Constipation: What is it and how to relieve it?

Written by Nutritional Therapist Kate Fisk DipCNM, mBANT, mANP, rCNHC

It's not the most comfortable topic of conversation, but more than 1 in 10 people in the UK suffer from constipation at any time, and women are 2-3 times more likely to be affected than men. So how does it happen, why is it so essential to get things moving, and what can we do to get some relief?

Constipation generally describes a difficulty or infrequency in passing stools. And according to the medical definition, anything more than three times a week is fine and dandy; however, for optimal health, we should aim for one to two healthy bowel movements daily.

But what exactly is a healthy bowel movement? Regarding consistency, we should aim for somewhere between 3 and 4 on the Bristol Stool Chart. Anything resembling 1 or 2 indicates constipation. We should be able to go to the loo without straining, without the use of laxatives, it shouldn't feel urgent, and we should be left with the sense of there having been a complete emptying. Also, you shouldn’t be able to see any blood or undigested food in your stool.  

So that describes what should be happening, but why is it so important?

Our colon, part of our large intestine, serves as a holding tank for waste matter, and, a bit like our kitchen bin, if we don't empty it regularly it’s only a matter of time before things get in a real mess. 

Regular bowel movements are essential to remove what the body doesn't need, including chemicals, spent hormones, bacterial by-products, and even the microplastics found in our food chain. Not moving our bowels regularly indicates that food is moving too slowly through the digestive tract. The longer our digested food sits in the gut, the higher the risk of these waste products going back into circulation, where they can wreak havoc with our body's delicate internal balance and put pressure on our liver, whose job is to process all the toxins in our body.

This disruption can lead to inflammation, imbalances in our gut bacteria, and hormonal fluctuations that can contribute to other symptoms associated with constipation such as acne, anxiety, weight gain, fatigue, headaches, irritability and other digestive issues such as bloating and heartburn. Not only that, but constipation can also inhibit the absorption of essential nutrients we need to feel our best.

What causes constipation?

Constipation is not often an illness in and of itself; instead, it indicates other issues that may need addressing elsewhere. The most common drivers of constipation that I see in clients coming to my clinic include:

• Poor diet
• Lack of physical activity
• Dehydration
• Stress or anxiety
• Food intolerances or sensitivities
• Imbalances of good and bad gut bacteria, including SIBO and IBS
• Hormonal imbalances, including underactive thyroid, PMS and peri-menopause
• Lack of digestive ability, e.g. low stomach acid or not chewing food properly

Certain medications such as PPIs (that reduce your stomach acid) and some anti-depressants can also contribute to constipation

So, what constipation remedies can you consider before turning to a health practitioner?

Foods to include

• Healthy fats, such as olive oil, ghee, coconut oil, avocados, olives, oily fish, and the omega-3s found in fish oil, lubricate our gastrointestinal pipes and help move our stool along. So try to include some with every meal. 

• Keep hydrated. Water, along with nutrients and electrolytes, is absorbed from digested food as it passes through our colon. If you’re dehydrated, too much fluid will be reabsorbed, resulting in a dry hard-to-pass stool. Try starting every day with a glass of water with a small pinch of sea salt or Himalayan salt – this will help rehydrate and balance electrolytes. In addition, keep a water bottle with you throughout the day.

• Flax seeds are my go-to with constipated clients. Try incorporating them in a smoothie, sprinkling them on your yoghurt or give these easy-to-make flax seed buns a go. Build up gradually to around two tablespoons a day.  

• Kiwi fruit is another excellent constipation-buster. Eating up to three a day has been shown to improve chronic constipation. 

• Resistant starch is a type of starch found in certain foods that our bodies cannot break down. Instead, it feeds friendly gut bacteria, which in turn maintain the health of our colon. Resistant starch is formed when certain foods are cooked and then cooled, so make up some of the following and keep them in your fridge to add to salads: potatoes, sweet potatoes, lentils, peas, and whole grains such as quinoa and wild rice.

• Fibre, found in all whole plant foods, is generally considered an essential constipation remedy: it adds bulk and helps keep stools soft. But it's not for everyone. If you suffer from SIBO or Irritable Bowel Syndrome, you may not be able to tolerate specific types of carbohydrates known as FODMAPs. These are a group of highly fermentable carbohydrates which can cause digestive issues such as constipation. Anecdotally, very low-carb diets or the increasingly popular carnivore diet, which are by nature very low in fibre, do not appear to cause constipation after an initial period of adaptation. And in fact, some studies do not associate a relationship between dietary fibre intake and constipation.  

Foods to avoid

• Common triggers for constipation include gluten, dairy, and refined carbohydrates such as white sugar, white rice and white flour. Try keeping a food and symptom tracker: note what foods you eat and how often you go to the loo. Then, you might be able to identify which foods contribute to your symptoms and adjust your diet accordingly.
• Alcohol tends to leave us dehydrated, so is best avoided if you suffer from constipation. However, if you do have a couple of drinks, offset each one with a glass of water to stay hydrated.
• Caffeinated drinks such as tea, coffee and sodas are not as dehydrating as we once thought. However, avoid going overboard – caffeine adds to our adrenal load, making us feel more stressed, which can slow the transit of food through our gut.

• Ultra-processed junk food with unrecognisable ingredients is best avoided. Such food is hard to digest and contributes nothing to gut health as it’s jam-packed with additives, such as emulsifiers, colourings, preservatives, sweeteners and flavourings. Instead, try to eat whole, real foods as much as possible – the fewer ingredients, the better.

Other things to try

Gentle physical activity throughout the day helps food transit through the digestive tract. Punctuate hours of sitting with short movement breaks such as a downward dog, a brisk walk up and down the stairs, or bicep curls with dumbells. Try to move every 45 minutes or so - breaking up your day like this will not only ease constipation but has been shown to have various health benefits.

Relax! When stressed, our nervous system prioritises those functions we need to deal with the perceived emergency, and 'non-essential' activities, including reproduction and digestion, are either deprioritised or shut down. (This is why our periods often stop in times of significant stress.) This slowing down of our digestive capabilities means food sits longer in the gut leading to constipation. Try setting up a relaxed morning routine. This doesn't have to be too elaborate: avoiding the news, exposure to natural light, and a few stretches and focused breaths before breakfast can help set you up with a calm headspace for the day ahead and help move things along. 

Taking four big belly breaths before you eat, ensuring that the out-breath is longer than the in-breath, is a great way to shift your body out of fight or flight' mode and into 'rest and digest' mode, ensuring food will more easily move through your digestive tract.

Be consistent! All of our bodily functions are closely linked to our internal body clocks and are easily disrupted. Always try to go to the loo at the same time every day, and when you know your routine is going to be disrupted by travel or holidays, for example, do what you can to maintain elements of your regular schedule: get up and eat at the same time as you would typically, incorporate movement, keep hydrated, keep up with the healthy fats and avoid the trigger foods listed above. Whenever possible, go with the flow when you feel the need to go - holding on for too long can exacerbate constipation.

Summary

As in all areas of health and nutrition, it's important to remember that we are all unique, and what works for one will not necessarily work for another. So try different things to see what works for you. But remember, healthy bowel movements depend on a healthy gut. So, if you have tried some of the most common constipation remedies but are still struggling, it might be a good idea to book some time with a Nutritional Therapist who will help you get to the root cause.

Never ignore chronic or regular constipation, and if you ever see any blood when you go to the loo, talk to your GP.