What is constipation?

Constipation is when you have

1. Fewer than three bowel movements a week
2. Stools that are hard, dry, or lumpy
3. Stools that are painful or difficult to pass
4. A feeling that not all stools have passed (tenesmus)

so, what is a normal bowel movement?

Normal bowel movements are soft and pass easily through your body.

How common is constipation?

With the evolution of food processing techniques, people prefer to eat a more refined thing and fiber content remains outside their plate. Due to drastic change in food habit of individual cases of constipation is increasing among Indians. It is common among all ages and populations in the United States. About 16 out of 100 adults have symptoms of constipation. About 33 out of 100 adults ages 60 and older have symptoms of constipation.

Do I need to have a bowel movement every day?

No, bowel patterns can vary from person to person. Everyone doesn't need to have a bowel movement every day. Some people might go three times per day. Others might have 3 to 5 bowel movements per week. So we can say everyone has their pattern and only you know what’s normal for you.

People who are at high risk to become constipated

Certain conditions and habits increase the risk of constipation, including

1. People with certain health issues, including gastrointestinal disorders
2. Elderly (above 60 years)
3. People eating less fiber
4. Non-Caucasians
5. Women, during pregnancy and after giving birth
6. People on certain medication or dietary supplement

What causes constipation?

Constipation can occur with:

1. A change in routine or traveling
2. Bad lifestyle
3. Calcium and iron supplements
4. Drugs like antacids with aluminum or calcium, calcium channel blockers, antihistamines, antidepressants, anticholinergics, narcotics (such as codeine), antispasmodics, anticonvulsants, diuretics, tranquilizers, some heart medications
5. Fiber intake – very less
6. Fluid intake – very less
7. Health conditions such as irritable bowel syndrome (IBS), colorectal cancer, eating disorders, underactive thyroid, diabetes, Parkinson’s disease, multiple sclerosis, celiac disease, hypothyroidism, and depression
8. Certain inflammatory diseases, like diverticular disease or proctitis
9. Intestinal obstructions like anorectal blockage or tumor and the anatomic problem of the gastrointestinal tract
10. Spinal cord and brain injuries
11. Ignoring the urge when you have to go to pass stool
12. Pregnancy hormones
13. Overuse of stool softeners (laxatives)
14. Stress
15. The slow movement of stool through your colon
16. Delayed emptying of the colon from pelvic floor disorders, especially in women
17. Colon surgery
18. Old age
19. Change in medicine
20. Change in eating pattern
21. Very low physical activity

When should I see a doctor?

Consult a doctor if have any of the following:

1. Sudden change in bowel movements without any change in daily routine
2. Constipated for several days and diet modification have not helped
3. Intense pain in the belly or rectum
4. Blood in the stool or bleeding from the rectum
5. constipation associated with unexplained weight loss
6. Constipation that alternates with diarrhea
7. Constipation with Vomiting or  fever  or lower back pain
8. Constipation and difficulty or inability in passing gas
9. It symptoms don’t go away with self-care or you have a family history of rectal or colon cancer

What medical tests are required to find out the reason behind constipation

However, the type of test depends exclusively upon your current health conditions, certain common tests are

Laboratory tests:

Some lab tests are recommended by doctors to look for the signs of certain diseases that may be the culprit for your current situations

Blood tests can show the signs of celiac disease, hypothyroidism, and anemia. 

Stool tests to check for the presence of blood and signs of inflammation and infections

Urine tests to find out diseases like diabetes. 

Endoscopy:

Depending upon your current health situation, your doctor may recommend endoscopy to check for any problem in your lower digestive tract including, the anus, rectum, and colon.

Main endoscopies for constipation include 

1. Colonoscopy
2. Flexible sigmoidoscopy

During these tests, a small piece of tissue may be taken as a sample for biopsy. A biopsy is a test in which your tissues are examined under a microscope to look for the signs of cancer or some other problems. 

Colorectal transit studies:

Your bowel function tests can be performed to see how well your stool moves through the colon. Test performed for colorectal transit studies are:

1. Radiopaque markers
2. Scintigraphy

In the radiopaque marker test, you have to swallow capsules with the markers, which take 3-7 days to come out with a bowel movement. X-ray is done to track the markers while they pass through your digestive system.

In scintigraphy, you have to eat a meal containing a small dose of a radioactive substance. Your doctor tracks the substance using special cameras, connected with a computer to check the movement of that substance through your intestines. 

Some other common bowel function tests

Some more tests may be recommended for you to look for the signs of diseases that can cause constipation

1. Defecography: an X-ray around the anus and rectum to check how well you can hold and release stool. 
2. Anorectal manometry: a test to check the sensitivity of your rectum and your anal sphincters. 
3. Balloon expulsion test: a test that involves pushing a small water balloon from your rectum to see if you have a problem pushing out stool Imaging tests
4. In some cases, doctors prefer imaging tests to find the actual culprit. 

• CT scan
• MRI
• Lower gastrointestinal series

What are the possible complications of constipation?

