Constipation is a common problem that affects around 1 in 7 people. Constipation is the passing of hard, dry bowel motions (stools) that may be infrequent or difficult to pass. The most common causes of constipation include a change in routine, medications, not enough fibre in the diet, not enough fluids, and a lack of exercise. Here are our tips on managing constipation.

Allow regular toileting times, don’t hold it or avoid going
A lot of people will avoid going to the bathroom if they are not in their home environment or when they are not comfortable or relaxed. Ignoring the urge to go leads to excess fluid being drawn from the bowel which in turn can make a stool drier and harder to pass. Going to the toilet when you feel the urge is important for health bowel motions.

Adequate Fluids

There is very little scientific evidence to suggest that the strategy to increase fluid intake alone is effective to resolve constipation, except in the presence of dehydration or when increased fibre recommendations are provided. The fluid intake of constipated person is thought to be the same as that of a non-constipated person. We know that bowel movement frequency decreases with a very low fluid intake of 500ml per day compared to a healthier 2500ml per day, however increasing fluid above 2500ml per day does not appear to have additional benefit on bowel motion output. If you are increasing your fibre intake or taking a fibre supplement, having an adequate fluid intake of 2-2.5L per day is recommended. Motions that look like pebbles or a lumpy sausage are often contributed to by a lack of fluid.

Adequate Fibre

Dietary fibre is the parts of plants that are resistant to the digestion and absorption in the small intestine, usually with some fermentation in the large intestine, fibre passes through to form the bulk of a bowel motion. There are 3 types of dietary fibre: insoluble, soluble, and resistant starch (we have written another blog on fibre for more info on this)

Ways to increase fibre include:

• Choosing wholegrain breads, cereals, crackers, pasta, brown rice, and other wholegrains such as quinoa
• Include 2 serves of fruit a day.
• Consume vegetables twice daily,
• Choosing vegetables and fruits with skin, seeds, or stem with have increased fibre content,
• Include legumes and lentils in dishes such as curries, salads, soup
• Choose high fibre snacks such as nuts and seeds, dried fruit, seeded crackers, savoury chickpeas, hommus and veggie sticks

Laxatives

Laxatives should be used under the guidance of a health practitioner as some are safer than others for long term use, however they play a vital role in managing constipation particularly those who are chronic sufferers or have a slow bowel transit time. There are different types of laxatives such as osmotic laxatives, stool softeners, oral stimulants, and rectal suppositories. Whilst using a laxative may not be your ideal scenario, they definitely have their place, as it is also not ideal to have constipation long-term as this can lead to health complications such as diverticular disease, haemorrhoids, and impacted bowel. If you have been constipated for 3 days or more, a laxative may be warranted to prevent long term health effects of constipation.

Correct Toileting Posture
The Continence Foundation of Australia recommends sitting with your knees higher than your hips (use a foot stool or other flat, stable object if necessary) lean forward and put your elbows on your knees. Relax and bulge out your stomach. For children adding a step under the feet can be a great addition.

Physical Activity & Movement

A lack of regular physical activity can lead to constipation, just as regular physical activity can lead to the bowels opening more frequently. Getting in 30 minutes of activity daily and avoiding prolonged periods of sitting may reduce your constipation risk.

Food Based Stimulants

Certain foods are known for their laxative or bowel opening effects. Examples include, pear juice, prune juice, dried fruit, kiwifruit, and chia seeds. Coffee also has a natural stimulant effect on the bowel as can other warm beverages. Several studies have examined the role of kiwifruit in the management of constipation  with one study of healthy adults with constipation-prone IBS, showed that eating 2 green kiwifruit per day for 4 weeks increased frequency of bowel motions and reduced colonic transit time. It is not known exactly what it is about kiwi fruits though it is thought to be the fibre component of kiwifruit having a particularly high water holding capacity and that this may assist with stool bulking.

By Caitlin Mannion, Dietitian