When constipation strikes, it slows down not only the movement of the contents of the bowel, which is more difficult to empty but also the daily activities of those who are constipated. It can have a major impact on quality of life, with symptoms of tiredness, bloating, sluggishness, discomfort, feelings of incomplete emptying after going to the toilet, and nausea.
According to Dietitian Connection, constipation is one of the most common medical complaints in Australia. One in four Australians, more than six million people, are affected by constipation.
Unfortunately, constipation is a topic not often discussed openly, due it its unpleasant symptoms. In a Dietitian Connection podcast episode, Accredited Practising Dietitian Sandra Mikhail, author of Gut Chronicles, explains that some patients with constipation may also present with conditions such as haemorrhoids, due to straining.
Nurse and nutritionist Madeline Calfas says constipation isn’t just the infrequency of bowel movements – it also includes the difficulty of passing a stool.
Our stools can be a good indicator of our gut health, so if they’re appearing as pellets, this is a sign of constipation and poor gut health.
Diagnosis can be reached through a visit to a doctor or dietitian, which may involve a physical examination, questions about lifestyle and medical history, or a colonoscopy if necessary.
In the Dietitian Connection podcast, Ms Mikhail addresses the importance of acquiring information about lifestyle and medical history, which may indicate the need for a multidisciplinary team in caring for the condition. This is because there can be many causes of constipation, which may not be nutritional, and which may need to be managed. For example, if nutritional intervention isn’t working, it may be that the cause is stress, in which case, linking the patient in with support for this, such as a counsellor, may be helpful. Another example would be if patients present with the symptom of ‘incomplete evacuation’. This may warrant an assessment by a specialist pelvic floor physiotherapist.
Causes
- Lack of fibre
There are different types of fibre, with two types helping in the prevention of constipation.
Firstly, insoluble fibre adds bulk to our stool to keep us regular. This can come from, for example, nuts, seeds, fruits and vegetables (with skin and seeds where possible) and wholegrain bread.
Resistant starch found in potato, pasta or rice that has been cooked and cooled increases stool bulk and speed of transit through the digestive tract, and can feed the ‘good bacteria’ that live in our large bowel.
Soluble fibre absorbs water and adds bulk to our stool, which helps to keep things moving. Such fibre is found in oats, avocado, legumes and fruits.
- Inactivity
Exercise strengthens the muscles in the digestive system, helping the contents of the bowel to move through quickly.
- Insufficient water intake
Even with enough fibre in the diet, those who don’t drink enough water can still get constipation. According to Dietitian Connection, fibre pulls water into the digestive tract and softens the stool. Without this water, the stool will be hard and difficult to move along the digestive tract.
- Stress
Stress can affect the gut, for example by causing inflammation, and can lead to constipation or diarrhoea.
- Avoiding bowel movement
Doing this can cause the stool to lose moisture, making it harder to pass when trying.
- Changes to routine
Sometimes a change in a usual routine – for example, less sleep, going on holidays, or shift work – can lead to constipation.
- Medical conditions
Other causes of constipation include medical issues, such as hernia, or an obstruction of the rectum or anus, and gastrointestinal conditions such as irritable bowel syndrome (IBS).
- Inadequate diet
Ms Calfas says not eating enough food can also contribute to constipation as the fewer calories and less food passing through the digestive tract slow the transit time of food, allowing the colon more time to absorb water from food content and drying out the stool.
Constipation management
It’s important to treat constipation before it becomes long-term and chronic, as this can lead to complications, including haemorrhoids or urinary incontinence, as the constant straining weakens pelvic floor muscles.
According to Dietitian Connection, dietitians know that lifestyle change is a first-line treatment for constipation – in the form of fitness, fibre and fluid. However, with many different causes and types of constipation now identified, this has meant more ways and complexity are involved in managing this condition. For instance, scientific research now shows how pre- and probiotics can play a role in getting bowels moving.
- Dietary improvements
Try to increase fibre intake by consuming whole grains and legumes. Great sources of wholegrains include rolled oats, brown rice and wholemeal pasta. Another way of boosting fibre intake is through eating a ‘rainbow’ of at least two fruits and five vegetables a day – with their skin on, which is where all the fibre goodness is.
