How often do you empty your bowels? That question, as nauseating as it sounds means that all is not well especially if you do not empty your bowels at least three times a week. It is a common digestive system to have constipation and shy away from telling others about it, because, well, it is supposedly deemed to be a private affair. Yet, not many people will visit the doctor because they are constipated, keeps telling themselves it is frivolous and will ease up sooner or later. Constipation is one of the most common digestive problems in the United States, affecting around 2.5 million people. It is defined as having hard, dry bowel movements, or going fewer than three times a week.

Your colon’s main job is to absorb water from residual food as it’s passing through your digestive system. It then creates stool (waste). The colon’s muscles eventually propel the waste out through the rectum to be eliminated. If stool remains in the colon too long, it can become hard and difficult to pass. Poor diet frequently causes constipation. Dietary fiber and adequate water intake are necessary to help keep stools soft. Fiber-rich foods are generally made from plants. Fiber comes in soluble and insoluble forms. The soluble fiber can dissolve in water and creates a soft, gel-like material as it passes through the digestive system. Insoluble fiber retains most of its structure as it goes through the digestive system. Both forms of fiber join with stool, increasing its weight and size while also softening it. This makes it easier to pass through the rectum.

Common causes of constipation

  • Low-fiber diet, particularly diets high in meat, milk, or cheese.

  • Dehydration.

  • Lack of exercise.
  • Delaying the impulse to have a bowel movement.
  • Travel or other changes in routine.
  • Certain medications, such as high calcium antacids and pain medications.
  • Pregnancy.

Risk factors that may lead to or worsen constipation

  • Physical inactivity

Low levels of physical activity may lead to constipation.

Some past studies have found that physically fit people, including marathon runners, are less likely to experience constipation than other people, although the exact reasons for this remain unclear. A study from 2013 notes that increasing mobility might help improve constipation among older adults. People who spend several days or weeks in bed or sitting in a chair may have a higher risk of constipation.

  1. Some medications

Some medications can also increase the risk of constipation. These include:

  • Opioid pain relief drugs.
  • Tricyclic antidepressants.
  • Certain anticonvulsants.
  • Calcium channel blockers- these lower blood pressure, and certain types lower heart rate. 
  • Antacids that contain aluminum.
  • Antacids that contain calcium.
  • Diuretics: These remove excess fluid from the body.
  • Iron supplements: Doctors prescribe these to treat iron deficiency anemia.
  • Irritable bowel syndrome-People with functional intestinal difficulty, such as irritable bowel syndrome (IBS), have a higher risk of constipation than people without the condition.
  • Aging-As people age, the prevalence of constipation tends to increase. Up to 40% of older people in the community and up to 60% of those in institutions may experience constipation.

The exact cause of this remains unclear. It may be that as people age, food takes longer to pass through the digestive tract. Many people also become less mobile, which may also contribute to constipation.

  • Changes in routine-When a person travels, for example, their usual routine changes. This can affect the digestive system. Eating meals, going to bed, and using the bathroom at different times than usual could increase the risk of constipation. 
  • Not drinking enough water.
  • Regularly drinking enough water can help reduce the risk of constipation. Other suitable fluids include naturally sweetened fruit or vegetable juices and clear soups. It is important to note that some liquids can increase the risk of dehydration and make constipation worse for some people. For example, those who are prone to constipation should limit their intake of caffeinated sodas, coffee, and alcohol.     

Constipation in pregnancy

  • According to one source, around 40% of women experience constipation during pregnancy.

This can result from:

  • Hormonal changes.
  • Physical changes, such as when the uterus presses on the intestines.
  • Dietary or physical activity changes.

Many women take iron supplements during pregnancy. These can contribute to constipation and other changes in bowel habits.

Constipation in infants-

If a breastfed baby goes a week without passing stool; this is not usually a problem. Breastfed infants do not usually experience constipation.

However, if parents or caregivers have concerns about a baby’s bowel movements, they can seek medical advice.

More commonly, constipation can occur:

  • When an infant first starts taking formula feeds
  • During weaning
  • During potty training
  • At times of stress

Symptoms of Constipation

  1. Passing fewer than three stools a week.
  2. Having lumpy or hard stools.
  3. Straining to have bowel movements.
  4. Feeling as though there’s a blockage in your rectum that prevents bowel movements.
  5. Feeling as though you can’t completely empty the stool from your rectum.

Are there certain foods that bind you up?

  • Caffeine-Can’t get through your day without too many cups of tea and coffee? It’s time to make a few changes. Too much caffeine can cause constipation.

  • White bread-White bread has a high content of starch and can lead to delayed digestion. This may slower your bowel movements and cause constipation. Opt for multi-grain or whole wheat bread if you want to. Also, instead of consuming plain buttered toast, make a sandwich with fresh veggies to add fiber to your meal.
  • Chocolate-You may be a chocolate lover, but anything in excess can affect your health. Chocolate is high on fat and contains almost no fiber. It can slow down your digestion process and the passage of food through the colon. If you are suffering from irritable bowel syndrome, it can even aggravate your symptoms.

  • Foods that contain gluten-One of the most common symptoms of gluten intolerance may be constipation. Even if you are slightly averse to gluten, consuming foods that contain it may slow down your digestion which can ultimately lead to constipation.

  • Refined flours and grains-Refined ingredients like white flour, white rice and food items made with it such as cookies and pasta have little fiber and can contribute to constipation.

Case management and treatment

  1. Self-care

Most cases of mild to moderate constipation can be managed by you at home. Self-care starts by taking an inventory of what you eat and drink and then making changes.

Some recommendations to help relieve your constipation include:

  • Drink two to four extra glasses of water a day. Avoid caffeine-containing drinks and alcohol, which can cause dehydration.

  • Add fruits, vegetables whole grains and other high-fiber foods to your diet. Eat fewer high-fat foods, like meat, eggs and cheese.

  • Eat prunes and/or bran cereal.
  • Keep a food diary and single out foods that constipate you.

  • Get moving, exercise.

  • Check how you sit on the toilet. Raising your feet, leaning back or squatting may make having a bowel movement easier.
  • Add an over-the-counter supplemental fiber to your diet.

  • If needed, take a very mild over-the-counter stool softener or laxative. There are many laxative choices. Ask your pharmacist or doctor for help in making a choice. Do not use laxatives for more than two weeks without calling your doctor. Overuse of laxatives can worsen your symptoms.

Medication/supplement review

In addition to self-care methods, your doctor will review your medications and supplements (if you take any). Some of these products can cause constipation. If they do, your doctor may change the dose, switch to another drug and/or ask that you stop taking the supplement. Never stop taking your medications or supplements before talking with your doctor first.

  1. A few prescription drugs are available to treat constipation. Your doctor will pick the drug that might work best for you based on the results of your tests.
  2. Surgery- Surgery is rarely needed to treat constipation. Your doctor may, however, recommend surgery if constipation is caused by a structural problem in the colon. Examples of these problems include a blockage in the colon (intestinal obstruction), a narrowing in a portion of the intestine (intestinal stricture), tear in the anus (anal fissure) or the collapse of part of the rectum into the vagina (rectal prolapse). Some causes of outlet dysfunction constipation may be treated with surgery. This is best discussed after testing. You may also need surgery if cancer was found in your colon, rectum or anus.

You can now safely ease up your constipation with all these fast tips. Having known what to do and what foods to avoid, I hope you find your time in the bathroom less difficult, yes, less difficult. As a general precautionary measure, do not read, use your phone or other devices while trying to move your bowels. Stay well and healthy.