Gut health guru Dr. Megan Rossi talks about strategies to consider when dealing with constipation

It’s a problem that affects millions of us and can be truly debilitating – and it’s one of the most common reasons people visit their GP.

I’m talking about constipation, a subject that we don’t talk about enough, even though it can have a major impact on our health and quality of life.

Every day in England, more than 200 people are admitted to hospital to be treated for constipation. Even in the mildest cases, it can cause bloating, worsen acid reflux, and contribute to a low mood.

There is no doubt that many people are shy about this. But you don’t need to suffer in silence.

In fact, there is good quality evidence that shows that with a few dietary and lifestyle changes, most people can overcome their constipation problem.

It’s a problem that affects millions of us and can be truly debilitating – and it’s one of the most common reasons people visit their GP. I’m talking about constipation, a subject that we don’t talk about enough, even though it can have a major impact on our health and quality of life.

But the truth is, there’s no one-size-fits-all approach – it’s more about finding the culprit of your constipation.

First, the word “constipation” can mean different things to different people.

For some, it all comes down to how often they poop, while others associate it with exertion, not fully emptying their bowels, or the consistency of their poop. These are all valid descriptions.

There are three main types of constipation. The first, known as slow transit constipation, occurs when a poo takes a long time to travel through the large intestine. This slow movement means there is more time for the water in it to be absorbed, resulting in hard, dry stools.

With the second type, known as a voiding disorder, things move at normal speed in the large intestine, but something is wrong with the final “push”, resulting in constipation.

This may be due to more mechanical issues, such as weak pelvic floor muscles, where things move but not in a coordinated fashion. This can result from problematic childhood bathroom habits (such as retention for long periods of time), or be due to physical or structural issues, such as a collapse of the intestinal wall in the vagina (known as rectocele name). If you suspect the latter, talk to your GP.

The third type is related to irritable bowel syndrome (IBS). For some people, managing constipation can improve their other IBS symptoms, including bowel pain and bloating.

Every day in England, more than 200 people are admitted to hospital to be treated for constipation.  Even in the mildest cases, it can cause bloating, worsen acid reflux, and contribute to a low mood.

Every day in England, more than 200 people are admitted to hospital to be treated for constipation. Even in the mildest cases, it can cause bloating, worsen acid reflux, and contribute to a low mood.

Here are some strategies to think about when dealing with constipation:

Do you move your body regularly? It also helps activate your intestinal muscles.

To get things moving, it’s best to try low-intensity exercise (like a walk around the block) in the morning, especially after breakfast. And breakfast itself can help wake up your gut if it contains carbs and fats, like a small bowl of porridge with full-fat plain yogurt or mixed seeds.

Do you drink two liters of liquid a day? Most of the time, water is best, but having coffee (or tea) in the morning can also help activate your bowels – in particular, the so-called “mass movement”, which is basically the ” final kick that gives a poo. If caffeine isn’t for you, decaffeinated coffee can also help.

Do you consume 30 g of fiber per day? It’s easier than you think: just have two fruits, five servings of vegetables, three servings of whole grains (like oats, quinoa, or barley; one “serving” is about a handful, or half a cup if cooked) and one to two servings of nuts, seeds or legumes daily.

There are good quality clinical trials supporting prunes, kiwi and psyllium husks (available at health food stores) among others.

Try 50 g of prunes or a kiwi a day for a week. If well tolerated, double the amount and continue for three weeks.

Or try psyllium husk: start with half a tablespoon a day and see how it goes (mix with water at a ratio of 150ml liquid per tablespoon – it forms a thick gel, therefore it is better to combine it with porridge or hot soup).

If your gut is very sensitive, start with one teaspoon a day and increase gradually. Increase it up to three tablespoons a day if tolerated. If there is no improvement after a month, stop.

Have you tried giving yourself a bowel massage? It might sound strange, but if you think our gut is lined with muscle, it makes sense that massaging it — especially the large intestine where things can get a little sluggish and trapped with gas — can help soothe bowel symptoms.

This strategy is supported by a trial undertaken by Umea University in Sweden, published in the International Journal of Nursing Studies in 2009. The study demonstrated that daily bowel massage for eight weeks was an effective complement to laxatives.

In fact, research found that compared to the laxative-only group, those who also performed bowel massage saw significant improvement in abdominal pain and bowel movements.

It has worked wonders for many of my clients with constipation, helping them to get off laxatives. The good thing about this type of massage is that it’s free – you can easily do it yourself (it’s best to do it daily and use massage oil) by following the simple steps outlined here (see box on the left).

If you are pregnant or have a history of inflammatory bowel disease, recent abdominal scarring or abdominal surgery, spinal problems or a history of colon cancer, discuss abdominal massage with your GP before to attempt.

NOTE: Consult your GP if there is blood in your stool, unintentional weight loss, low iron, fever, family history of cervical cancer or colon or new ongoing constipation or other bowel symptoms, especially if you’re over 50.

Have you tried giving yourself a bowel massage?  It might sound strange, but if you think our gut is covered in muscle, it makes sense that massaging it — especially the large intestine where things can get a little sluggish and trapped with gas — can help soothe bowel symptoms.

Have you tried giving yourself a bowel massage? It might sound strange, but if you think our gut is covered in muscle, it makes sense that massaging it — especially the large intestine where things can get a little sluggish and trapped with gas — can help soothe bowel symptoms.

Did you know?

Have you heard that eating often will boost your metabolism? While it’s true that digestion does increase your metabolism a bit, that’s not enough to override other factors like meal size. Instead, to boost your metabolism, feed your gut microbes plenty of plant foods — this can also help regulate your appetite hormones.

Try this: Beet, Lentil and Goat Cheese Salad

This winning flavor combination will give you 14g of fiber per serving, which is nearly half of your daily fiber needs. It is therefore also ideal for shaking things up.

For 4 people

  • 500 g cooked Puy lentils
  • 4 cooked beets, sliced
  • 20 sun-dried tomato halves, packed in oil, chopped
  • 60g hazelnuts
  • 60g green leaves of your choice (e.g. spinach, arugula)
  • 160g goat cheese

To train

  • 2 tablespoons balsamic vinegar
  • 1 teaspoon of honey
  • 2 tablespoons extra virgin olive oil

Add lentils, beets and sun-dried tomatoes to a mixing bowl. Whisk together dressing ingredients, then pour over salad and let marinate for at least five minutes. Preheat the oven to 180 c/160 c fan/thermostat 4.

Place the hazelnuts on a baking sheet and bake for five minutes or until golden brown.

Leave to cool then coarsely chop. Place the green leaves on a plate, followed by the marinated mixture. Crumble the goat cheese on top, add the hazelnuts and toss the salad before serving.

Email drmegan@dailymail.co.uk or write to Good Health, Daily Mail, 2 Derry Street, London W8 5TT – please include contact details. Dr. Megan Rossi cannot enter into personal correspondence.

Answers should be taken in a general context; always consult your GP for any health concerns.

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