We're launching a new series digging into the what, why and how on all your gut-related questions. First up, we're talking constipation with Gastroenterology Dietitian Dr Sammie Gill. As our most frequently asked customer question, we're explaining exactly what chronic constipation is, what causes it and how you can help manage it.
What is chronic constipation?
Chronic constipation is used to describe the collection of symptoms that relate with difficulty going to the toilet.
There are different types of chronic constipation - two of the most common types are functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C).
Although FC and IBS-C are separate gut disorders, there is overlap in symptoms (e.g. bloating, gas, lumpy or hard stools). The main difference between them is that people with IBS-C will often experience abdominal pain. This isn’t usually present in FC.
Other types of constipation can occur as the result of an underlying health condition (e.g. inflammatory bowel disease, underactive thyroid, diabetes, Parkinson’s disease) or medication use (e.g. opioids, iron supplements).
Generally, for a diagnosis of chronic constipation you must experience some of the following:
- Straining
- Pooing less than 3 times per week
- Having lumpy or hard poo (Bristol Stool Form Scale 1-2)
- Having the feeling that you haven’t fully ‘emptied’ or having the sensation of blockage
*Diagnosis is defined using the Rome IV Diagnostic Criteria for Constipation.
Why does it happen?
Some of the reasons for chronic constipation include:
- A diet that is low in fibre
- Not drinking enough fluids or dehydration
- Low levels of physical activity/being sedentary
- Heightened emotions (e.g. stress), anxiety, and depression
- Hormone levels (e.g. pregnancy, menstruation)
Other reasons include:
- Pelvic floor dysfunction – a disorder that happens when you have difficulty coordinating the muscles that support the bowel, bladder, and uterus (in women). Management of pelvic floor dysfunction includes biofeedback training and physical therapy.
How can you help manage it?
It's all in the toilet position
Keep your knees higher than your hips (use a box or stool) when you go to the toilet and lean forwards. You might find this image handy.
Think about your diet
Gradually increase plant-based diversity. Focus on wholegrains, fruit, veg, nuts, seeds, and legumes. As to specifics, kiwis, prunes, linseeds/flaxseeds, and chia pudding can help stimulate gut motility, as well as softening and bulking out poo making it easier to pass. You could also consider a fibre supplement, such as psyllium husk. For IBS-C, trialling the low FODMAP diet (or relaxed version) may be recommended.
Keep your fluids up
Drink regularly and maintain hydration (e.g. water/infused water, fruit tea, milk, small glass of fruit juice). Fluids also help fibre to work. Having a coffee or tea in the morning can help ‘wake up’ your gut.
Consider relaxation techniques
Mindfulness, meditation, yoga, and belly breathing can help to relax the gut. Listen to your body signals. Don’t put pressure on yourself to go. Go to the toilet if you have the urge to go.
Try massage
Gently massaging your abdomen area lying down can relax the gut muscles and stimulate gut motility. Start on the lower right-hand side, moving up and underneath your ribs and down the left-hand side.
Focus on physical activity
Keeping active, such as walking or light cardio, can help stimulate gut motility.
Trial a probiotic
Studies have shown that probiotics may help to stimulate gut motility through changes in gut microbes and their compounds (e.g. short chain fatty acids). Record your symptoms over the time you’re taking them (usually 4-12 weeks) so you can decide at the end whether it’s worth continuing or not.
NB: There is no one approach to treating chronic constipation and different approaches will work for different people. It’s often a combination of approaches that can help. For tailored advice, please seek advice from a registered dietitian.
