Feeling stuck? Chronic constipation affects 25 to 30% of all Canadians, however, only a small proportion actually seek medical care. At Ignite Nutrition, our dietitians are experts in digestive disorders and gut health. We often see that there is a lot of misinformation about chronic constipation, so let’s clear it up!
What is the difference between Irritable Bowel Syndrome-Constipation and Chronic Constipation?
Chronic constipation and Irritable Bowel Syndrome-Constipation (IBS-C) are DIFFERENT! It’s very important to get a proper diagnosis and distinguish between the two as the treatment and management of symptoms for the two are very different.
The diagnosis criteria for IBS-C is having abdominal pain for greater than 1 day per week for 3 months WITH 2 out of 3 of the following:
- Pain related to defecation
- Change in frequency of stool
- Change in consistency of stool
On the other hand, the diagnosis for chronic constipation is having at least 2 of the following symptoms for at least 3 months:
- Straining for ¼ of defecations
- Lumpy or hard stools for ¼ of defecations
- Sense of incomplete evacuation for ¼ of defecations
- Sensation of blockage for ¼ of defecations
- Manual maneuvers to facilitate ¼ of defecations
- Less than 3 spontaneous bowel movements per week
Additionally, for a diagnosis of chronic constipation, loose stools must RARELY be present without the use of laxatives, and must NOT meet the criteria for IBS-C.
In general, chronic constipation does NOT regularly and consistently involve abdominal pain and bloating or a change in frequency and consistency of stools, like IBS-C. Chronic constipation relates more to the straining and sensation piece of things!
So now that we’ve cleared up that chronic constipation is NOT the same as IBS-C, let’s talk about the possible causes of chronic constipation!
What causes chronic constipation?
There are several different factors that can cause chronic constipation, and they tend to vary from person to person. At Ignite Nutrition, we take a holistic approach, looking at all aspects of health and lifestyle to understand the underlying cause of your chronic constipation.
However, there are some common causes of chronic constipation that we see more than others:
Diet and Lifestyle: As you probably know, diet and lifestyle play an enormous role in how your gut functions. Nutrition and lifestyle factors like exercise can affect the consistency, frequency, and timing of your bowel movements. Specifically, a lack of fibre and water in your diet can lead to constipation. In terms of lifestyle, a lack of movement and stress can also lead to issues with bowel movements like constipation.
Dyssynergic Defecation/Pelvic Floor Dysfunction: The muscles of the pelvic floor are extremely important in helping control bowel movements. There needs to be a coordination between the abdominal muscles and pelvic floor to pass a bowel movement. In pelvic floor dysfunction, there is an inability to tighten and relax the pelvic floor which can result in constipation. 1/3 of women and 1/9 of men experience pelvic floor dyssynergia (problems in coordination). If you want to know more about pelvic floor dysfunction, check out this interview with pelvic health physiotherapist, Renae Hunter.
Medication: Certain medications can cause constipation. If you are taking any medications and are experiencing constipation, talk to your family physician or pharmacist to see if there is an alternative. Here is a list of common medications that can cause symptoms of constipation (please note that this is not an exhaustive list):
- Birth Control
- Iron Supplements
Slow Colonic Transit: Decreased movement in the colon can lead to slow transit constipation. As it moves through the colon slower, more water is pulled from the stool, leading to the formation of hard stools which are difficult to pass. There are a variety of interventions, from nutrition & lifestyle to medication to help manage slow colonic transit.
Watch for Red Flags
Consult a physician if you have a sudden onset of constipation, family history of colorectal cancer, irritable bowel disease, or are experiencing bleeding, unexplained weight loss or waking up in the middle of the night for bowel movements.
What are the treatment options?
The goal for the treatment of chronic constipation is to first identify the contributing factor(s) and then manage these factors with an individualized treatment plan.
Treatment strategies for chronic constipation can be categorized as follows: dietary changes, lifestyle management, and medication management. Your dietitian can help you figure out an individualized plan for you.
