Constipation is a common complaint that often results from dietary and lifestyle habits and is defined as a reduction in bowel movements or difficulty passing stool.
When food particles enter the colon, water and electrolytes are absorbed from the food particles into the intestine. As the food particles move through the colon, bacteria further metabolise the food particles into faeces. The slower the “bowel transit time” (the time it takes for your stools to move from the beginning to the end of the intestine) the longer the faeces spends within the intestinal tract, therefore, the more dehydrated the stools become and the more difficult it becomes to pass the stools resulting in constipation. Repeated withholding of stools can cause constipation, it is, therefore, best to move your bowels when first feeling the urge to “go”.
Everybody’s stool pattern differs from each other, some people “go” once to three times a day and others only three times a week. Although everyone’s bowel habits differ, people who are constipated usually have less than three bowel movements per week. Keeping a diary of your bowel habits is a good tool to identify your stool pattern and possibly identify causes for irregular changes in one’s bowel habits.
Constipation can often be associated with:
- hard, dry or lumpy stools
- stools in the form of small, hard balls (like stones)
- straining during bowel movements (pain and discomfort)
- inability to empty the bowels fully
- bloated abdomen
- small streaks of red blood in the stools or on the toilet paper after wiping.
What is normal?
- When feeling the urge to “go”, one can hold for long enough to get to a toilet.
- Ability to have a bowel movement within a few minutes of sitting on the toilet without any strain or pain.
- The satisfying feeling of an empty bowel after a bowel movement.
- Formed stools that are easy to pass. According to the Bristol Stool Form Scale seen in the picture below, ideally, stools should be the consistency and shape indicated as Type 3 and 4.
Nutritional management to promote healthy bowel movements.
Drink 1 – 2 litres of fluids every day. Preferably clean water.
Dietary fibre includes the parts of plant foods your body cannot digest or absorb. Instead, dietary fibre passes relatively intact through your intestines increasing the weight and size while softening your stools. As some people experience gas or abdominal cramps when rapidly increasing their fibre intake, it is especially important to gradually increase fibre as well as fluids in your diet to allow time for the bowel to adapt and prevent discomfort. For optimal benefits eat a variety from both types of dietary fibre groups, namely:
- Water-soluble fibre, which softens stools by bringing water into the bowel dissolving the fibre to form a gel-like material. Increase your intake of water-soluble fibre by including fruits (apples, bananas, citrus fruit), vegetables, legumes (lentils, dry beans, soya and split peas), oats and oat bran daily. Hints:
- Eats oats porridge regularly or use oats as a thickener.
- Add bran to porridges, yoghurt, soups or stews.
- Add lentils, dry beans or split peas to stews and soup when cooking.
- Eat at least 5 portions of fruits and vegetables every day.
- Water-insoluble fibre, which increases stool bulk promoting the movement of food through the intestines. Increase intake of water-insoluble fibre by including vegetables, fruits, cereals, whole-wheat products and wheat bran. Hints:
- Eat whole-wheat or brown bread instead of white bread.
- Use whole-wheat flour instead of white flour when cooking or baking.
- Use unrefined maize meal.
- Add lentils to rice when cooking or make lentil spread.
- Eat at least 5 portions of fruits and vegetables daily without removing the peels and pips.
- Eat popcorn or nuts as a snack.
- Choose foods with a fibre content of at least 5g/100g.
Probiotics and prebiotics
Probiotics and prebiotics are both active in building a healthy colony of “good bacteria” supporting the gut and aiding digestion. Probiotics are live “good bacteria” that occur in many fermented foods, including yoghurt, kefir, sauerkraut and tempeh. Prebiotics are types of fibre presented in fibre-rich foods such as whole grains, fruits and vegetables that feed the “good bacteria” in the digestive system.
Staying active on a daily basis also improves gut mobility and aids digestion which in turn promotes healthy bowel habits. Make physical activity part of your daily routine.
Go to the toilet as soon as you feel the need to go, and do not keep the stool back. Visit the toilet for about 15 minutes at the same time every day to establish a routine. Never ignore the need to use the toilet.