Welcome to episode 34. I’m Anna Mapson.
This is part two of a constipation basics, diet for constipation. Part 1 was episode 33, which covered the causes of constipation. It’s really important that you listen to that, or at least you have some understanding about what might be triggering your bowel movements slowing down, becoming erratic and harder.
If you have got some idea, then you’ve got a chance to remedy it. This episode is going to be more about what you can do about it. I will cover some things about diet and foods that you can eat and dietary practices that help to get more regular bowel movements.
I’m also going to talk about laxatives and the way that I approach clients who have constipation.
How to deal with an IBS-C flare up
I wanted to start with my basic first stage checks that I run through when anyone says they were better, but then things are starting to go bad again. Or sometimes clients have asked me,
well, how will I know what to do if things slow down again? How will I know how to get back on track?
And I say, these are the top things to start with. They’re really kind of common sense things. Well it’s easy to let them slide. Actually it takes a little bit of work to get all of these things as part of your daily routine.
The importance of movement for constipation
So the top things I would run through is, are you doing some sort of movement every day? And by movement I mean exercise. I mean 30 minutes, ideally walking or running if you’re a little bit more active.
- But you need to be moving your body every day
- ideally 30 minutes a day.
A good walk. It could be exercises at home. It could be going swimming, yoga, cycling to work, whatever. Something that gets your heart rate up.
The good thing about walking is that it does get a bit of jiggling within your torso and can help to stimulate the need to go.
If you’re worried about needing to go suddenly and whether you’re going to be near a toilet or not. Just go for some varying loops from the house. Out round the block a couple of different ways so you don’t have to stray too far from your house or from a toilet.
Staying hydrated helps constipation
Then you want to make sure that you are well hydrated. Two litres of water a day can be hydrating. Just getting enough liquid in that your body is not going to be over absorbing liquid back out of the stool making it quite hard and difficult to pass.
Do make sure you are drinking regularly throughout the day There’s just no point in drinking three pints in a row. And then not drinking for the rest of the day.
- It needs to be dripped into you ideally throughout the day
- Set a timer if you need to make sure you take a bottle of water out and about with you
- Put flavours into it if you have to like Squash or herb tea. It doesn’t have to be plain old water. It just has to be liquid. Get it in.
Eating fibre to avoid constipation
Then in terms of your diet, we want to make sure that you are having around 25 to 30 grams a day of different types of fibre. Lots of variety.
If you’re not anywhere near this, this could be one of the causes of constipation. We need to make sure that there’s different types of fibres.
Ideally a good way to start is just trying to get your five a day. Three vegetables, two pieces of fruit, and some whole grains, you know, pulses, nuts, all of these different things.
So slowly increase your fibre. I know this is not a once and done overnight change, but it is something to check if you feel like constipation is an ongoing battle for you. Are you eating enough fibre? That is something that you can check over time.
Diet for constipation – what to eat
And then there are particular foods that are well known to help you want to go, including prunes and like dried fruits, also kiwis, and then flax seeds or chia seeds ground up.
These are useful because they help to draw water into the bowel and create a softer stool. Now depending on your cause of constipation, you may not need necessarily to have more. water drawn in. It might be the case that you’ve got very slow transit time. It might be that you’ve got some pelvic floor dysfunction.
That’s not necessarily going to be helped by having a very soft stool, but it won’t harm it. So, I think those foods are good. Kiwi particularly, I’m going to come back to in a minute. Dried fruits, all of these things are well known. So just try and load up with some of those. Now prunes can make you a little bit gassy and a bit bloated.
It might be worth it though, to get things moving.
Eating healthy fats can help motility
The last diet thing as a quick check is to make sure that you have been eating some sorts of healthy fats as well. So if you haven’t. been eating any fats at all, you may not get enough bile going and actually bile helps us emulsify our fats. But it also helps to kickstart the motility of your digestive system.
So it’s a helpful motility aid as well. If you have a very, very low fat diet, you might just be struggling to release it enough.
Managing your stress levels
And then the other thing is stress and managing how your body feels and how your mood is. Generally, talking therapy is the best long term solution to that. But just including mindfulness practice like deep breathing, diaphragmatic breathing can be so helpful.
