As a society we rarely talk about our bowel habits. Even the mention of it can cause people blush with embarrassment or make them attempt to divert the conversation in another direction. However, apart for the social discomfort that it can bring the physical discomfort of altered bowel habits is also an issue for many. Heaviness, bloating, sluggishness and even migraines, joint pain and brain fog can all stem from slow bowel movements.
The thing is, what one person considers normal may be very different from another. It is also important to remind ourselves what is a symptom and what is a condition. Constipation is a sign that there is an imbalance which may stem from a number of different areas, many of which are disconnected from the digestive system itself and can result not just in discomfort but hormonal dysregulation and increased risk of colon cancer.
Why Do We Even Need To Go Regularly?
Toxin build up
- Once the stool reaches the large intestines the final stages of water absorbed is carried out along with electrolytes and vitamin K. However, if the stool remains in the gut for a prolonged period of time toxins and excreted hormones will also be reabsorbed back into circulation. This places the burden back on the liver to reprocess them for elimination where they go back into the colon – only to be reabsorbed again. Round and round they go.
- Chronic constipation also increases the risk of colorectal cancer which is part of the reason why a high fibre diet is suggested to keep things moving and therefore decrease the risk. So, what if just adding extra fibre doesn’t work? In some cases it may even make things worse.
While laxatives may seem like the only option it’s important to understand that long term use can result in higher doses being required to have the desired effect which can then lead to poor muscle tone in the colon.
Let’s get graphic…
So, what is normal?
Well, this is a good question. One way to find an answer is to look at indigenous people to see what ideal bowel movement would be. Research has indicated that the ideal movement would be:
- 1 – 3 easily passed stools a day
- Little sustained aroma
- Medium brown in colour
- Long, log-like piece or few pieces
- No discomfort, no training, do delay
Whereas constipation would be:
- Infrequent bowel movements (less than 3 / week)
- Having to strain to pass a stool
- Hard, pellet-like or incomplete stools
- Incomplete evacuation
So where do we start?
Constipation Check List
There are 3 main categories of constipation,
- Primary – no presence of underlying medical issue and responds well to simple dietary and lifestyle adjustments.
- Secondary – as a consequence of certain conditions such as diabetes or hypothyroidism.
- Latrogenic – the constipation is the result of side effects caused by medication
It is important to systematically work through the most common causes of constipation before delving deeper. However, if you have been diagnosed with any of the conditions mentioned later in this article which are known to impact the digestive system, ensuring that they are properly managed is vital for resolution of symptoms. For now, we’ll concentrate on primary causes.
There are only 2 parts of the digestive process that we consciously control – chewing and swallowing. It is important that we thoroughly chew out food properly. Eating in relaxed environment is also paramount as activation of the fight or flight arm of the central nervous system. Evolutionary, the fight or flight arm of the central nervous system (parasympathetic activation) was activated during periods of stress, think being chased by a lion, in these situations digestion isn’t at the top of the list so blood is directed to skeletal muscle to power the getaway from the threat and the release of digestive enzymes is supressed. Chronic (long term) stress will also wreak havoc on the gut wall increasing undesirable permeability which can also result in immune imbalances and may worsen constipation type symptoms.
Behaviour / With Holding
Public toilets or going to the loo at social gatherings can make some people nervous and they with hold the bowel movement and supress the urge. If the stool is withheld for a prolonged period of time the urge with pass, the stool will impact in the bowel, more water will be reabsorbed and the stool will be even harder to pass. This impaction may require the one off use of a laxative to get things moving.
In addition to the benefit exercise has on our entire body it can also help to stimulate colonic muscle activity. Also, it can help to reduce stress thus sending us from our the “fight or flight” part of the nervous system and into to the “rest and digest”
Leaving Time Between Meals
Grazing may result in slower bowel movements as it is the distention in the stomach from a significant meal that stimulates the peristaltic waves down the digestive tract. Smaller, frequent meals do not activate this motor response in the gut which results in slower movement down the digestive tract. Also, grazers are also more likely to have a more eating episodes throughout the day which can interrupt a mechanism known as the migrating motor complex (MMC). The role of the MMC is to act as a sweeping mechanism to push removing debris and dead bacteria from the
Insufficient water or fibre (soluble or insoluble)
Soluble fibre can bulk up the stool; and soften it so it’s easier to pass while insoluble fibre helps to move it along. If you are suffering from other IBS symptoms (bloating, distention) fibre may not be the best option. One option would be psyllium husks (contains both type of fibre) slowly increasing by 1 teaspoon every few days. Make sure 6+ glasses of water are being consumed first. 1 – 2 tablespoons of ground flaxseeds can also provide gentle relief.
- Fruit (especially bananas)
- Seeds (ground flax seeds)
- Non-starchy vegetables
Squatting is the most natural position to pass a stool as it allows the colon to fully release. There are food stools on the market (eg the squatty potty) that simulated this position. The important things is to have your knees above your hips.