Article: Having Trouble with Constipation

May 21st, 2012 | by Pam Stuppy
Published in: Articles

Bowel habits can vary from person to person and still be considered “normal.” Variations are seen in frequency, consistency of stool, and ease of passage.

We think of constipation, however, when there are longer periods of time between bathroom visits and bowel movements become more difficult or painful. There can be a number of reasons for this and some can be eased by taking a few preventive steps.

Stress, illness, low levels of physical activity, hormonal changes, aging, fluid intake, diet, and some medications can all affect our bowels. Lowering stress levels and getting regular exercise are two positive steps you can take to normalize bowel habits.

Exercise can speed up transit time in the intestinal tract. On the other hand, sitting long periods of time at your desk, in a car or plane can be triggers for constipation.

If your constipation is caused by medication, check with your health-care provider to see if your medication can be changed to one that does not have constipation as a side effect or if the dose can be lowered. Some supplements, like calcium or iron, can also cause constipation. If possible, try getting the nutrient from foods rather than supplements or take the supplement in several smaller doses or with food at a meal.

When it comes to hormones, women may experience changes in bowel status at different times of the month because of menstruation. Pregnant women also frequently report episodes of constipation. In both cases, increasing physical activity, fluid intake, and dietary fiber can be helpful.

Low fluid intake is a common reason for constipation. Many people do not drink enough fluids throughout the day. Adults should try for at least 64 ounces a day, more if the weather is hot, humid, or you are exercising. Some good clues about being adequately hydrated are the frequency of urinating and the color of your urine — paler is better.

One common reason for constipation is the typical American diet. The downfall occurs from a higher intake of processed foods and lesser amounts of foods containing fiber. Fiber creates bulk in the bowel, exercises the muscles there, and triggers the action that pushes the contents along. There are two major types of fiber in the diet, insoluble and soluble, and both can be helpful in slightly different ways.

Insoluble fiber we also call roughage. It is the part of foods that do not digest, so it creates bulk. It tends to be somewhat rougher than soluble fiber, so if someone is already constipated or bowel movements are painful, the diet should contain a lesser amount of this type of fiber and more of the soluble fiber. Examples of where this type of fiber is found include wheat bran, beans (note that beans contain both types of fiber), and the skins/seeds of fruits and vegetables.

Think of soluble fiber as a sponge. When moistened, a sponge is softer. The soluble fiber absorbs water and creates a more gentle mass as it passes through. This type of fiber is often recommended for people with irritable bowel syndrome, a condition that is a frequent cause of constipation or a vacillation between diarrhea and constipation. If your bowel movements have been hard and difficult to pass, focus on consuming more of this type of fiber. Some of the more concentrated sources of soluble fiber are oats and oat products, barley, beans, fruits vegetables, and psyllium.

If your diet does not currently contain much fiber, add it slowly over several days or weeks. If your body is not used to much fiber and you add large amounts all at once, you might experience abdominal pain and bloating. The final goal for adults is about 25-30 grams of fiber a day. For children, figure their age plus 5 gms (for example, a 9 year old would need about 14 gm of fiber a day). Again, do not forget to consume adequate fluids with a higher fiber diet or the higher fiber can trigger constipation.

Increasing fiber in your diet starts at the grocery store. Buy more whole grains, fruit, vegetables, nuts, seeds, and beans. Read food labels and buy products containing more fiber. Check out the local farmers market for some new ideas.

Try new recipes that use these foods. In cooking, ground oats, whole grain flours, ground nuts, fruit, and sometimes pureed or shredded vegetables can easily be added to baked goods. Oatmeal or oatbran is a great way to start the day. Beans can be added to salads, soups, stews, stir fries, grain dishes (like brown rice or quinoa), or eaten as a side dish. Dried fruit, prunes, and prune juice have a natural laxative effect and can be really successful in prompting stubborn bowels.

Because the medications often used to trigger frequent bowel movements, like laxatives, can be damaging if used long term, try increasing physical activity, lowering stress, and increasing fluid and dietary fiber as a first response. These are all positive lifestyle habits and the foods containing fiber also provide a number of nutrients important for overall health.

If constipation causes extreme pain, is persistent, or results in fever, bleeding or vomiting, contact your health-care provider as it may require more serious medical attention. Otherwise, try some of the steps suggested above to reduce the risk of becoming constipated or to address a milder case.

Pam Stuppy, MS, RD, CSSD, LD, is a registered, licensed dietitian with nutrition counseling offices in York, Maine, and Portsmouth. She is also the nutritionist for Phillips Exeter Academy. Visit www.pamstuppynutrition.com for nutrition information, some healthy cooking tips and recipe ideas.