Constipation has affected most of us at some point in life. It can be transient, cyclical or a long term issue. Being constipated is essentially different for different people. For some it means reduction in number of times of passing stool, while for others it might be passing stool that is hard and difficult to pass or a feeling of incomplete evacuation. Constipation can be primary, when it is linked with the function of the large gut or secondary, when it is a consequence of something. This can range from quality of diet, lifestyle, change in diet, change in environment, conditions affecting balance of the gut flora, certain diseases such as diabetes and medication. Stress and functional conditions of the gut such as IBS can also cause constipation. As there are different reasons, the generic advice to increase dietary fibre, have more water and be more active might not be useful to all sufferers and frustrates those who already have these elements in their diet and lifestyle. I find it very useful to explore the reasons that might be responsible for a person feeling constipated before a solution is offered.

Role of diet and lifestyle

Diet and lifestyle have a very important role to play and this blog aims to briefly explain the main elements involved.

Conventional advice is to increase fibre to help constipation, so sufferers with bunged up bowels head to switch to wholemeal bread, pasta, brown bread, bran etc. However it is important to know that fibre is not one entity and increasing it too quickly can have a negative effect on symptoms. There are two types of fibre, soluble and insoluble, and these act differently on the gut and its function, hence choosing the right type of fibre for your symptoms is an important consideration. Although most carbohydrates have both type of fibre, some have higher proportion of soluble fibre and others have more insoluble fibre. It would be rare to find a natural source that has either soluble or insoluble fibre.

Intolerance to certain fermentable carbohydrates can cause bloating and constipation. A diet that is manipulates these highly fermentable carbohydrates (low FODMAPs diet) under supervision of a specialist dietitian can be very effective in management of constipation.

Conclusion

Constipation is disruption in normal bowel routine. This can be due to many factors such as diet and lifestyle that lack the elements that promote regular bowel movement, some diseases or medications or change in number of gut bacteria. Majority of times constipation is transient and can be helped by following dietary and lifestyle changes. Sometimes constipation can be quite refractory to treatment and the above measures don’t help. If possible seeking advice from a gastroenterologist, arranging a hydrogen/methane breath test to check if there is imbalance of bacteria can help pinpoint specific reason behind constipation. If there is imbalance of bacteria or the constipation is a part conditions such as irritable bowel syndrome (IBS) or small intestinal bacterial overgrowth (SIBO), an exclusion diet such as low FODMAPs under guidance of a specialist Dietitian can be very effective.

2018-04-12T17:50:42+00:00