Constipation

12 March 2017.

Normal bowel habits vary from person to person. Some adults go to the toilet more than once a day, whereas others may only go every three or four days. When you’re constipated, passing stools becomes more difficult and less frequent than usual. It may also be more difficult to pass stools and you may feel unable to empty your bowel completely. Your stools may appear dry, hard and lumpy, as well as abnormally large or small [1].

It is very common for people who menstruate to experience constipation in the days leading up to menstruation (often this is followed by diarrhoea, or loose stool, as menstruation begins). This is thought to be due to higher levels of progesterone delaying the transit of waste food travelling through the gut [2].

Constipation affects twice as many women as men, and is also more common in older adults and during pregnancy [1]. In fact, idopathic (otherwise medically unexplained) constipation almost exclusively effects women of reproductive age (i.e. people who menstruate) [3]. These findings suggest some sort of link between ‘female’ sex hormones, and the cause(s) of constipation in some people.

Other symptoms of constipation can include [1]:


Note: If your symptoms are caused by your hormonal medication, we suggest that you discuss your options with a doctor. These steps may reduce symptom severity, but are unlikely to be able to stop them completely whilst you remain on the same medication.


The good news is that hormone-related constipation responds particularly well to the steps outlined on our ‘all symptoms‘ page!

Try a hormone-balancing diet– As outlined in this blog, a vegetable-based ‘anti-inflammatory’ diet can significantly improve all hormone-related symptoms. We highlight a few of the key steps that are especially relevant for those suffering from constipation, below;

– Eat lots of fibre (and drink water)- Beans, whole grains, and pulses are high in fibre, which can help reduce constipation by adding more bulk and increasing the water content of stools, which together allow a much more effective transit through, and elimination from, the body [4].

TOP TIP! Drink plenty of water when eating high-fibre food, otherwise you may not feel the benefit…

– Try nutritional supplements– Magnesium (100-300 mg daily) is particularly beneficial for avoiding hormone-related constipation [5].


Exercise regularly– Exercise helps to keep the bowels moving and allows food waste and matter to pass more effectively through the intestines.  A lack of exercise, therefore, can slow everything down, meaning that stools become hard and dry, increasing the risk of you becoming constipated .

Exercise (together with fibre and water) is therefore one of the most effective, cheap, and natural ways to relieve constipation, and should be tried before turning to laxatives [6]. This is especially important in the premenstrual phase of the menstrual cycle (approx. 14 days before menstruation) when you are more likely to experience constipation. Going for a 30 minute walk every other day is enough to make a significant difference to your health and well-being.


Most of us know that our mood and emotions can affect our digestive system: For example, if we are nervous before a job interview, or other social event, we may experience temporary diarrhoea. Research also shows that ‘mood’ issues such as depression or anxiety, can often be accompanied by changes in our bowel habits- including constipation [7].

It is thought that circulating levels of ‘stress hormones’ such as cortisol and adrenaline, may be responsible for these changes [8].  So, an improvement in self-esteem and a reduction in stress levels could potentially reduce, or even eliminate, constipation, if caused by low mood, or anxiety [9] [10].


If you have tried the suggested tips and tricks for at least 3 months, and your symptoms do not improve, please consult your doctor.

If you have any suggestions, or tips, for managing constipation- please let us know– we can share them with others!


Further information:


Page last reviewed and updated: June 2018


References:

  1. NHS. (2015) Constipation. [ONLINE] Available at: http://www.nhs.uk/Conditions/constipation/Pages/Introduction.aspx. [Accessed 6 April 2017
  2. Wald A, Van Thiel DH, Hoechstetter L, Gavaler JS, Egler KM, Verm R, Scott L, Lester R. (1981) ‘Gastrointestinal transit: the effect of the menstrual cycle’. Gastroenterology. Jun;80(6):1497-500. PubMed PMID: 7227774
  3. Kamm, M. A., Farthing, M. J., Lennard-Jones, J. E., Perry, L. A., & Chard, T. (1991). ‘Steroid hormone abnormalities in women with severe idiopathic constipation’. Gut, 32(1), 80–84
  4. Rao SS, Yu S, Fedewa A. (2015) ‘Systematic review: dietary fibre and FODMAP-restricted diet in the management of constipation and irritable bowel syndrome’. Aliment Pharmacol Ther 41: 1256–70
  5. Murakami K, Sasaki S, Okubo H, Takahashi Y, Hosoi Y, Itabashi M; (2007) ‘Association between dietary fiber, water and magnesium intake and functional constipation among young Japanese women’. Eur J Clin Nutr. May;61(5):616-22. Epub 2006 Dec 6. PubMed PMID: 17151587
  6. De Schryver AM, Keulemans YC, Peters HP, et al. (2005) ‘Effects of regular physical activity on defecation pattern in middle-aged patients complaining of chronic constipation’. Scandinavian Journal of Gastroenterology 40(4):422-9. PMID: 16028436. DOI: 10.1080/00365520510011641
  7. Whitehead WE, Engel BT, Schuster MM. (1980) Irritable bowel syndrome: physiological and psychological differences between diarrhea-predominant and constipation-predominant patients. Dig Dis Sci. Jun;25(6):404-13. PubMed PMID: 7379673
  8. Buckley, M. M., O’Mahony, S. M., & O’Malley, D. (2014). Convergence of neuro-endocrine-immune pathways in the pathophysiology of irritable bowel syndrome. World Journal of Gastroenterology : WJG, 20(27), 8846–8858. http://doi.org/10.3748/wjg.v20.i27.8846
  9. Ford AC, Moayyedi P, Lacy BE, et al. (2014) ‘American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation’. American Journal of Gastroenterology 109:S2-S26. PMID: 25091148. DOI: 10.1038/ ajg.2014.187
  10. Saha L. (2014) ‘Irritable bowel syndrome: Pathogenesis, diagnosis, treatment, and evidence-based medicine’. World Journal of Gastroenterology 20(22):6759-73. PMID: 24944467. DOI: 10.3748/wjg.v20.i22.6759

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