Constipation
Constipation is a very common gastrointestinal problem that is characterised
by infrequent bowel movements, straining during bowel movements and/or
passing hard stools.
A ‘normal’ frequency for bowel movements varies widely but, in general,
constipation is experienced when fewer than three stools are passed in a
week, and the stools are hard and dry.
The causes of constipation
While a number of factors can cause constipation, the most common causes
include an inadequate intake of fluid, a lack of fibre in the diet, repeated
ignoring of the urge to have a bowel movement, inactivity, illness and the
frequent use or abuse of laxatives. Children may also become constipated if
they are afraid of or unwilling to use the toilet, and older children may ignore
or forget to attend to bowel movements.
Fortunately, most cases of constipation are temporary. Simple lifestyle
changes, such as getting more exercise and eating a high-fibre diet, can go a
long way toward alleviating constipation.
The management of constipation
Ensure an adequate dietary fibre intake. Fibre is fermented in the large
bowel and provides the bulk that helps to stimulate the muscles of the colon
to push digested food through the gut. Fibre can also soften stools and make
them softer to pass. Aim to have between 20to 35g of fibre daily by including
fibre-rich foods, such as those listed below:
Vegetables and fruit – fresh, frozen, canned and dried
Oats and oat bran – add to yoghurt and cereal
Wheat and digestive bran
Bran-rich cereals, such as bran flakes, Weetbix, Hi-fibre bran,
Whole-wheat Pronutro
Rye bread, Ryvita
Digestive biscuits
Dried beans, chickpeas, split peas – canned and dried
Soya mince - add to mince dishes to increase the fibre content
However, foods rich in ‘gritty-fibre’ should be restricted, as this type of fibre
often remains hard and lumpy throughout the small and large intestine
(colon). This can cause blockages and further aggravate constipation.
Avoid the use of the following foods, or if you do eat them, chew them
thoroughly:
Whole-wheat kernels in whole-wheat or wholegrain bread
Skins of dried peas, beans and lentils and bean sprouts
Popcorn, sweetcorn and mealies
Raisins and sultanas
Nuts and crunchy peanut butter
Sesame and poppy seeds
Whole grain ‘gritty’ crackers
Fibre should always be gradually added to the diet to help reduce gas and
bloating.
Over-the-counter fibre supplements may be helpful for people who cannot
or will not eat sufficient amounts of fibre. These products can help to keep
stools soft and regular. However, it is important to drink plenty of fluid
when taking fibre supplements or constipation may worsen.
Increase consumption of fluids to at least two litres daily. Start the
day with a large glass of water as you get up in the morning and drink
water with all meals. Limit caffeine intake, which can worsen symptoms of
constipation by causing dehydration.
Plan regular exercise as it helps stimulate bowel movements. Getting
at least 30 minutes of exercise most days of the week is recommended.
Consider a daily probiotic supplement. Various probiotic products are
available on the market to supplements the diet. Examples include
Intestiforte, Probiflora and Gastro choice. Activia yoghurt is an example of a
food that contains probiotics known to assist with easing constipation.
Instructions and directions must be carefully followed for maximum benefit.
Take the time for bowel movements. Set aside sufficient time to allow for
undisturbed visits to the toilet, and don't ignore the urge to have a bowel
movement.
Be careful with taking laxatives. These products can become habitforming and should be considered as a last resort. For occasional relief, a
saline laxative, such as milk of magnesia, may be used to lubricate the stool.
Do not give laxatives to children without a doctor's approval.
Colon cleansing - is it helpful or harmful?
Some people believe that colon cleansing removes toxins, boosting energy
and improving immunity. Colon cleansing may be useful in preparation for a
medical examination of the colon, but it is not currently recommended by
medical experts for better health or to prevent disease. The colon doesn't
require enemas or special diets or pills to eliminate waste material and
bacteria as it does this naturally on its own.
Colon cleansing may even be harmful as it may disrupt the body’s fluid and
electrolyte balance, causing dehydration and salt depletion. Long-term or
excessive cleansing programs can also lead to problems, such as anaemia,
malnutrition and heart failure.
Meal-planning ideas
Breakfast
A cup of oats porridge cooked in low fat milk with added raw oat bran
and half a pawpaw with lemon
A cup of bran flakes with low fat milk or yoghurt and 1 sliced banana
A slice of brown toast with 1 poached or boiled egg with a grilled
tomato and an apple
Smoothie – blend 1 cup fat free yoghurt or milk with two fruits and 1
Tbsp smooth peanut butter and oat bran
Snacks
A piece of fresh fruit and a small tub of low fat or fat free fruit yoghurt
Four Ryvitas with cottage cheese and cucumber or hummus or peanut
butter
A slice of anchovy toast
Milo with low fat or fat free milk
Light meal
1-2 thin slices of brown bread with tuna in brine / skinless chicken /
lean beef / cottage cheese and salad vegetables with ½ small
avocado or 5 olives
2 mini pitas filled with egg mayonnaise (2 boiled eggs with 1 Tbsp lite
mayo)
A bowl of split lentil vegetable soup and grated mozzarella cheese and
1 slice of brown toast
1 tin sardines on 2-4 rye crackers with a mixed green salad and ½ a
small avocado
Main meal
A small baked sweet potato or a small cup of cooked brown rice
+ 1 palm sized portion of skinless chicken / lean beef / pork fillet /
fish + vegetables or salad with ½ small avocado or 5 olives
Stir fry vegetables with 1 palm sized portion of beef, pork or chicken
strips with 1 Tbsp sesame oil and soya sauce served with a small cup
brown rice mixed with split peas or spaghetti
Two Pilchard fish cakes with sweet chilli sauce and 2-3 boiled baby
potatoes and steamed vegetables
Mushroom and tomato omelet (2 eggs) served with roasted
vegetables
Optional
dessert
A small piece of fruit with some low fat or fat-free yoghurt
Note – portion sizes are estimated and serve only as a guide. Contact a
private dietitian for an individualised meal plan and portion guide.