Constipation is very common. It affects up to 27 percent of the North American population, says Marisa Battistella, a clinical pharmacist at the University Health Network in Toronto. Surveys reveal it’s twice as common in women as men, although this could be because women are more willing to admit experiencing constipation.
Almost everyone is familiar with the signs: abdominal bloating; straining; lumpy, hard stools. But most of us don’t know how frequently we should be “going.” According to experts, you shouldn’t be worried 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 Dr. John Marshall, an associate professor of medicine at McMaster University and a staff gastro-enterologist at Hamilton Health Sciences. What does matter is that movements are soft and don’t cause you to strain—which can lead to hemorrhoids. “People should have realistic expectations,” says Marshall. “There is a lot of folklore about bowel movements and since few people discuss it publicly, a lot of people don’t know what is normal.”
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Common causes and your best cures
Constipation is often caused by lifestyle factors such as not eating enough fibre, 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 Battistella. Drugs that may slow down your bowels are antidepressants (selective serotonin reuptake inhibitors [SSRIs] such as paroxetine), antipsychotics, certain antihypertensives, anti-Parkinson’s medications and, most commonly, opioids such as morphine, Percocet and Tylenol with codeine. Supplements such as calcium and iron can also cause constipation. Here’s what you can do to get things moving:
1. Eat more fibre
“It is recommended you have 25 to 50 grams of fibre a day,” says Marshall. (Example: One cup [250 mL] of Raisin Bran, two slices of whole-grain bread, a half-cup [125 mL] of raspberries, one cup of cooked adzuki beans and an apple would add up to more than 34 grams of fibre.) Yet, Marshall adds, “Canadians average five to 10 grams per day.” Foods with lots of fibre 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 fibre 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 also 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 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. 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.)
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6. If necessary, use laxatives, but don't overdo them
Most over-the-counter products are safe to use, 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 or Prodiem, 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 Laxilose, 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 and Ex-lax, cause muscle contractions in the intestines that are needed to get things moving, and should be used sparingly. Stool softeners, such as Colace, Surfak and Soflax, make them easier to pass. At-home enemas can be used in cases of acute constipation. Suppositories may also help, but they only clear out the end of the colon. 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 ‘fibre, fluid and exercise,’ ” says 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-fibre foods such as granola bars. And take your running shoes with you, so you can be sure to get that crucial exercise.
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