Bowels

The bowel is part of our digestive system, and it works to digest the food we eat, absorb the goodness and nutrients, then expel the waste that the body cannot use.

Muscular contractions squeeze the food through the different sections of the bowel. This is called peristalsis and usually takes 24 to 72 hours.

Normal bowel emptying occurs between three times per day to three times per week. If you are emptying your bowel less than three times per week you could be constipated.

Signs and symptoms

These may include:

• fewer bowel movements than normal
• pain and straining or a sore bottom
• stomach pain, abdominal bloating or cramps
• stools that are hard and dry
• unpleasant smells due to passing wind
• bad taste in the mouth or bad breath
• decreased appetite or nausea

Common causes

• not enough fire in the diet
• not drinking enough fluids
• putting off going to the toilet
• reduced mobility
• change in normal routine
• some medications (i.e. pain killers, iron supplements) other medical conditions (i.e. neurological disorders, anxiety, stress, depression)
• pregnancy

Managing constipation

There are many ways to alleviate the symptoms of constipation which include some simple lifestyle changes.

Diet and fluids

Eating regularly is the best stimulant for your bowels. Skipping meals, especially breakfast, can lead to an irregular bowel habit.

Taking the right amount of fibre in your diet will help contribute to good bowel health. Recommended daily intake of fibre is a minimum of 18 grams.

Easy ways to increase file intake include swapping white bread, pasta, and cereals for whole grain varieties. Other fibre-rich foods include nuts, beans, pulses, fruit, and vegetables (including tinned and frozen varieties). Try to cut down on processed and pre-prepared foods as they often contain less fibre.

Without fluid, dietary fibre cannot do its job as fibre acts like a sponge absorbing water, making stools softer and easier to pass. You should aim to drink 1.5 to 2 litres (3 to 4 pints) of fluid per day.

Good toilet habits

It is important not to ignore the urge to open your bowels as this can make constipation worse. Allow yourself plenty of time for sitting on the toilet. A good time for this may be after meals as this is when your bowels are most active.

Consider how you sit on the toilet. Ideally your knees should be slightly higher than your hips and you should lean forward into your knees (please see diagram on the next page). A footstool will help you achieve the correct position.

Only use a footstool if it is safe to do so.

Avoid straining by using the correct sitting position and maintain normal breathing. Relax your stomach muscles and widen your waist, push back and downwards into your back passage while relaxing your anus. If this attempt is unsuccessful do not panic, try again when you next get the urge to have your bowels open.

Medication

Laxative medications are substances that loosen stools and increase bowel movements. They should be used short-term to treat constipation.

Treatment with a laxative is only needed if the lifestyle measures mentioned previously do not work. Some laxatives work quickly, and others may take several days.

Examples of foods that can act as natural laxatives for some people are:

• prunes and prune juice
• figs and fig juice
• liquorice
• chocolate
• coffee
• spicy food

There are four main groups of laxatives:

• Bulk forming laxatives: these bulk up your stool very much like fibre does and you need to ensure you drink plenty of fluids while taking them (i.e. Fybrogel).
• Osmotic laxatives: these help by allowing the stool to retain water so they don’t become hard (i.e. Movicol, Laxido, lactulose).
• Stimulant laxatives: these stimulate the nerves in the bowel, increasing peristalsis and making the bowel muscle squeeze harder (i.e. Senna, bisacodyl).
• Stool softener: these work by wetting and softening the stool (i.e. liquid paraffin).

A good way of working out your bowel transit time from eating to defeaction is eating a good portion of food with does not digest, for example sweetcorn.

Make a note of the date and time you ate one large portion then again when is has completed the transit and passed in the stool.

This is a rough idea of your bowel transit time.

The longer feaces sits in the bowel the more water is absorbed via osmosis and the dry the stool will become causing constipation if the bowel transit is slow.

Fibre

Soluble fibre

Found in fruit, vegetables, and seeds.

Absorbs water to form a gel-like substance which binds to other substances. It slows down digestion and relieves constipation.

The recommended intake is 30g per day.

Examples:

• Broccoli
• Oats
• Sweet potato
• Chia seeds
• Flax seeds

Insoluble fibre

Found in wholegrain cereals, nuts, and pulses.

Stimulates the gastrointestinal tract.

Included in the recommended intake of 30g per day.

Five portions of fruit and vegetables.

Examples:

• Green beans
• Fruit with skin
• Wholegrain
• Bran cereals

Exercise

Keeping active helps to keep your bowels moving.

Suppositories and enemas

Suppositories and enemas are rectal laxatives which provide immediate relief from constipation and are an alternative for someone who cannot take oral medication.

If your constipation does not respond to treatment, you should seek medical advice.

Seek medical advice should you experience any of the following:

• a persistent change in bowel habit, causing you to go to the toilet more often and pass looser stools, usually together with blood on or in your stools
• a persistent change in bowel habit without blood in your stools, but with abdominal pain
• blood in the stools without other haemorrhoid symptoms (such as soreness, discomfort, pain, itching or a lump hanging down outside the back passage)
• abdominal pain, discomfort or bloating always provoked by eating, sometimes resulting in the reduction in the amount of food eaten and weight loss