Constipation Guidelines

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By Dr. Ritu Krishnatreye, B.H.M.S.

Constipation guidelines

Almost everyone is familiar with the signs and symptoms of constipation:

• Abdominal bloating
  
  
• Straining
  
  
• Lumpy dry hard stools

Constipation affects people of all ages. Although constipation is often not viewed as a serious problem, if it is not treated or if treatment is delayed, it can lead to complications like fissures or hemorrhoids.

It is therefore important to treat constipation before complications arise.

For occasional constipation, home measures and lifestyle changes can be applied.

There are a number of treatment strategies and constipation guidelines that can be used to prevent further episodes of constipation.

However, in the case of persistent or progressive constipation, a visit to the doctor may be needed.

Diet and Constipation

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The cause of constipation may be as close as your dinner plate. Too much of the wrong foods and too little of healthy foods may contribute to constipation.

Diet related causes of constipation may be dealt with by simply changing the grocery items you shop for.

This article covers:

1. Foods That Help Prevent Constipation
   
   
2. Foods That May Cause Constipation
   
   
3. Other Lifestyle Issues and Constipation
   
   
4. Taking a Laxative
   
   
5. Drugs That Cause Constipation

1. Foods That Help Prevent Constipation

First constipation guidelines:

Foods with fiber

Whole grain products, bran cereals, fruits, vegetables, oats, legumes, nuts and seeds are some of the foods that can help remedy constipation or prevent it from occurring. 

They are foods high in fiber, which adds bulk to stool, leading to better peristalsis (the wave-like contractions of the colon that moves stool along).

In the fight against constipation, don’t think of veggies and fruits as optional dishes, but as a crucial part of every balanced meal. Vegetables and fruits tend to be high in soluble fiber.

If you are not accustomed to eating raw veggies, it may be easiest to start with steamed vegetables, as they are easier on the digestive system. When possible, avoid frozen fruits and vegetables. Rather, choose fresh produce.

Yogurt and kefir

Another food item that is helpful to include as a daily item is low fat yogurt or kefir. These contain beneficial bacteria that help with digestion. 

Try to choose one that doesn’t have artificial flavoring, artificial sweeteners and flavors, or a high sugar content.

If the above mentioned foods are not enough to relieve constipation, consider adding a daily fiber supplement. 

These supplements are processed or synthetic and help in relieving mild cases of constipation. Some of the more common fiber supplements are Perdium, Citrucel and Metamucil. 

Probiotics are helpful for constipation

Several studies have shown that probiotics can improve symptoms of constipation. Probiotics are supplements that contain beneficial bacteria needed for our guts to function correctly.

Our colon contains a balance of both healthy (good) and unhealthy (bad) bacteria. At times, this internal environment or balance is disrupted, which may lead to digestion related problems.

Why probiotics may be needed

Our ancestors ate fermented foods that kept the beneficial bacteria replenished. Sadly, fermented foods have mostly disappeared from our diets. 

To make matters worse, just a single course of antibiotics can wipe out the beneficial flora in our gut, allowing yeasts and other less desirable microbes to take over. Desserts and other sweets are food for the bad bacteria. Eating too many sweets will allow bad bacteria to gain dominance.

The role of probiotics is to provide our guts with the good bacteria needed to maintain a healthy environment in the digestive system. 

They multiply and displace potentially harmful bacteria to enhance the protective barrier of the digestive system. 

Probiotics are available in the form of tablets, liquids, powder and capsules. 

2. Foods That May Cause Constipation

Dairy

Dairy products such as milk, cheese and ice cream are high in fat and low in fiber. 

When viewing constipation guidelines, pasteurized dairy contain proteins that are difficult to digest, since pasteurization kills milk enzymes needed to digest it.

High fat and hard to digest proteins cause dairy products to move more slowly through the digestive tract. The longer food lingers in the colon, the more water that is extracted. A slow transit speed causes stool to become dry, hard, and difficult to pass.

Fast foods

Items like pizza, burgers and muffins are highly processed foods that lead to several digestive ailments. The processing of foods removes most if not all of the fiber. 

Processed foods

These foods, which make up most of the food found at the grocery store, tend to be higher in salt and sugar, and low in fiber. 

These foods are a major cause of constipation. Moreover, foods like candy, cookies, cakes, pies and pastries contribute to other digestive problems like flatulence (gas), and bloating.

3. Other Lifestyle Issues and Constipation

Constipation Guidelines - Staying hydrated 

Dehydration is a major cause of constipation. If you are dehydrated, then 6 to 8 glasses of water a day may be just the remedy you need to treat your bowel problems. 

Drinking plenty of water and other liquids, including fruit and vegetable juices and clear soups, may help to prevent constipation. 

When the body is dehydrated, it will draw extra water from stool to use in other, more urgent applications. Stool becomes dry and hard.

Drinking too many alcoholic beverages and caffeinated products such as tea and coffee can lead to dehydration. Caffeine works as a diuretic that can cause too much water to be flushed from the body. 

To counter the diuretic effect, for every alcoholic or caffeinated beverage that you drink, drink a glass of water. 

