There are many reasons why constipation is so common.

• Diet is probably at the top of the list, followed by

• poor water intake, then

• lack of exercise or physical activity

• Anxiety around finding a bathroom (worse when travelling or stressed)

• Medications or food that slows down the bowel movements,

• You may be genetically prone to a ‘sluggish’ gut, although this too may be related to your lifestyle.

• History of stress or anxiety in your life which affects the sensitivity of the nerves that supply our gut.

What is constipation and what symptoms might you have?

When you are constipated your bowel motion, also known as your ‘stool’, is hard and dry and difficult to pass.

You may also pass a bowel motion less often, so instead of daily it could be every other day or even every second day.

For some people passing a bowel motion every other day is normal for them, but they usually say that the stool is normal i.e. not hard or difficult to pass.

Diverticular disease

When you are constipated the hard stool can cause pain in the rectum as you try to pass it and this leads to straining to pass a bowel motion, which often leads to the formation of varicose veins in the rectum, also known as haemorrhoids. When children experience pain with constipation, they usually then avoid trying to go to the toilet as they know it will be painful. Of course this makes things worse and can lead to a very large stool that is even more difficult to pass. What can happen it the rectum and lower intestine can gradually become bigger as they try to accommodate the large stool. You can probably see what happens next, the widened intestine or rectum then allows a bigger stool to form which is even more difficult to pass! Not very nice for children.

Constipation can also cause little pouches to form along the intestine which are known as diverticula. Later in life they can become irritated and sometimes infected as stool and bits of harder undigested food collect there where they should be passed out of the bowel.

The advice to eat more seeds and nuts may actually irritate your intestine if you have diverticula, so always assess your won response to any changes in your food; it may not agree with you.

Anal tear and haeorrhoids

Along with heamorrhoids and diverticula, you may also develop a small tear in the rectum known as an anal fissure. This can cause an intense pain even when not trying to pass a motion and can become infected, often with thrush.

Both haemorrhoids and an anal fissure can cause fresh bleeding which either coats the stool or you notice it on the toilet paper afterwards.

But never assume that fresh bloods is just from a fissure or haemorrhoids, discuss it with your doctor, have an examination and consider checking a blood count to ensure you are not loosing blood from a lesion in your intestine.

So what can you do to reduce your chances of becoming constipated?

As an individual you have to replace refined foods such as white bread, white pasta, cakes and other refined cereals with whole grains.

Consider eating porridge for breakfast. A lot of cereals containing bran also contain a lot of sugar which is just no good for your intestines, immune system and body in general.

Add chopped fresh fruit to your porridge, such as apples or pears which contain sorbitol a sugar that helps the bowel keep moving.

If you like eating sandwiches for lunch choose wholegrain bread and add extra virgin oil to the filling to aid digestion and movement through your intestine. This kind of fat is beneficial for your heart also.

For dinner, again replace starchy refined carbohydrates like bread and pasta with whole grains like quinoa, or wholegrain pasta and brown rice. Even better, swap more carbohydrates for lots of whole vegetables steamed and cover with extra-virgin olive oil. Keep some of the fat on your meat or fish or chicken of you eat these.

Consider cooking lentils and chickpeas as a good source of fibre. But beware, if you have diverticula you may find that one or both irritate your intestine.

As your intestine is long and needs time to recover from constantly being constipated, you may want to consider periods of intermittent fasting where you could drink pressed vegetable and fruit drinks for energy, if needed.

Add seeds and nuts to your daily diet, either as a a snack or try adding to your cooked food.( But remember some people ned to blend the seeds or nuts into a butter so that it doesn’t irritate their intestine)

What snacks can help constipation?

• Try making your own oatmeal or energy bars with porridge oats as the base, adding dates and maybe banana for sweetness and nuts and seeds for more fibre. ( You can use nut and seed butters too.)

• Eating a ripened pear can really help as it contains sorbitol, as mentioned above.

• Having some dried fruit at hand instead of eating biscuits.