Possible complications from constipation include:

1. Hemorrhoids
2. Cracks or tears in the anus
3. Muscles and ligaments weakness that hold the rectum in place
4. Blockage of stool in the large intestine

How can my diet help with constipation?

Fiber and fluids work together and keep bowel movements regular. Fibre-rich foods hold water or liquid in the stools to keep them soft. Aim to drink 2.5 to 3.5 liters of fluid every day. We observe water is the best choice of fluids.

Add fiber to the diet gradually over a few weeks. A sudden increase in fiber content can cause cramps and gas. When the consumption of fiber is more, remember to drink more fluids or water.

Which foods have fiber?

Consumption of food high in fiber is good for overall health. Increasing fiber intake and fluid help in alleviating the symptoms of constipation and abdominal bloating.

There are two types of fiber present in the diet: 

1. Soluble Fiber 
2. Insoluble Fiber

Soluble Fiber

Soluble fiber is completely digested by the body and helps in reducing cholesterol, reducing insulin resistance and making available insulin to work, stabilizing blood sugar, and detoxifying the liver and overall gastrointestinal tract. Soluble fiber act as a bulking agent and slows down the movement of waste through the gastrointestinal tract. 

Foods that contain soluble fiber 

oats

beans

legumes

sweet potatoes

onions, and 

fruits such as apples, bananas, and pears

Insoluble Fiber

Insoluble fiber is not digested or absorbed by the body and is excreted as a waste product. This fiber is required to keep the bowel regular and discourages the development of complications like hemorrhoids. 

Foods that contain insoluble fiber 

wheat bran

nuts

seeds

skins on vegetables and fruits

Both soluble and insoluble fiber is important for overall nutrition good health. When you are experiencing constipation, adding insoluble fiber to the diet is beneficial to promote stool regularity. It is important to add and increase fiber slowly over a few weeks. Adding too much fiber too quickly can make constipation worse.

Some general guidelines for alleviating constipation

1. Drink plenty of liquids - Fluid helps your body to process the ingested fiber without discomfort. A good starting goal is 2.5-3 liter or five to six 500ml glasses of fluid per day.

2. Gradually increase your fiber intake - NIN and USDA guidelines stressed on the daily goal should be between 25-35 grams daily.

3. Eat 3-5 servings of fruits and vegetables daily - Restrict your meal from 4-5 servings to 3 servings of fruits and vegetables daily

4. Choose foods that promote regularity - Fiber is mostly found in plant-based foods, such as vegetables and fruits including dried fruit, beans, legumes, whole grain cereals, and oats, oat bran, barley and quinoa, dried beans, split peas, and lentils, nuts and seeds

5. Try plum or prune juice - Start with fewer amounts (½ cup). Eating dried prunes is also a good option to relieve constipation.

6. Try to include exercise or physical activity in your daily routine. Physical activity and exercise based on age is natural way to improve the symptoms of constipation. For any exercise or physical activity, you must discuss it with your doctor first.

7. Talk to your healthcare team about medication or supplements to help with constipation. Over-the-counter medications are widely available in India as well as in many parts of the world. Some are good and some may increase your problem. We recommend you should always check with your doctor first before taking any OTC medications.

These are also important regarding constipation

1. Whole fruit is always a better option than juice. If you are diabetic then you may opt for low glycemic index fruits. If excessive gas or bloating is bothering you then you must include low FODMAP fruits in your diet.  Here is a complete list of low and high FODMAP food.

2. It is important to eat the skins and edible seeds for extra fiber and try to include organic fruits so that skin is free from any pesticides. Pesticides are well known for gastrointestinal tract abnormalities.

3. Try to have a low glycaemic fruit or and vegetable with each meal.

4. Eat recipes that are made with 100% whole grain.

5. Have brown rice in place of white rice or starchy potatoes.

6. Try to avoid refined products.

7. Eat more beans, lentils, and peas. Add them to soups.

8. Beans are also a good source of protein, so you can add to increase the protein content of the food. Beans can be gas forming as it is high in FODMAP, so add them gradually. If bloating or discomfort is more, you can limit them in the diet.  

Commonly asked questions on constipation

Q. Cooking process can reduce the amount of fiber?

A. No, Cooking process like cutting, steaming, blending, or pureeing food does not decrease the amount of fiber.

You can also add fiber to your diet by adding 1 to 2 tablespoons of chia seeds, ground flax seeds, or bran (wheat, rice, or oat). For packaged food, read the Nutrition Facts label to find out the percentage of fiber. Look for foods with a percent daily value (%DV) of 15% or more for fiber. This means the food has ‘a a lot’ of fiber. 

Q. How much fiber in a food is called “high fiber food?”

A. Foods that have at least 4g of fiber per serving are considered high fiber.

Q. How much fiber is required for a patient at risk of bowel obstruction?

A. If you are at risk for a bowel obstruction, do not consume high fiber without consulting a medical practitioner. A doctor will make you understand how much fiber in a diet is right for you.

Q. I am on the medication which you have described to cause constipation. So changes in diet can improve my constipation or not? 

A. Diet medications are less likely to improve your constipation if a medication or a medical condition caused it.

Read more about constipation