So once I get a new client and I start working with somebody from the beginning, I’m going to check through some of those things that can be crossed off. And worked on day to day, like movement. Are you getting enough movement? Are you doing some sort of mindfulness practice? Deep breathing? Are you eating foods that are going to help to soften the stool?
You can work on those straight away. Those are like the basic checks.
Getting bowel moving in constipation
Then, you really want to think about how to get your bowels moving. Because in order to get regular you want to make sure that you’re eating sufficient fibre. You can’t do that if you have got a very slow transit time and hard impacted stool.
Just pushing more fibre in there is going to make you very uncomfortable and isn’t the best thing to do. So what we want to do is to try and get your bowels moving.
I often recommend to my clients taking laxatives or other supplements. That can be quite helpful. In order to get things moving. I know people get worried about taking laxatives and saying, thinking that they may become dependent on them.
But it’s often not the case, particularly with different types of laxatives that you can get.
Different types of laxatives
So there are things like bulk forming laxatives which include psyllium husk. Includes things like Fibrogel.
Fibre containing laxatives
Which is basically just adding fibre into your gut, so it’s a fibre supplement, effectively. And it helps by forming a bigger stool and causing you the urge to want to go.
It will also help to draw a little bit of water in and make it jelly like. These typically take two to three days to work. And you don’t get a lazy bowel where you have to have them in order to go. They can be a helpful intervention to help you get moving. It’s like if you had a really slow moving river that’s blocked.
What we want to do is just clear that blockage so that we can get the river running. faster and smoother.
The other type of laxative that can take a few days to get working is an osmotic laxative. That means that it passively draws water into the bowel chemically. That includes things like lactulose and also magnesium oxide.
Now, magnesium citrate can also do this in some people, but not as effectively. But magnesium oxide is a particular form that’s not very well absorbed and it does draw a lot of water into the bowel to soften the stools. Again, this is not a laxative that you become dependent on.
It’s good to try it for a few days, get things moving, and keep going for a week or two so you can start to change your diet.
You just want relief at the beginning, don’t you? You want to feel better.
The third type of laxative is a stimulant laxative. That typically works much quicker, within 6 to 12 hours, and it includes things like Senna, or Bisacodyl, which is Dulcolax. This helps to stimulate the gut to want to get rid of what’s inside it.
These are the ones where people can become a bit dependent on the action, but this won’t happen to you in a week or two. It’s not like you’re going to be unable to poo without these laxatives in a couple of weeks. It’s really where people are taking them long term or abusing them over time. That is where you can get more problems.
You can take more than one type of laxative at the same time. You can take a fibre type laxative plus a stimulant, or you can take osmotic plus fibre. There are different ways that they’re working and it’s okay to take different types at the same time.
I wouldn’t go straight in and take several different types, but if you’re taking one laxative and it’s working to an extent, but not really working completely, Then you can add in another type of laxative.
I would go and talk to your pharmacist about this if you have any concerns and questions. They are a really good source of information for products like this.
Side effects of laxatives
Some laxatives can cause a bit of bloating and gas and cramps. You shouldn’t take them long term but taking them for a week or two is absolutely fine.
We do want you to stop when the constipation improves and you can alternate the types or you can just, like I said, layer on laxatives for a day or two until things just feel a bit more normal and you are going more regularly. Also, what can happen is it can go too far. So you can take too many laxatives, which is definitely why I say take them slowly to begin.
Do not go in with, you know, six packets all at once. Start small, start low and slow and build up.
Start increasing fibre when bowels are moving
Assuming that you either do some of the first line checks and you end up getting a more regular bowel or that you take some laxatives for a little while and you start to get a regular daily bowel movement.
Even if it’s every other day, as long as more is coming out than it was and things are starting to move. Then we want to look at really changing your diet for the long term.
So we need to work on the underlying cause of the constipation and work on your diet.
Gradually increase your dietary fibre intake
Some people will need to increase their fibre levels. You may have been restricting fibre over time because you found that it gave you more bloating.
That can be because you’re really backed up and blocked and then you’re adding more and more fibre in. It’s bloating and fermenting. That slow transit time can also be a real opportunity for methane producing microbes to overgrow and methane can actually slow down your gut transit time.