• Make you own biscuits with oats and seeds and dried fruits

• A warm drink can help stimulate the intestine to move. It doesn’t have to be coffee.

What can I take to improve constipation naturally?

There are many medicines to get your bowels moving, the most common is lactulose which unfortunately is full of sugar.

I have four things that I recommend to patients to try, along with changing their diet:

1. Add 4 cups of water to 4 tablespoons of flax seeds and boil for 10 minutes until all the oil and gelatinous material comes out of the seeds into the water. Then strain the liquid into small glass jars and cool until tepid. Drink one small glass a day until your bowels are moving and soft. Stop if your bowel motion becomes too soft. And drink a smaller volume if it becomes hard again.

2. Try a glass of prune juice each day, or blend up pears and apples into a juice or smoothie. These fruits are high in a type of sugar which helps keep your stool soft.

3. Glycerin suppositories. These are great if your are straining to pass a bowel motion and it feels painful. Often if you are constipated you may have caused a scratch or cut in the rectum which makes passing a bowel motion even more painful. The glycerin provides a smoother exit of your stool!

4. Coconut oil. Apply this around the rectal area; use gloves. Similar to the glycerin suppository, the oil allows you stool (bowel motion) to pass more freely through your rectum without pain. It is also an anti-inflammatory, so if have any haemorrhoids or a fissure( a cut in the rectum) that is irritated the oil will help heal this. Also try adding a desert spoon of coconut oil to your porridge or try cooking with it. Eating more natural fats will help soften your stool.

When Should I worry that constipation could mean something serious?

No matter what age you are if you have a persistent change in your bowel habit- either they become hard and less frequent or they become very soft / loose and more frequent- then see your doctor.

Bowel cancer is more common as you age and that’s why screening for bowel cancer using the home stool kit is for people over the age of 60 years. However, it can occur even in young adults, depending on your risk factors, or simply a genetic mutation that occurs randomly.

If your constipation does not improve over 1- 2 weeks with usual treatment outlined above then you should see your doctor.

Obviously, if you are not passing any bowel motion for three or more days then see your doctor in case there is another reason for the obstruction

What medications can I take for constipation if the natural treatments don’t work?

Children

• Movicol

• Lactulose

• Glycerin suppositories

Adults

• Movicol

• Lactulose

• Glycerin Suppositories

• Senna- derived from a plant. Not suitable for all patients; always consult a doctor first.

• Arachis Oil-this is a stool softener. Do not take if allergic to Soy or peanuts; always consult a doctor.

There are many more drugs that your doctor can prescribe. It is always sensible to see your doctor in case there is another cause for your constipation. Your doctor can decide with you on what medications to try and if any bloods tests or further investigations need done.

Sometimes you may need to have a rectal examination if there has been bleeding and if your blood count is low on a blood test.

What else improves constipation?

• How you empty your bowels can have a big effect on whether you become constipated.

In many countries squatting over a latrine facilitates better emptying of the rectum and is linked to reduced number of people getting bowel cancer.

In the UK, a useful alternative is to have a small foot stool in front of your toilet, onto which you can place your feet in a raised position.

This is not suitable for anyone with hip pain, but you can try it and see.

• Keeping active

• Drinking plenty of water especially if you live somewhere warm or have the heating or air conditioning on at work.

• Abdominal massage can help both babies, children and adults and it’s something we rarely do. Try using some coconut oil oil and massaging the abdomen from the bottom right corner upwards and down to the bottom left corner.

• For little babies it was common to stimulate the rectum with a cotton bud with some oil on it. This usually resulted in the passing of a bowel motion immediately after. This procedure is still done in some countries and but should only be done by a medical professional. From my experience a glycerin suppository or a using coconut oil int he rectum works well without introducing a cotton bud.

If you have any concerns about your bowels, Dr.Graham-private GP at Vitalis Health- can assess you or your child and help you decide what needs to be done next.

You can book online or call 02896913000