Patients with a medical condition such as IBS should seek the assistance of a healthcare provider or dietitian for dietary advice, as even a high-fibre diet may cause issues.
- Supplements
A dietitian’s approach is usually to treat through diet first, then, if little improvement is achieved, supplementation may be recommended.
Fibre supplements may be helpful if someone is unable to include the appropriate foods in their daily diet. However, according to the Better Health Channel, fibre supplements can also aggravate or cause constipation, so it’s best to always check with a doctor or dietitian before using them.
- Pre- and probiotics
The gut microbiome comprises trillions of bacteria and microorganisms living in the digestive system. A healthy microbiome is one that has many kinds of bacteria and high levels of ‘good’ bacteria, such as lactobacilli and bifidobacteria.
Dietitian Connection says that some pre- and probiotics have been linked to reducing constipation. In particular, the prebiotic galactooligosaccharides (GOS), which are found in beans, chickpeas, lentils, cashews and pistachios (along with GOS-enriched foods such as milk) have the potential to nourish helpful microbes, such as bifidobacteria, that play a key role in digestive health.
Specific strains of probiotics, such as B. lactis in foods such as yoghurt and kefir, may be able to support the regularity of bowel movements.
A dietitian can help identify foods that have the relevant probiotic strains in a dose suitable for certain conditions, such as constipation. Similarly, with regard to probiotic supplements, a dietitian recommendation would be ideal, as Ms Mikhail explains in the podcast that specific strains of probiotics can be more suited to assist with specific types of constipation.
- Move more!
Aim for 30 minutes a day, even if it’s just walking. Food waste is massaged down the length of the large intestine by waves of muscular contractions, called peristalsis, and exercise can stimulate the digestive muscles.
- Drink more water
Dietitian Connection recommends 30ml of water per kilogram of body weight each day. This can assist with softening of stools to help them move through the digestive tract.
- Laxatives
“The use of laxatives over a long period can lead to dependence on them and further compound the problem,” Ms Calfas said, adding that she recommends a healthcare professional be sought if constipation is persisting despite lifestyle measures, to determine if other underlying factors may be contributing to constipation.
“Prevention through lifestyle is always going to be the recommended approach. The use of supplements to alleviate constipation would be considered an immediate and short-term measure, and in some cases where medications are contributing to constipation. Pharmacists are well placed to recommend supplements if someone hasn’t passed a bowel motion and is experiencing symptoms.”
- Seek help from a dietitian
“Diagnosing the underlying reason leading to constipation is important before recommending specific products,” said Victoria-based Accredited Practising Dietitian (APD) Jacinta Sherlock
An APD is well qualified to assist with this.
Role of pharmacies
Ms Calfas says pharmacies may identify any medications that might be contributing to constipation and recommend the appropriate laxative.
“Pharmacists [and pharmacy assistants] may also have additional training in lifestyle medicine and holistic care approaches that can enable them to make more specific recommendations,” she said
“There can be many benefits for the patient of pharmacists collaborating with other health professionals, such as GPs, naturopaths and nutritionists. They can write a letter of referral to provide some basic information, such as when the patient first presented to the pharmacy with this issue, the treatments tried (both pharmaceutical and natural) and the outcome. This can be helpful to the practitioner receiving the referral and provides them with an opportunity to liaise further with the pharmacist.”
References:
- dietitianconnection.com/app/uploads/2022/01/Bega-GHM-2022-Patient-resource-v13.pdf?utm_medium=email&utm_campaign=Bega%20GHM%20EDM%20Feb%202022&utm_content=Bega%20GHM%20EDM%20Feb%202022+CID_1a96febe4bd262f089998b568000f288&utm_source=CreateSend
- betterhealth.vic.gov.au/health/conditionsandtreatments/constipation#medical-causes-of-constipation
- dietitianconnection.com/podcasts/beyond-fibre-fluid-fitness-managing-constipation/?utm_medium=email&utm_campaign=GHM%20gut%20health%20month%20EDM%207&utm_content=GHM%20gut%20health%20month%20EDM%207+CID_1b24b425f262f684393d1c535eefd973&utm_source=CreateSend&utm_term=LISTEN%20HERE
Written by Tracey Cheung.
This feature was originally published in the July issue of RPA e-magazine.
