What is it?
Constipation can be defined as any of the following:
Infrequent bowel actions
Passage of small, hard, pellety motions
When passing a motion causes difficulty or pain.
In addition to these symptoms, people often complain of having to strain to use their bowels, bloating and abdominal pain. Less common symptoms include backache, nausea and headache. Straining should be avoided, as it can lead to piles or a split in the skin of the back passage (anal fissure), both of which can produce bleeding when passing a motion
What are the possible causes?
The most common cause is lack of fibre in the diet, often in association with an inadequate fluid intake. Other, less common causes include:
Pregnancy
Painkillers, especially those containing codeine
Other medications such as iron tablets, antacids, and a whole host of prescribed medications
Irritable bowel syndrome (IBS), where constipation often alternates with episodes of diarrhoea
Underactive thyroid gland
Immobility, especially in elderly people
Poor bowel-moving habits. This can be the result of poor toilet training in childhood, or repeatedly ignoring the urge to open the bowels
Overuse of laxatives, particularly in people with eating disorders
Colon cancer. This is a less common but important cause of recent onset of constipation in the over 40s
Why are fibre and fluids so important?
In an ideal world, the well-behaved bowel contracts rhythmically and regularly to propel the contents smoothly onwards. This regular contraction is dependant on a certain amount of food residue (roughage/fibre) in the bowel, and fluid to keep the residue soft. Lack of fibre or fluid causes the bowel to lose its rhythm.
Modern diets are often significantly low in fibre. The recommended daily fibre intake is between 35-50g. A slice of white bread contains 2.7g. Most fast-foods and convenience meals are very low in fibre, as are most snack foods. As tastes have moved away from fibre-rich foods towards more starchy and sugary foods, constipation has become a more common problem.
How to increase fibre intake
Incorporate more fibre-rich foods into the daily eating plan. Good fibre sources include wholemeal, high bran and granary breads; wholewheat or bran re-inforced cereals; rye or bran crispbreads; wholemeal pasta and brown rice; baked potatoes with the skin; legumes such as dried peas and beans, lentils, baked beans and sweetcorn; nuts; fruits such as dried apricots, dried figs, prunes, dates, raspberries and blackberries; vegetables such as broccoli, spinach, and parsnips. Watery fruits, salad vegetables, and other vegetables contain surprisingly little fibre.
For those who can't contemplate eating higher-fibre foods, unprocessed bran can help. Fine, unprocessed bran can be added to a small glass of a fruit juice such as orange juice, and drunk down before each meal. It's best to start with a teaspoon of bran each time, and work up towards a tablespoon if necessary. The bran doesn't dissolve, but shouldn't be too noticeable if fine bran is used. Just stir it round and slug it down.
For those who can't contemplate that either, there are packeted, powdered vegetable husk preparations available from pharmacies. These are plain or citrus flavoured. They are mixed with a specified amount of water to make a drink. This has to be drunk quite quickly, as the husk doesn't dissolve and will settle in the bottom of the glass if left too long.
