With several million pounds being spent each year on laxatives, constipation is clearly a very common problem, though women are three times more likely to suffer from it than men. Yet in healthy people it is an ailment that is almost entirely preventable by simple, natural methods and laxatives should rarely be needed.
Many people consider themselves constipated if they do not ‘go’ regularly every day. But we all have our own natural rhythm. Some people go twice a day, some people every two or three days and both are quite normal if the habit is regular. In fact, bowel habits naturally vary and, as long as the motion is soft and well-formed and the bowel movement effortless, it doesn’t matter if it occurs twice a day or twice a week.
Medically speaking, being constipated usually means passing hard, pellet-like stools with considerable effort and straining. Symptoms also include a bloated abdomen and a feeling of fullness. Being ