Constipation can range from occasionally missing a day to going days (or even weeks) at a time without having a bowel movement. Whether it is an issue or not depends on how often this happens and most importantly, why it is happening.
Ideally, we would pass a stool at least once per day. Characteristics of the perfect bowel motion include:
• well-formed (not loose, sloppy or pellet-like)
• one long piece (can even be as long as your forearm!)
• sausage, banana or s-shaped
• smooth surface
• easy to pass without straining or pain or having to wait a very long time
• disappears to the bottom of the toilet
• is not overly foul-smelling
• a nice medium-brown colour
• contains no blood, mucous or undigested food
• is not messy (no need to wipe your bottom for hours – you should be left quite clean)
• and you feel completed evacuated once done
This means that someone suffering constipation is likely experiencing a different scenario then what is listed above. This may include:
• ‘skipping’ a day or more at a time, and on a consistent and regular basis (not a once-off occurrence)
• dry and/or hard stool
• appears as small pellets (think rabbit poop) or perhaps larger but broken into a few or many pieces, or are very lumpy and bumpy
• abdominal cramps, bloating or other pain
• straining or ‘pushing’ required to pass stool, and may be accompanied by pain or bleeding
• not feeling completed evacuated once you’ve gone to the toilet
Think about your own experience – is this you? If so, there are steps you can take to achieve healthy bowel function.
But first, what causes constipation?
There are many causes of constipation and different populations where this occurs more frequently; for example, the elderly, pregnant women, those taking certain medications or supplements, food intolerances, people experiencing gastrointestinal disorders, physical mobility limitations, not going when the urge occurs (‘holding it’), dehydration, too little of the right kind of fibre, a sedentary lifestyle and/or lack of exercise, or overuse of laxatives in the past. Depression and periods of grief are also linked to constipation, as well as stress and anxiety (although stress/anxiety is more often linked to diarrhoea or alternating constipation/diarrhoea).
What is the problem with missing days?
The issue with not having at least one healthy, easy bowel motion every day (aside from the unpleasant signs and symptoms listed above), is that this is a big clue that the digestive system, and overall health really, are not working optimally. And it is important to pay attention to your body’s clues that something isn’t right. Why? Because the longer these are ignored, the more severe this can become, and the greater the likelihood that other body systems and functions will start to be affected in a negative way.
Our body has methods of elimination for a reason. It allows us to get rid of waste that is no longer useful to us, or may contain toxins. For example, we sweat, urinate, defecate; even exhaling removes waste from our body. This is an important process that allows us to remain healthy. If we retain faeces inside of us for long periods, we end up absorbing its moisture and toxins back into the body. This causes the stool itself to become dry and hard (making it even harder to pass), and makes more work for our body to try and eliminate these waste products that have gone back into the system. We definitely don’t want this to be happening. At best, it is just a little discomfort, perhaps some skin issues or pain; at worst, chronic constipation may be a contributing factor in colorectal cancer, although there have been some conflicting conclusions in studies.
How to fix this…
I’ve seen many clients with varying degrees of constipation, many of them pregnant women. As mentioned earlier, it is important to investigate the cause so that we know how to prevent this from continuing to occur. This involves individual consultations. In the meantime, there are a number of things you can do to help digestive function if you are experiencing constipation.
- First and foremost, ensure you are drinking enough water every day. The amount required varies, but most of us of average size can count on about 2L each day, more if you are a larger person, and even more when you are exercising. The get the most out of your water, try to sip it throughout the whole day, rather than go long periods without drinking and then gulping down a large amount at once. If you drink herbal teas, then this counts as part of your daily water intake. Coffee, black tea, alcohol, soft drink, cordials and supermarket juices do not count and are best consumed in very small quantities or eliminated altogether. Ideally your water is pure and filtered to avoid as many contaminants as possible. Add in a couple of pinches of good quality Celtic, Himalayan or other sea salt (not table salt) to increase the benefits.
- Make sure you are including plenty of healthy fats in your daily diet, particularly Omega-3 fatty acids, which are found in fish and nuts like walnuts. Not only are these required for many bodily functions and overall health, but they will also act as a lubricant. Healthy fats for this purpose include olive oil, coconut oil, butter, ghee, flaxseed, nut and seed oils, fish oils.
- Increase your fibre. And by this I do not mean run out and buy a bran cereal. These are very abrasive and do not contain the whole grain. It is by increasing fruits and especially vegetables every day that you will ensure you are getting insoluble fibre that makes for a happy gut! Not only will this help to move faeces through and out of your digestive system, but this type of fibre also contains prebiotics which provide fuel for the bacteria in your gut, helping everything to function better. A great little tip which I use with many of my clients: eat some grated apple in the evening and again in the morning to see quick results. Or soak some prunes and/or dried figs overnight and eat the fruit and drink the soak water in the morning. Kiwi fruit blended with the skin is also excellent for this, as well as very soft, ripe pears.
- Probiotics. Various studies show several specific strains of probiotic bacteria that significantly improve constipation. Some of these include Bifidobacterium animalis, Bifidobacterium lactis, and Lactobacillus rhamnosus. Specific formulations would be prescribed to you depending on your whole picture, but without a nutrition consultation, you can be fairly safe to get some benefits by picking up a good multistrain probiotic supplement, as well as consuming fermented foods and drinks regularly, such as kombucha, cultured vegetables, sauerkraut, yogurt, and tempeh. It is important to be aware of which of these (and how much) can be tolerated, and only a small amount is required (i.e., a spoonful of fermented veggies with a meal).
- Spending most of the day sitting and lack of exercise can make for a very slow digestive system. Have you ever noticed soon after you’ve gone out for a big walk or had a session at the gym that need to have a bowel movement? Getting moving gets things moving!
- Check your medications and supplements. Some medications are well-known to cause constipation. Ask your doctor if this is the case, and what could be done about it. Some supplements, such as supermarket or chemist iron tablets, can also cause gut irritation and constipation. Speak to your nutritionist to find out what a better option for you might be. This often involves just switching to a practitioner-only product.
- Identify and remove food intolerances or sensitivities, and work on healing the gut (the reason they are not being tolerated). These may or may not be obvious. Work with your practitioner to identify these and take appropriate action. I provide hair testing that tests for a wide range of foods and household items for biocompatibility which is very specific and targeted.
- Ensure a wide variety of vitamins and minerals. These will ensure that you are getting the necessary nutrients for all your digestive functions. Some of these include magnesium, vitamin C, B vitamins, and other antioxidant and detoxifying nutrients. Adequate protein every day is also very important. You can cover all of these by consuming a wide variety of colourful fruits and vegetables, seeds, nuts, eggs, and good quality meats (pastured/grassfed, free range, etc.). Some people will require supplements to be prescribed, depending on your individual requirements.
- Observe your bathroom habits. Sitting on a toilet is not the ideal or natural position for us to have a bowel motion – squatting is! In the absence of a squat toilet, find another way to raise your feet up closer to the level of the toilet. You can buy special stools for this, or just use what you’ve got in the house. Do you still have a few big phone books lying around? Put those under your feet. Or a step stool, or a tree stump…the possibilities are endless. And when you feel the urge to go to the toilet, go immediately or as soon as you can. Ignoring this signal can have unwanted consequences.
- Self-care. With a link between constipation and depression, anxiety, stress or other mental health issues, it is important to take particular care of your health and happiness. Ensure that you are doing activities throughout your week that bring you joy. If you don’t know what this could be, think about what used to make you happy, even when you were a child. Find ways to relax, such as meditation, listening to soothing music, having a bath, getting enough rest, reading, or doing some exercise, such as yoga or walking. If you are pregnant, get off those feet as often as needed. Ask others for support. Being on your feet all day long will make constipation worse.
- Make an appointment with your local Nutritional Medicine Practitioner. When all else fails, come in and see me or your local practitioner for a deep dive into your case, to do some important investigations to discover the root cause for you, and to start seeing some relief and improvement to your health. It may be a simple solution, or something that requires a bit more work, but there is a light at the end of the tunnel. And you might like to explore working also in conjunction with other beneficial practitioners, such as physiotherapy, osteopathy, chiropractic, Traditional Chinese Medicine/acupuncture, or massage therapy.
A last word on pregnancy…
The Australian Department of Health has noted that various studies show that between 25% – 39% of pregnant women reported experiencing constipation, with the greatest amount earlier in the pregnancy and with a bit of a decrease in incidence moving further throughout the pregnancy.
Although constipation is quite common during pregnancy, again, it is not normal. Or at least, it doesn’t have to be everyone’s ‘normal’. Sometimes it is specific medications and supplements that cause or exacerbate this. Making some changes to these, as well as addressing any other possible causes, using food as medicine, getting adequate rest, staying off your feet when you can, slowing down when possible, and any other required changes can rectify your digestive issues and allow you feel better, especially during this special time. It is important to remember that being pregnant is in itself a full-time job. Try not to overdo it or take too much on, if possible. Work with a caring and understanding healthcare practitioner that can support you and remove some of the burden of taking care of everything yourself.
Are you happy with your digestive function?
Mahan, Raymond & Escott-Stump, 2012, Krause’s Food & the Nutrition Care Process, 13th ed.
Osiecki, H., 2010, The Nutrient Bible, 9th ed.
Rogers, S., 2016, Fruits and Vegetables as Medicine, 2nd ed.