Patient confusion about the best way to manage constipation. Is it just about increasing your fibre?
By Accredited Practising Dietitian Geraldine Georgeou, Director of DESIGNER DIETS™
Helping my patients understand what constipation is and communicating to them the difference between treatment and prevention is a huge challenge in my private dietetic practice. Many of my patients arrive having already consulted “Dr Google” and have formulated many different concoctions to deal with their bowel irregularity (often leading, unfortunately to limited results). Self-treatment and non-medically guided constipation relief is often a “recipe” of different fibres (including seeds and food fibres), teas, supplements and herbal remedies. This often exacerbates the constipation and then there is no real action plan when limited bowel result occurs.
To be able to manage constipation successfully you do have to understand your bowel health. You need to be able to identify the cause and work with your health professional to agree on the best prevention and treatment plan to put in place. Managing constipation needs a long term approach to minimise complications.
I am particularly concerned when patients go looking for their own advice from the internet, commonly searching terms like “constipation treatment” or “quick constipation treatment relief”. From my own tests in doing this “googler” tends to find advice about increasing fibre and fluids but no direction for medical help or advice about when to use a medication such as a laxative (as medically directed). Fibre clearly has its place but if your bathroom at home is blocked up then clearly you don’t keep throwing toilet paper down there. You need something to unblock the system before you can quickly resume normal function.
Constipation can be a very debilitating condition and it is estimated that approximately 20% of the general population (as per the Gut Foundation) suffers from this. Constipation can be defined as a passing of hard, dry bowel motions (stools) that may be infrequent or difficult to pass. Many of my patients associate abdominal discomfort including pain, cramping, bloating, indigestion, “feeling fat” with constipation and can even report at least 4-7 days without passing a bowel motion.
The most common causes of constipation include a change in routine, inadequate fibre intake in the diet, not enough fluids and lack of exercise.
Constipation (both chronic and acute) is not only related to lifestyle issues but can also be related to other cofactors including :
- Some medications – codeine, antidepressants, iron supplements, calcium-channel blockers - antihypertensives, and non-magnesium antacids are known to slow bowel movements.
- Pregnancy – due to hormonal changes, uterus changes and growth of baby.
- Advancing age – commonly due to changes in the muscles that contract to move stools in the bowel and the use of medications.
- Illness – due to bed rest, surgery or change in routine, many people can suffer a transient constipation and the use of laxatives can be overlooked.
- Medical causes can include – slow transit time, anal fissure, obstruction, rectocoele, hernia, IBS, other medical co- morbidities including endocrine disorders such as thyroid disorders and diabetes, bowel tumours or even neurological conditions are associated with an increased susceptibility to constipation such as Multiple sclerosis and stroke.
The importance of fibre
Dietary fibre is made up of the indigestible parts of plants and other carbohydrates that are not digested and pass through our stomach and intestines. It keeps our “gut” healthy, keeping your bowel motions regular as well as stabilising glucose and cholesterol levels.
The best sources of dietary fibre include wholegrain breads and cereals, fresh fruit and vegetables, lentils, beans, oat bran and psyllium husks. Aiming for Approximately 25g of fibre per day will help promote bowel regularity.
Simple ways to include more fibre in your diet:
- Eat wholegrain breakfast cereals that contain wheat, oats or barley.
- Switch to multigrain bread, brown rice and pasta.
- Aim to have 5 serves of vegetables daily and 2 serves of fruit per day
- Snack on fruit and nuts.
- Top your yoghurt or cereals with pumpkin and sunflower seeds, Chia bran or psyllium husks.
- Fibre supplements – Fibre supplements aren’t a bad idea to assist with increasing your fibre intake, especially if you’re not getting enough from your diet. If problems persist always seek advice from your medical practitioner or Accredited Practising Dietitian.
Fibre-rich diet Meal Plan
- Breakfast: 1 bowl of wholegrain cereal (e.g. Weet-Bix High Bran, Goodness superfoods- Protein 1st) + 1 cup of low fat milk + 1 small piece of fruit
- Snack: 100g yoghurt + 1tb of pumpkin seeds
- Lunch: Wholegrain sandwich + 1 cup salad + tuna +/- 1 piece of fruit
- Snack: 3-4 dried figs + handful of nuts
- Dinner: 200g of lean protein (meat, chicken, fish) + ½ cup cooked lentils + 1 cup of cooked vegetables.
Prevention of constipation
- Adequate daily fibre intake
- A variety of fibres in your diet
- Adequate daily fluid intake
- Possible use of probiotics to encourage “good” gut flora and bacterial health
- Keeping active
- Consume food regularly
Treatment of constipation
- Seek professional health and medical advice
- Consider the use of a medication such as a “laxative” under medical supervision
- Don’t just self -help with increasing fibre alone as this may worsen the constipation.
Where to get help
- Your doctor
- Dietitians Association of Australia Tel. 1800 812 942