Constipation is a disorder that is characterized by infrequent bowel movements or a bowel movement that occurs every 3-4 days. Normal transit time for bowel movements occurs every 12-24 hours. When one is constipated it can be between 48-72 hours or longer. Regular bowel movements require proper working sphincter, migratory motor complex, and a diet that is rich in fiber and adequate water intake. Food intolerances, sensitivities, and allergies can negatively affect transit time and lead to constipation.
Constipation is most common in women and in the elderly (individuals over the age of 65). It affects 5-30% of children, a third of whom will continue to experience chronic constipation into adulthood.
There are different types of constipation. Functional constipation, which has no exact cause. Chronic constipation persists for 3 months or more. It often occurs due to a lack of dietary fiber and water, as well as a decrease in mobility. Chronic constipation can lead to hemorrhoids, rectal bleeding and impaired quality of life. Refractory constipation is a type of chronic constipation that persists for over a two year period. Rapid transit constipation consists of rapid movement through the small intestine and but a slow down in stool elimination in the large intestine.
Food intolerances are a result of a lack of enzymes needed to digest specific food. Common intolerances include; lactose intolerance, gluten intolerance and fructose intolerance. Symptoms of food intolerance can include loose stools, diarrhea or constipation or both, excessive gas, bloating and distention. Abdominal pain, indigestion, and nausea are other symptoms.
Food intolerances can increase motility within the small intestine and upper large intestine. This can leads to a stool that is acidic and undigested causing a great deal of pain when it leaves the body, most often as diarrhea. The pain of the bowel movements often leads to holding behaviors in children and adults alike leading to fecal retention. Recall retention is one way that food intolerances can lead to the development of constipation.
Food intolerances can lead to inflammation in the bowels affecting the transit time and (Medrek-Socha, M, et al., 2018) are also shown to reduce the mucosal layer of the digestive tract, contributing to constipation. Once an elimination diet is implemented many individuals find their digestive system improved (Carroccio, A., et al., 2005).
Various forms of constipation have been connected to food intolerances as a means for restricting motility. A 2011 study looked at children with intractable constipation who also experienced rapid transit constipation. 40% of children showed signs of allergic reactions, skin conditions or asthma. They also had symptoms such as abdominal pain and fissures, which are linked to food intolerances leading the researchers to suspect a connection between rapid transit constipation.
Patients who are unresponsive to treatment for constipation can look towards their diet to see what could potentially be contributing to their infrequent bowel movements. Certain foods have been shown to affect constipation, including processed foods, refined sugars, and junk food. Common protein allergens and intolerant foods including dairy, wheat, soy, eggs, nuts, and seafood can also negatively affect the digestive tract and transit time, leading to constipation.
Increasing water and fiber consumption, and implementing a low FODMAP diet can greatly improve digestive health and prevent constipation. Participating in an elimination diet can be one of the best things to try when experiencing constipation that is a result of food intolerance. The research has shown that dietary changes resulted in a decreased use of laxatives and improved motility.
Elimination of common trigger foods and their slow and careful reintroduction under the guidance of a health professional or nutritionist can be incredibly beneficial. It is important to be careful when starting an elimination diet with children as it is a restrictive diet with psychological and nutritional risks. A variation of the elimination diet can be used, working on one food at a time and adding in an equivalent alternative. Any dietary change in children should always be done under the guidance of a health professional.
Fiber is essential to prevent constipation, reduce bloating and distention. Adequate fiber intake also reduces gar and abdominal pain. Psyllium is one of the best sources of fiber to consume when experiencing constipation as it is soluble and easy on the digestive system. Insoluble fibers tend to make symptoms worse.
Some other great tips for eliminating constipation include,
- Drink water – slowly, and not so much that you feel sick. Pace yourself. Water should be your #1 go-to drink.
- Fiber – beans, greens, and pectin fruit (blueberries, berries, black currants, apples, pears). Fibre will help to move your waste out.
- Reduce Stress – If you are stressed you are in ‘fight or flight’ mode. Your body has cut off power to your digestive system and it’s focusing its attention elsewhere. Be calm when you eat, and afterward try to keep your stress at a minimum.
- When you have to go – GO – don’t be self-conscious, everyone goes poop. Literally everyone – human and animal. So when you get that feeling, go! It’s not good to keep holding it in. The more you hold it in, the more pressure is placed on the nerves that are connected between your bowels and your brain. Eventually, they will get exhausted and the signal will begin to fade or stop completely (it can be powered up again – though it takes a lot of work).
- Excercise – walk or join a gym and take some classes, if you don’t like going to the gym gets some friends together, make a team and join a sporting club. Swimming is a great way to get your body into motion. Jump some rope, ride a horse, ride a bike, climb a mountain. Just move your body.
References
Arranga, T., Underwood, L., & Viadro, C.I. (Eds). (2013). Bugs, Bowels, and Behavior. The Groundbreaking Story of The Gut-Brain Connection. New York, NY: Skyhorse Publishing.
Croxton, S., & Brooks, K. (2015). What Causes GERD, Constipation, and Reflux…And Natural Remedies that Work! Retrieved August 9, 2016, from The Digestive Sessions.
Cutler, E. W., & Kaslow, J. E. (2005). Micromiracles: Discover the healing power of enzymes. United States: St. Martin’s Press.
Enders, G. (2015). Gut: The inside story of our body’s most under-rated organ. Australia: Scribe Publications.
Haas, E. M., & Levin, B. (2006). Staying healthy with nutrition: The complete guide to diet and nutritional medicine – Twenty-First-century edition (21st ed.). Berkeley: Ten Speed Press.
Holford, P. (2004). The optimum nutrition bible: The book you have to read if you care about your health. London: Piatkus Books.
Lipski, E. (2011). Digestive Wellness: Strengthen the immune system and prevent disease through healthy digestion, fourth edition (4th ed.). New York, NY: McGraw-Hill Professional Publishing.
Rao, S.S.C., Fedewa, S.Y.A. (2015). Systemic Review: Dietary Fiber and FODMAP-restricted diet in the management of constipation and irritable bowel syndrome. Alimentary Pharmacology and Therapeutics. Volume 41, Issue 41, Issue 12, pages 1256-1270.
Waingankar, K., Lai, C., Punwani, V., Wong, J., Huston, J.M., Southwell, B.R. (2018). Dietary exclusion of fructose and lactose after a positive breath test improved rapid-transit constipation in children. Journal of Gastroenterology and Hepatology Foundation. Volume 2, Issue 6, pages 262-269.
