We all know the signs of constipation: abdominal bloating; straining; and lumpy, hard stools. But most of us don’t know how frequently we should be “going.” According to experts, don’t worry if you go only every other day and your husband or sister goes twice a day; both patterns are fine. “Anything from three times a week to three times a day is normal,” says John Marshall, MD, an associate professor of medicine at McMaster University and a staff gastroenterologist at Hamilton Health Sciences. What does matter is that movements are soft and don’t cause you to strain—which can lead to hemorrhoids.
What Causes Constipation?
Constipation is often caused by lifestyle factors such as not eating enough fiber, not drinking enough fluids, and not exercising regularly, as well as mental health issues such as stress, depression, and anxiety. Genetics are also thought to play a role, albeit a minor one. As well, certain medications can cause constipation, says clinical pharmacist Marisa Battistella. Antidepressants, antipsychotics, certain antihypertensives, anti-Parkinson’s medications and, most commonly, opioids such as morphine, Percocet and Tylenol with codeine may slow down your bowels, as can supplements such as calcium and iron.
Here’s what you can do to get things moving:
1. Eat more fiber
“It is recommended you have 25 to 50 grams of fiber a day,” says Dr. Marshall. (Example: One cup of Raisin Bran, two slices of whole-grain bread, a half-cup of raspberries, one cup of cooked adzuki beans and an apple would add up to more than 34 grams of fiber.) Foods with lots of fiber include cereals such as wheat germ and bran, whole-wheat and rye flours, grainy breads, fresh fruit (especially berries), dried fruits such as prunes and figs, vegetables, and legumes such as chickpeas, lentils and beans. Increase fiber intake gradually to avoid getting gas or diarrhea, or worsening constipation.
2. Exercise regularly
Aim to be physically active at least three times a week for 30 minutes or more, says Battistella. Physical activity stimulates your intestinal muscles to work more efficiently. It also decreases the amount of time needed for food to move through your intestines, so stools stay moist.
3. Drink lots of water
Battistella recommends eight glasses of water a day. Water lubricates the intestines and moistens the food you eat, aiding its flow through your body.
4. Lose the stress
“Psychological stress has a huge effect on bowel function,” says Dr. Marshall. “We say the bowel is the little brain of the human body. The brain and bowel are highly interconnected.” Bowel movements depend on intricate signalling between the gut and the brain. When the brain is under stress, the bowel is, too. Plus, people who are stressed are less likely to exercise and eat nutritious foods.
5. Stick with a regular routine
Bowel movements occur according to the body’s internal “clock.” When you ignore the urge to go to the bathroom, there’s more time for water to be extracted from the stools into the body, making them harder to pass. (One idea: Give yourself enough time to make bowel movements part of your morning at-home routine.)
6. Use laxatives if necessary, but don’t overdo them
Most over-the-counter products are safe, as long as you follow package directions. But overuse can make the bowel lazy. “Fix your lifestyle first,” advises Battistella. For occasional help, there are several laxatives to choose from: Bulk-forming laxatives, such as Metamucil, increase water content and bulk up the volume of the stool so it moves through your bowel faster. (Take them with a lot of water.) Osmotic laxatives, such as MiraLAX, help fluids to flow and stimulate muscles that aid in digestion. Saline laxatives, such as milk of magnesia, draw water into the colon so the stool passes more quickly. Stimulant laxatives, such as Dulcolax, cause muscle contractions in the intestines that are needed to get things moving, and should be used sparingly. Stool softeners make them easier to pass. Ask your pharmacist which laxative is best for you.
7. Be prepared for travel
For some people, when they’re on the go, it’s hard to, well, go. “I tell people ‘fiber, fluid and exercise,’ ” says Dr. Marshall. “And all those are compromised when you travel.” He suggests drinking lots of water and, when eating out, choosing menu items with fruit and vegetables in them. Pack high-fiber foods such as granola bars. And take your running shoes with you, so you can be sure to get that crucial exercise.
May 2009 issue of Best Health magazine