpasteurised sauerkraut and other fermented vegetables, kefir or kombucha drinks.
If the constipation still persists despite all your efforts, contact your doctor or health practitioner. If you have symptoms of blood loss in your bowel motions or unexpected weight loss you should always consult your doctor.
What if I still have abdominal discomfort, bloating and wind?
A change in bowel habit with bloating and wind could be irritable bowel syndrome (IBS) and it is worth talking to your doctor. Dietary changes can help IBS and up to 75 per cent of people find symptoms are triggered by a food intolerance, such as an intolerance to FODMAPs.
Our Fodmaps toolkit will give you a lot more on this topic, and on this website we have low fodmap recipes together with recipes that can easily be made low fodmap. A specialist dietitian working in the area of digestive health and food intolerance can also help.
Some girls and women have constipation with IBS symptoms to find they have endometriosis triggering their bowel symptoms. If period pain or mid-cycle pain are also present, then discuss your symptoms with your doctor.
For more information on constipation and irritable bowel syndrome, go to www.iffgd.org.
Getting more fibre
It’s easy to eat more fibre. Slowly try to add these higher-fibre options into your day.
- Choose grainy, high-fibre bread made with wholemeal flour (look on the nutrition information panel of the pack for bread with more than 5g fibre per 100g).
- Eat fresh or cooked fruit with the peel left on, such as apples or pears rather than canned fruit.
- Add 1-2 tablespoons of bran to high-fibre breakfast cereal (eg. oats, Weet-Bix or muesli, which contain more than 5g fibre per 100g). Some people find bloating worsens with wheat bran, so try oat bran or rice bran.
- Add veges to eggs on toast – try rocket, spinach leaves, mushrooms and tomatoes. Top with a sprinkle of sunflower and pumpkin seeds.
- Add a handful of green leaves to smoothies including spinach, silver beet leaves, rocket or kale.
- Add 1-2 tablespoons of linseeds (also called flaxseeds) to cereal, or to vegetable juice or a smoothie. You can buy them ground or whole.
- Snack on raw nuts, sunflower seeds, pumpkin seeds.
- Choose grainy, high-fibre crackers or biscuits made with oats, oat bran, dried fruit, linseed, wholemeal flour, nuts, pumpkin seeds or sunflower seeds.
- In sandwiches, add extra salad, or try having a couple of handfuls of vege sticks as a side.
- Make meals that let you add lots of veges — soups, stir fries, salads or bakes. Enjoy hummus and salad as a high-fibre filling in sandwiches.
- Here are a few high fibre recipes to try: Roasted carrot and onion galette, Grilled chicken with mango salsa, Mexican eggs, Lamb souvlaki wraps
- See all our high fibre recipes
Your fibre profile
Tally your answers to the questions below:
Q. How often do you eat a slice of wholegrain bread, such as multigrain, wholemeal or rye or a half cup of brown rice or pasta?
B. 3-4 times a week
C. Every day
Q. How often do you include half a cup of legumes (baked beans, lentils, chickpeas), barley or potato salad in your diet?
B. 3-4 times a week
C. Every day
Q. How often do you have at least 2 pieces of fresh, unpeeled fruit and at least 5 serves (2 1/2 cups) of vegetables a day?
B. 3-4 times a week
C. Every day
Q. How often do you eat high-fibre breakfast cereal, eg. wholegrain flake biscuits, bran flakes, muesli or oats etc?
B. 3-4 times a week
C. Every day
How you scored:
Your total intake and mix of fibres is likely to be low. Check the advice here and aim to gradually increase your fibre intake from a variety of sources.
You’re on the right track to eating enough fibre. Check out different sources of fibre and aim for a variety of these foods each week.
You’re an absolute ‘fibre star’! You should already be getting enough total fibre and mix of fibres in your diet.
Quiz courtesy of The Gut Foundation