- Fibre: Fibre is found in all plant-based foods (vegetables, fruits, whole-grains, legumes, nuts and seeds) and is an important aspect of our health. There are two types of fibre: soluble and insoluble fibre. Soluble fibre attracts water and forms a gel, and thus slows down digestion. Insoluble fibre, on the other hand, does not dissolve in water and speeds up the passage of food and water. Insoluble fibre increases fecal bulk, and can help prevent constipation. It is commonly found in whole grains and vegetables. Some specific foods that are a great source of insoluble fibre, and are proven to improve constipation include 1) bran buds, 2) ground flax seed, and 3) wheat bran. Aim for a total fibre intake of 25–38 g per day, and include foods like whole grains and vegetables (carrots, potatoes, celery, etc.) in your diet! Start slowly by simply adding 1 or 2 high fibre foods daily. You can track your fibre intake in an app like MyFitnessPal.
- Other Specific Foods to Improve Constipation: Certain foods can speed up movement in the gut and improve laxation. Try consuming these foods to improve constipation: (1) Prunes: Prunes are proven to help with constipation. Prunes are high in insoluble fibre, as well as sorbitol, which is considered a natural laxative. Try to eat 5 to 6 prunes a day to get that osmotic pull into the gut and help improve constipation. (2) Kiwis: Kiwis contain an enzyme called actinidine, this enzyme increases movement in your upper gastrointestinal tract which can help with constipation. Scientific evidence supports the use of 2 kiwi fruits per day to improve constipation.
- Adequate Fluid: Inadequate fluid intake is likely to make constipation worse. When your body is hydrated, less water is drawn from your colon. This will keep your stool soft, and easy to pass. Aim to drink at least 2 to 3L of fluid per day. An easy tip is to carry a water bottle around with you, this can remind you to drink more water.
- Probiotics: There is some evidence to support that probiotics may help relieve constipation and bloating. Probiotics are live microorganisms that provide health benefits by improving the gut microbiota. Be aware that not all strains of bacteria improve constipation and bloating, your dietitian can help you find the right strain of bacteria and probiotics for you.
- Low FODMAP: The low FODMAP (Fermentable Oligosaccharides, Disaccharides and Polyols) diet is an elimination style diet that involves a period of short term elimination of all FODMAP containing foods, followed by a period of strategic reintroduction. Certain FODMAP’s can aggravate constipation and this diet is meant to help you understand those ‘trigger foods’. If other dietary interventions are inadequate, and your symptoms overlap with IBS, your dietitian may suggest a low FODMAP diet.
- Exercise: Movement can help with constipation by lowering the amount of time it takes for food to move through your digestive tract. As the food is moving through your digestive tract faster, there is a decrease in the amount of water absorbed. Hard, dry stools are harder to pass. Aim for at least 150 minutes of moderate- to vigorous-intensity physical activity per week.
- Stress: The gut microbiota can regulate communication between the gut and the brain via the gut-brain axis. When messaging from the brain to the gut is negative, for example when we experience stress or anxiety, this can cause a series of changes in physical symptoms, i.e. constipation. Consider using mindfulness-based stress reduction techniques like guided meditation, journaling or reading to improve constipation. Many patients benefit from more targeted therapy practices. At Ignite, we have a psychologist on our team that specializes in this gut-brain connection. Book an appointment with her today!
- Toilet Positioning: Toilet positioning can help reduce the strain from constipation. A squatting position with your knees higher than your hips while sitting on the toilet is recommended to alleviate straining. There are toilet accessories made for this purpose, like a ‘Squatty potty’ or you can simply use whatever you have on hand, like a step-stool.
There are pharmacological and non-pharmacological medication options for the treatment and management of chronic constipation. Non-pharmacological medications include encapsulated peppermint oil which can work as a motility agent to help movement in your gut. Pharmacological medications include osmotic or stimulant laxatives, or motility agents. For pharmacological medications, speak to your family doctor or pharmacist as certain medications may not be appropriate for you.
There are many things to consider when talking about chronic constipation. Your dietitian can help create a customized plan that fits your needs and gets you feeling your best! Book an appointment with one of our Calgary-based dietitians today!