So this is why some people may find the low FODMAP diet helpful because it strips out some of that fermentable carbohydrate.
Starting with low FODMAP fibres
This is why you might want to start when you’re increasing your fibre starting with low FODMAP fibres to begin. That can help you to bulk up the fibre without so much of that fermentable gas causing effect.
And remember with fibres, we want two types. We want the one that increases the bulk so that it increases the urge to want to go, but we also want a gel forming to get a nice soft stool. So that’s why you need to eat a lot of variety in your diet.
Stool consistency in constipation
There’s not actually though that much difference percentage wise in liquid stool.
So like if you’ve literally got diarrhoea, it’s about 90 percent water and a very formed stool is about 75 percent water. So even a formed poo and a very hard poo even is still about 72 percent water.
Water is a big important part of it and it’s the fibre that holds the water in the stool. That’s why we want to make sure you’re eating enough of it.
So, as I’ve mentioned lots of times before, you really need to start slowly increasing up your fibre intake. Just starting with literally half or one extra gram of fibre per day, or even per week if it’s that difficult for you. Really slowly increasing up the types of fibre, and also the amount.
Some specific foods that are known to help with constipation
Firstly, kiwi. Kiwi is low fodmap, and even two kiwi fruits are considered a low FODMAP portion. It’s rich in vitamin C and also B vitamin like folate. It’s as effective as things like prune and psyllium husk. But it has less bloating and gas.
Eating kiwi fruit helps constipation
I really like using kiwis with people because it’s a food way of doing it, rather than taking any supplements.
Try and have about two kiwis a day, ideally have them in the evening. But actually any time is okay. Takes about 24 hours for food to get through us anyway.
Flaxseeds in your diet can help constipation
Next, another food that’s really good is flaxseeds, so ground flaxseeds can help improve your stool regularity.
They’re bulk forming fibre, but they also create this soft gel by drawing water in. Chia seeds are quite similar. You can grind them up, add them to porridge. Add them to yoghurt. Or even sprinkle them over salads. Doesn’t really matter how you get them in but just get them in. Make sure you’re drinking water because they do tend to draw the water in.
Dried fruit helps constipation but watch out for bloating
Now prunes and other dried fruits we know are really good at drawing water into the bowel helping to stimulate a bowel movement. But prunes are high in sorbitol which is one of the FODMAPs. Sorbitol is also in apples and pears and apple and pear and apple juice can actually be very helpful here as well at increasing bowel regularity.
Wheat bran could be making constipation worse
Now one food, it’s really only one food I would say to stay away from, and that is wheat bran. So wheat bran is the large coarse insoluble fibre particles that can really irritate the gut lining. This can sometimes stimulate more water and mucus secretion. It can actually make constipation worse by adding to the dry bulk rather than more gel like softer poos.
So I recommend staying away from bran. If you have muesli or a cereal, just check if it has much wheat bran in it. Don’t eat products like all bran, bran flakes.
Coffee can be part of a diet for constipation.
Coffee is another food, or drink I should say, you can add to your diet to help to stimulate a bowel movement. It’s not just the caffeine in coffee which helps you to want to go.
There’s actually a compound in it called chlorogenic acid. Which stimulates a bowel movement, sometimes within a few minutes. So, it’s not the case that the coffee is getting to your large intestine and that’s stimulating to want to go. It’s actually triggering a hormonal response, and that creates the need to want to have a bowel movement.
That’s why sometimes it’s literally a sip and people need to go. But in constipation, It doesn’t help for everybody, but if it does, you can increase coffee in your morning routine.
A morning routine for constipation
And actually, that is what I want to move on to now, a morning routine. When you’ve got constipation ongoing every day. It can be very challenging and a lot of pressure on that morning needing to go.
So, A couple of ways we want to try and address that.
- Firstly, I would say, have a little glass of water when you wake up. It can be warm water, it’s fine. It’s just getting a little bit of hydration in first thing.
- Eat your breakfast. Normally within about an hour of waking, eat your breakfast before you go to work or before you get going.
