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Constipation is an intestinal disorder that is characterized by difficult, infrequent, or incomplete defecation and Bristol 1 or 2 type stools. It can be defined as an individual having less than three stools per week. However, some people may be constipated and still go to the bathroom daily. Chronic constipation affects up to 27% of the world’s population, 75% of whom are women. It can be caused by a variety of factors including motility disorders (irritable bowel syndrome, diabetes, hypothyroidism, pregnancy, etc.), neurological effects (Parkinson’s disease, stroke, spinal cord disorders, etc.), changes in the gut microbiota or from side effects to medications (calcium antagonists for hypertension, opiates, antipsychotics, etc.).
There are four subtypes of constipation: constipation predominant irritable bowel syndrome (IBS-C), slow-transit constipation, chronic idiopathic constipation (CIC) (also called functional constipation), and constipation due to pelvic floor dysfunction. There are different solutions to a constipation problem, the effectiveness of which varies depending on the type of constipation. Here are ten remedies for constipation.
Stools are composed of mostly water, and when they are less hydrated, they are more difficult to evacuate. Water requirements depend on a variety of factors including body weight and level of physical activity. Other beverages such as tea and coffee in moderate quantities can also be good hydration options. To make sure that you are well hydrated, drink sips of water regularly during the day and aim to have light-coloured urine at all times. To get more tips to help you drink more water, read this article.
According to a meta-analysis of nine randomized controlled clinical trials, physical activity, and in particular aerobic exercise, has been shown to have significant benefits as a means of improving constipation symptoms.
One of the first remedies to try when you suffer from constipation is to increase your fiber intake. It is preferable to try to optimize your fiber intake through your diet (fruits, vegetables, whole grains, nuts, seeds, and legumes), as food also contains a variety of other nutrients (vitamins, minerals, antioxidants, etc.). There are different types of fibers. The ones that are best tolerated and most effective for constipation are those that have the characteristics of increasing the water content of stools to produce large, soft, and easy-to-evacuate stools, and they must be present in the stool, which means that they must not be highly fermentable. The best fiber supplements for constipation are psyllium and methylcellulose, as they are not fermentable, retain water and are water soluble. However, it is worth noting that for people with a slow transit, a high fecal load, or a pelvic floor disorder, adding fiber can be like adding more cars to a traffic jam and can result in making the situation worse! In the case of slow intestinal transit, taking laxatives or a magnesium supplement at a sufficient dosage (at least 400 mg per day) may be necessary to help speed up gastric emptying. If you suspect that your constipation problem may be caused by slow transit or pelvic floor dysfunction, you should consult with a doctor so that they may perform the proper medical tests in order to diagnose these conditions.
A low FODMAP* diet is an effective method of relieving gastrointestinal symptoms associated with Irritable Bowel Syndrome (IBS) in about 75% of cases. However, before trying out this diet, it is important to optimize the lifestyle habits mentioned above, i.e. hydration, physical activity and fiber intake.
Kiwi is a fiber-rich fruit (4g of fiber for 2 kiwis) that has a high water holding capacity, which aids fecal bulking and promotes laxation. It contains an enzyme called actinidine that can facilitate laxation by stimulating colon receptors. According to some studies, the consumption of kiwifruits may be effective in increasing stool volume, frequency and improve consistency in patients suffering from constipation. Note that the kiwi is a good fruit choice for people with IBS because it is low in FODMAPs.
Rhubarb contains anthraquinone glycosides and sennosides that act as laxatives by stimulating the peristalsis of the intestine. In Japan, rhubarb is used as a prescribed drug for constipation. However, current scientific evidence comes from studies conducted in rats, and studies performed in humans are needed to assess its effectiveness.
In a randomized controlled clinical trial, prunes were found to be more effective than psyllium in relieving constipation, although they were both effective. The laxative effect of prunes can likely be attributed to a combination of their sorbitol, fiber (6 g of fiber for a 100g serving) and polyphenol content. Because sorbitol is a FODMAP, prunes may not be suitable for some people with IBS.
Biofeedback therapy and pelvic floor physiotherapy may be helpful for people suffering from constipation related to pelvic floor dysfunction, also known as dyssynergic defecation, a condition that affects about 40% of patients suffering from constipation. Medical tests performed to diagnose this condition are anorectal manometry and defecography. The treatment involves working with a specialized physiotherapist to reorient the functioning of the pelvic muscles. Biofeedback can be used to strengthen or relax pelvic floor muscles. This technique uses a device that produces auditory or visual stimuli, allowing the patient to understand exactly what their muscles are doing by giving immediate feedback when they perform properly or improperly the pelvic floor muscle exercises.
Using a stool to raise the knees above the hips while sitting on the toilet can be helpful in reducing constipation.
A randomized controlled clinical trial suggests that the probiotic strain L. Reuteri is more effective than a placebo in improving stool frequency in adult patients suffering from functional constipation.
*FODMAPs are fermentable carbohydrates that are partly responsible for causing symptoms in people with irritable bowel syndrome (IBS). For more info, read this article.