It’s not something that is discussed much in circles of friends and colleagues – for obvious reasons – but constipation is common. In the UK, approx.12% of the general population suffer from chronic constipation. Twice as many women than men struggle with it, and the over 65s are most affected: 25% of free living older people experience constipation, but a shocking 80% of the elderly living in nursing homes.
Because bowel habits are not a popular topic of conversation, it is hard to know what is normal and what isn’t. If you can answer ‘yes’ to two or more of the following, you are probably constipated:
- Do you ‘go’ less than three times per week?
- Do you often strain (at least 25% of the time)?
- Are your stools often hard or lumpy (at least 25% of the time)?
- Do you often feel that you haven’t been able to excrete everything (at least 25% of the time)
A comparison with the Bristol Stool Chart may also help you see where you are.
Why does it matter?
Not being able to ‘go’ can be extremely uncomfortable, but not everybody feels that way. Some people have infrequent bowel movements and feel fine. In fact, according to the (official) diagnostic criteria just emptying the bowel three times a week is ok. However, the ideal transit time for food is 12 to 24 hours. Defecating three times a week constitutes an average transit time of 56 hours, which really is too slow. A bowel movement at least once a day is what we should all strive for.
If you are not sure, you can test your transit time: Eat three or four whole beetroots and make a note of when you ate them. Wait and see when the beetroot comes out the other end. It should dye your faeces crimson. If you don’t like beetroot, try it with a generous amount of corn on the cob.
Having faecal matter sit in the colon for too long is undesirable for several reasons. Bile acids contained in it can irritate the gut wall, if faeces aren’t excreted swiftly, causing damage. The colon’s main function is to recycle nutrients and water back into the system and to eliminate waste products. In order to do this job properly it needs a healthy gut microflora. Chronic constipation can upset the balance of good and bad bacteria, and an imbalanced gut flora can lead to constipation – a vicious circle. If waste remains in the colon for too long, putrefying bacteria start working on it, releasing toxins, which then cause damage to the intestinal lining with potentially serious long-term consequences.
Old oestrogen, which was meant to be excreted, gets attached to a protein called sex-hormone binding globulin (SHBG) in the liver. SHGB is the vehicle to see the oestrogen out. However, some strains of bad bacteria have the ability to uncouple hormones from SHBG, thus enabling those hormones to get reabsorbed. This can contribute to oestrogen dominance and related disturbances and diseases (e. g. PMS, fibroids, breast cancer). The slower your transit time, the more time bacteria have to send old hormones back into circulation.
Straining to excrete hard stools is the most common underlying cause for haemorrhoids (piles): enlarged, swollen blood vessels around the anus. Once formed, they can make defecation even harder and very painful, and they often cause rectal bleeding.
Other health issues linked to constipation are bad breath, body odour, depression, fatigue, flatulence, food sensitivities, headaches, indigestion, joint pain and dark circles under the eyes.
What causes constipation?
The most common causes by far are a sedentary lifestyle, dehydration and a low-fibre diet. The vast majority of sufferers get rid of the problem by increasing exercise, increase fluid intake and change to a diet high in fibre, eg from vegetables, beans and pulses, as well as wholegrains.
You can add extra soluble fibre by taking linseeds (flaxseeds) or chia seeds. These seeds soak up water and form a gel, which makes stools soft and easy to pass, but make sure to always have them with lots of water otherwise they can make the problem worse. Prunes, too, are excellent helpers. Not only does the fibre they contain help bulk up the stool and move things along, but they are also food for the good bacteria. Bacteria convert the fibre from prunes into short-chain fatty acids, which become fuel for the cells of the gut wall.
Another common contributor to constipation is magnesium deficiency. (Remember last week’s post on vegetables?) Magnesium is involved in the proper function of muscles. The entire digestive system is surrounded by smooth muscle, which contracts in stages (like a Mexican Wave) to move intestinal contents along, a process called peristalsis. For peristalsis to work, magnesium is required. Food processing causes the loss of 75% of the magnesium contained in food, and deficiency is very common. Yet another good reason to move away from junk food – which is also low in fibre! – and start cooking your own.
Putting off going to the toilet can also lead to constipation. If you continuously postpone a bowel movement, the nerves of the rectum become less sensitive to the rectum being stretched and stop sending the message to the brain. If you think that you may already have lost that sensitivity, you can retrain your nerves: Sit on the toilet for 20 minutes every morning and relax. Your colon will soon learn to relax again, too. And stop putting off your trip to the loo: You may not like to go and empty your bowels when you’re not at home, but at work or travelling, but you need to get used to that. It’s what people do.
There are many more reasons why someone would develop chronic constipation. It is, for example, a very common side effect of medication. If you suspect your prescription drugs, take out the leaflet and have a look. If constipation is listed, speak to your doctor. Maybe there is a similar drug that you can tolerate better.
Constipation is also part of a number of diseases, such as stroke, diabetes, kidney disease, illnesses that affect the nervous or muscular systems (eg multiple sclerosis, spinal injuries), over- or underactive thyroid. Stress or depression, pregnancy, high calcium levels, iron supplements and the long-term use of laxatives can be behind the problem. Constipation is very common in irritable bowel syndrome (IBS), diverticulosis and colon cancer. If your bowel habits change for no apparent reason, you must tell your doctor.