- And include a coffee if coffee doesn’t make you really jittery and you can manage to drink coffee okay.
- I do also really recommend going for a short walk or doing some exercises at home, which also just helps to wake your body up, helps to get things moving. Anything where you’re jumping up and down, running on the spot even. Or going for a nice gentle walk with your dog perhaps can be very helpful to get things moving.
- Then, even if you don’t feel the urge to want to go to the toilet, I suggest going to sit on the toilet 20 minutes after eating for around 5 minutes. If nothing happens, you can get up and move on, but what I want you to do is to sit there in a specific way, which I’m going to go through now, to help you open the pelvic floor in the right way to make it as easy as possible for the poo to come out.
Sitting right on the toilet can reduce straining
Before we all lived in houses with nice clean toilets with flushes. Humans used to sit and squat on the ground to have a bowel movement. This change in our physical position when we’re sitting on the toilet, just isn’t optimal. Lots of women sit too far forward on the toilet and hovering.
If you ever do this in a public toilet, you just can’t release all the right muscles in the right way.
So it can also. add to the pelvic floor blockage in letting go. Now you might not have thought that there is a correct way to sit on the toilet, but there actually is. It’s not just sitting there.
Raise up your knees
The best thing to do is to get a small step, or a box, or something that you can put your feet on, in order that your knees will be raised up higher than your hips.
And what you want to do, put your feet on the box, sit on the toilet, lean forward a little bit, so you’re resting your elbows on your knees. And this is a bit more like a squatting position. It is shown in lots of studies to reduce the amount of time that you’ve been sitting on the toilet, and it also reduces straining.
Straining with constipation can lead to tears
And when we’re straining to get a larger poo out, it can be associated with fissures, that’s like little tears, and also haemorrhoids from the increased pressure. So it’s really important if you have constipation that you are sitting correctly on the toilet. When you’re in this position, your pelvic floor can relax.
When you’re sitting forward at that angle, there’s a little muscle called the puborectalis muscle, and it loops around your rectum, that’s like the last bit of your colon, like a sling. And when we’re sitting normally, like you would just sit in a chair upright, There’s like an extra barrier to a bowel movement coming out.
So what you can do is use this small step or a pile of books or a box or anything, really, to raise your knees above hip level. And that just relaxes this muscle, which helps you have a better, easier bowel movement.
Why breakfast should be part of your diet for constipation
Now, I mentioned having breakfast as part of your morning routine. You probably have heard me again, if you’re a regular listener podcast, I talk about the gastrocolic reflex, it’s strongest in the morning and we can capitalize on this.
It’s your body’s natural way to make room for more food coming in by triggering a poo coming out. If you don’t feel hungry in the mornings, just start building up your tolerance for breakfast by having a smoothie, having something small, eating it at the same time every day. It trains your body to be hungry at a certain time.
If you always eat at a certain time, you will become hungry at that time. Now, in order to get more of a breakfast, be more of a breakfast person, Sometimes you have to build your sleep up more, which is why IBS treatment is really holistic. It’s not just ever one thing. You need to be going to bed early enough that you can wake up in time.
You don’t feel too tired to have breakfast, that you’re not too rushed. This morning routine I’ve mentioned. You need a bit of time to do this, and obviously that’s really challenging if you’ve got small children, people you care for, and you have to leave early for shift work or something like that. It can be really challenging, I know, but this is the goal, and what I do with my clients is work out how to tailor it to your own routine and your own life.
It’s very personal, what would work for you best, but these are some of the things to think about if you struggle with constipation and you’ve had some real problems.
Your next steps
If you want to work on your bowel habits and regular constipation and food intolerances with me. I would love to hear from you. I run a three month gut reset, either one to one with lots of one to one coaching or in a group where you have some one to one calls with me and some group calls.
And with all of them, you get some recipes. You get a whole host of videos and educational support and you get access to ask me questions. Whenever you like for the whole three months.
The link to join those is in the show notes, but that is it for this week.
I’ve got lots of ideas of things to delve into a bit more detail of these. Particularly around probiotics for constipation, other foods and other dietary patterns that can be helpful. Or not so helpful, but for now, I’m going to leave it there.
Thanks for listening. Bye.