How to Relieve Constipation

As a society, we rarely talk about our bowel habits.  Even the mention of it can cause people to blush with embarrassment or make them attempt to divert the conversation in another direction. 

However, apart from the social discomfort that it can bring the physical discomfort of altered bowel habits is also an issue for many. IBS, heaviness, bloating, sluggishness and even migraines, joint pain and brain fog can all stem from slow bowel movements. 

It is important to systematically work through the most common causes of constipation before delving deeper into the less common causes. The simple suggestions are important to set a firm foundation for gut health and improving symptoms of IBS and constipation. [1] 

How to know if you’re constipated – signs & symptoms  

Constipation is a digestive symptom but this symptom alone does not tell us why it’s taking place. Diving deeper, there can be several possible reasons for constipation and gut symptoms. 

Certain approaches can be helpful to manage the symptoms of constipation (such as laxatives and stool softeners) however, to resolve constipation the root causes may need to be considered. 

Constipation can be divided into 3 sub-types. This does not mean that the symptoms for each type of constipation are different from each other. However, it does mean that these 3 categories of constipation can help to understand the causes of constipation and how best to resolve it. 

What are the categories of constipation?   

There are 3 main categories of constipation: 

1. Primary – no presence of underlying medical issue and responds well to simple dietary and lifestyle adjustments. 

1. Secondary – as a consequence of certain conditions such as; gut imbalances, diabetes or hypothyroidism. 

1. Latrogenic –constipation is the result of side effects caused by medication 

For each category of constipation, there may be a different approach to using the right tools to get the bowels moving again. [2] 

5 ways to relieve constipation  

There are 5 key approaches that can be considered to address constipation.  

These include: 

1. Fibre intakes 

1. Water and hydration 

1. Movement 

1. Probiotics 

1. Stool softeners and gentle laxatives 

Increase your fibre intake  

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 and a Low FODMAP diet may be a more suitable approach. 

One option would be psyllium husks (which contain both types 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. 

Soluble fibre 

• Oats 

• Peas 

• Beans 

• Apples 

• Citrus fruits 

• Carrots 

• Barley 

• Psyllium 

Insoluble fibre 

• Seeds (ground flax seeds) 

• Kiwi (with the skin) 

• Whole-wheat flour 

• Wheat bran 

• Nuts 

• Beans 

• Cauliflower 

• Green beans 

• Potatoes [3] 

Drink more water  

Water intake is gauged by various factors. These can include how much liquid is absorbed through foods and how much is lost via sweating. 

The general rule of thumb is to drink until urine is a light straw colour. A darker shade of urine will indicate that more water may be needed. 

It’s also important to remember that caffeinated teas and coffees can act as diuretics. This means that they can increase how much water is lost via urine, possibly leading to dehydration. 

Increase your daily exercise  

In addition to its benefits for our entire body, exercise can also help stimulate colonic muscle activity. It can also help reduce stress, thus shifting us from the “fight or flight” part of the nervous system to the “rest and digest” part. 

While there isn’t a specific exercise for constipation movement such as running or cycling can support bowel movements as they interact with the bowel abdominal region. 

Abdominal massage therapies can also help to stimulate the bowel in a similar way to exercise. 

Try natural remedies such as probiotics  

Probiotics are a key tool to help support the gut and the gut microbiome. These are 2 areas that may underlie constipation. 

Regarding the gut microbiome, imbalances or overgrowths of methane-producing bacteria (as seen in methane SIBO/IMO) can contribute to constipation. Probiotics can help to support the balance of these organisms. 

Additionally, the specific strain of probiotics bacteria, Bifidobacteria HN019, has been found to support bowel movements to relieve constipation. This may be via supporting more appropriate contractions of the muscles in the gut. 

Prebiotics such as PHGG have also been found to help normalise bowel patterns and relieve constipation. [4] 

Gentle laxatives and stool softeners 

While gentle laxatives and stool softeners can help to get the bowels moving, they won’t actually address the underlying cause of constipation.  

In the clinic, these are often used in the shorter term as a form of symptom management while treatment is in place to address the underlying issue. 

These include: 

• Magnesium oxide 

• Vitamin C 

• Lactulose 

• Dulcoease 

Lifestyle changes that can help your bowel movements  

Alongside making sure there’s enough physical activity, other lifestyle factors can help to set a firm foundation for gut health and bowel movements. 

These can be where managing stress levels as well as getting enough sleep can support the immune response as the balance of the gut microbiome. These are two ways to support not only gut health but also general health. 

Get tested for SIBO and IMO 

An overgrowth of methane-producing bacteria in the small of large intestine may contribute to constipation. This is due to methane in the gut inhibiting muscle contractions. 

If positive, a methane breath test can influence the treatments with both natural antimicrobial herbs being considered as well as pharmaceutical antibiotics. [5] 

When to seek medical advice about constipation  

Ongoing digestive symptoms can be investigated by a doctor or nutritionist in a variety of ways. 

However, certain symptoms should be taken more seriously, especially if they appear suddenly. These can be described as red flag symptoms and include: 

• A sudden change in bowel movements 

• Blood in the stool 

• A palpable mass in the abdomen 

These symptoms may require further examination and testing to rule out possible causes. [6] 

FAQs

What is the best toilet position for constipation  

Squatting is the most natural position to pass a stool as it allows the colon to fully release. Squatting is the way humans have evolved to pass a stool and in many traditional cultures, this is still the norm. 

With the invention of the seated toilet, this had changed and may have impacted the ability for a complete bowel movement. 

There are footstools on the market (eg the squatty potty) that simulate this position. This is placed under the feel whilst seated on the toilet and raises the knees above the hips. 

Should I eat regularly for constipation?  

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 episode 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 small intestine. 

While eating and food are crucial for human health, time away from food allows the gut to reset. This can be as simple as leaving 4 hours between eating events as well as leaving 4 hours from the last meal until bedtime. 

Can stress cause constipation?  

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 a 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 suppressed. 

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.