Constipation Guidelines - Staying active 

Another contributing factor to constipation is a sedentary lifestyle. There are many issues that result in a person being sedentary. 

It may be:

• A medical condition
  
  
• A hectic daily schedule
  
  
• Excessive body weight
  
  
• An injury

Regular exercise helps the digestive system stay active and healthy. Almost any form of physical activity helps to stimulate bowel activity, including:

• Aerobic exercises
  
  
• Stretching exercises
  
  
• Strength training
  
  
• Taking a walk 

4. Taking a Laxative

Constipation Guidelines - Do I need a laxative? 

When the above mentioned measures don’t work, it may be necessary to turn to a laxative. 

There are different types of laxatives, and it is recommended that you consult your health practitioner to find the best one for you. 

The main categories of laxatives are:

• Bulk-forming laxatives
  
  
• Stimulant laxatives
  
  
• Osmotic laxatives
  
  
• Stool softener laxatives

Laxatives are not a long-term solution 

Stimulant laxatives work by agitating the nerves in the colon, provoking the wave-like contractions that move waste materials through the colon (these wave-like contractions are called peristalsis).

Laxatives should be used only for a short time, since over time they tend to make the body dependent on them.

Constipation Guidelines - A better long-term answer 

A better long term solution is to take 300 to 400 mg. of a Magnesium functions as an osmotic laxative that draws water into the colon. This helps to moisten stool, making it soft, slippery and easy to pass.

A magnesium supplement has few side effects, plus it is non-habit forming, meaning that the body doesn’t become dependent on it.

Since most Americans don’t get enough magnesium in their diets, taking a magnesium supplement may result in numerous health benefits. 

5. Drugs That Cause Constipation

If you are currently on a pharmacologic regimen and have noticed changes in your bowel movements, don’t get alarmed. Drugs are one of the major reasons for irregular bowel function.

Although drugs may induce constipation in any age group, it is more commonly seen in the elderly, since they often experience chronic health problems that require treatment with multiple medications.

• Medications may cause symptoms of constipation indirectly by affecting the central nervous system, which in turn affects the peristaltic activity in small and large intestines.
  
  
• Medications can directly affect the muscles in the gastrointestinal tract. Let us see what medications cause constipation as their side effect. 

Constipation Guidelines - Pain medications 

If you are taking over-the-counter or prescribed pain medications that contain codeine, it may result in constipation. Painkillers like opioids affect the gastro-intestinal tract in a variety of ways.

• They increase the amount of time it takes waste material to pass through the intestines.
  
  
• They decrease the peristaltic movements that are critical in moving food through the intestines.
  
  
• They paralyze the stomach muscles so that the food remains in the digestive track for a longer period of time.
  
  
• Opioids containing medications reduce the secretion of digestive juices in the body, which in turn decreases the urge to defecate.

Chronic users of pain relievers like aspirin and ibuprofen are at a higher risk of developing constipation. 

Constipation Guidelines - Anti-cholinergic drugs

 Anti-cholinergic drugs include a wide range of medications such as:

• Allergy medications
  
  
• Anti-depressants
  
  
• Medications used for urinary incontinence

Constipation is one of the side effects of these drugs, plus other effects like blurred vision and irritability. 

Constipation Guidelines - Diuretics 

Diuretics are medications that increase the excretion of water from the body. Diuretics may lead to dehydration, causing constipation. 

Constipation Guidelines - Iron Supplements

Iron supplements are one of the major causes of pharmacologic constipation. Iron supplements are prescribed to treat iron-deficiency, also called anemia. 

Most individuals who take an iron supplement suffer from symptoms of hard, dry stools.

Iron supplements cause constipation in two ways:

• They disturb the flora in the gut, causing bad bacteria to flourish, which in turn disturbs the internal environment and causes constipation.
  
  
• Iron tablets may cause constipation by slowing down digestive activity. If a person is anemic, the body holds feces in the colon for a longer period in an effort to extract more iron. 
  
  However, when it stays longer in the colon, extra water is also extracted from stool, making it dry and hard.

Iron supplementation is important to treat anemia. It is also especially important for pregnant women. 

To prevent constipation caused by an iron supplement, talk to your health care provider and request a more quickly absorbed iron. 

Constipation Guidelines - Anti-depressants

Anti-depressants affect the central nervous system and slow down nerve activity. They suppress neuronal activity, which in turn negatively affects peristalsis, the propulsive motor activity of the intestines. 

Constipation Guidelines- Beta Blockers and other drugs

Some heart medications like calcium channel blockers and beta blockers also cause constipation. 

Other drugs that cause constipation include the following:

• Ganglion blockers
  
  
• Sympathomimetic agents
  
  
• Vinca alkaloids
  
  
• Cholestyramine

If your constipation is being caused by medication, you will usually find the condition eases once you stop taking the medication. 

However, make sure you do not stop the medication unless you talk to your general practitioner. 

Conclusion, constipation guidelines

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Constipation may be caused by multiple factors.

Hopefully the above guidelines will help you to identify the underlying condition that is causing sluggish bowel movements.

Once you know what is causing constipation, you will be better equipped to deal with it.

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