Most of us aren't comfortable talking about our bowel movements. In fact, a recent survey found bowel health was second only to sexually transmitted infections on a list of embarrassing things to talk about with our GPs.
And yet, the same research revealed that 1 in 7 adults and 1 in 3 children have constipation at any one time in the UK. An average of 182 people are admitted to hospital every day with constipation, and the cost to the NHS for treating unplanned admissions due to this condition was a whopping £145 million in 2014/2015.
It's a big problem, and our collective unwillingness to talk about bowel health and constipation was found in the study to stem from a lack of knowledge of the issue combined with the taboo nature of the subject of "poo". But we're not shy here, so let's throw open the toilet door, and talk about constipation:
What is considered 'constipation'?
Constipation is not just about frequency (or infrequency) of bowel movements, but rather it describes a collection of symptoms that include the following:
- Excessive straining
- Hard, pellet like stools
- Feeling of incomplete evacuation
- A sensation that you cannot go or will not be able to go
- A decrease in frequency of bowel movements
Importantly, when it comes to defining constipation, everyone is a little bit different. According to Dr Anton Emmanuel, Senior Lecturer in Neuro-Gastroenterology at UCL, there is no "normal" when it comes to bowel movements:
"Constipation is highly individual. There is no necessity to have a daily bowel action, and in fact only about half the normal population have one bowel action per day."
Rather, it's about being conscious of your own bowel movements, and crucially be able to talk about them when necessary.
What causes constipation?
Constipation has dietary, psychological, physical, emotional and hormonal components to it, and the combination of these will be different for every individual. Here are some of the most common causes:
Not eating enough fibre
Dietary fibre is mostly indigestible, which means that as it moves through the digestive tract, it pushes the rest of the food along too. Fibre also tends to absorb water, helping to keep your stools soft and bulky (that's a good thing, promise).
An all too typical 'Western diet' that is high in processed foods and low in fruit and vegetables tends to be very low in fibre too, and this is likely to be underlying a larger number of cases of constipation. Studies have indicated, however, that fibre may not be that useful in curing constipation, but better at preventing it. Whole grains, oats and lentils are some of the best sources of fibre.
Constipation is a common side effect of a number of prescribed drugs including narcotics, antidepressants, diuretics, blood-pressure medication and some antacids (containing calcium and aluminium). Some types of iron supplements can also cause constipation. If you're not sure of the side effects of the pills you're on, check with your GP.
Studies on constipation in adults have confirmed psychological factors can play a big role. We know that the brain and the gut are very closely linked, and the impact of stress and unresolved issues can effect your toilet habits (you may have experienced this, for example before an exam or job interview, with that sudden urge to go). In some cases of constipation, your bowels could be indicating something that you're not acknowledging consciously.
Dependency on laxatives
Chronic sufferers of constipation may be prescribed laxatives (or buy them over the counter) to help with their bowel movements. Whilst these are effective, over time they allow the bowel to get lazy. Individuals become reliant on them to be able to go, and when they then to stop taking them, constipation often occurs.
Ignoring the urge to go
Many people have issues with going to the toilet in public places or in the workplace while others feel too busy to go. But peristalsis, which is the gut contraction that precedes a bowel movement, only occurs on occasion and it's important not to ignore this signal. Putting off going to the loo for a more convenient time (such as when you get home), can result in constipation. The longer the stool sits in the bowel, the more water gets reabsorbed from it and the harder it gets, making it more difficult to pass.
Women may experience their bowel movements change depending on where they are in their menstrual cycle. This is largely due to fluctuations in levels of the hormones oestrogen and progesterone, which can effect gut transit. Pregnancy also brings about hormonal changes which can make a woman more susceptible to constipation.
Not exercising enough
Regular exercise is necessary to promote normal contractions of the bowel, and leading a very sedentary lifestyle can underly chronic constipation. This is particularly common in the elderly, when mobility can become restricted.
Not drinking enough water
If you're dehydrated, your body will try to compensate for the lack of water by absorbing it from as many sources as it can, and the stools are its first target. This can make the faeces dry, and difficult to pass. Water is also essential to keep things moving through the gut, and if it's in short supply, gut motility can slow down.
What's the best way to treat constipation?
If constipation is chronic, the first step should be to go to your GP and check that there are no medical conditions underlying it. With most cases, there are no underlying non-bowel problems so if this is your diagnosis, there are certain lifestyle changes to try:
Make it a part of your morning routine
Try to go to the bathroom at the same time each morning: the motor activity of the colon is highest at this time. Make sure you give yourself enough time to go. If you're not relaxed or are in a hurry it just won't happen.
Know your own triggers
For some individuals, it's a strong morning coffee, for others it's their daily breakfast cereal that triggers a visit to the loo. You may have experienced constipation when you go on holiday, and this is often due to a change in daily routine. If you know what your 'toilet trigger' is, you can try and maintain this on your holiday.
Keep a food and symptom diary
If you think diet might play a role, the best way you can identify the culprit foods is to keep a food and symptom diary for at least a few weeks, and look for patterns. Some common food triggers for constipation include dairy, eggs and meat, although this is very individual.
Increase fluid intake
Use the colour of your pee as a guide to whether or not you are dehydrated. It should be a pale straw colour. You should also be mindful that alcohol is very dehydrating for the body, and should be avoided, or at least kept to a minimum, if you are suffering from chronic constipation.
Try relaxation techniques
If you believe stress or emotional issues may be underlying your constipation, relaxation techniques such as meditation and breathing exercises can be helpful.
Exercise lik yoga
Keeping physically active can be extremely beneficial for supporting the flow of digestion. In particular, certain yoga poses (mainly ones that involve twisting) increase blood flow to the digestive tract and stimulate the intestines to contract, which can help to relieve constipation.
Dr Emmanuel says: "For some, magnesium can help - it has a laxative action in terms of drawing water in to the bowel. There are other speculations that it may increase gut contraction, but this remains unproven". Rich dietary sources of magnesium to include in your diet are dark leafy greens, nuts, seeds, fish, beans, whole grains and avocados.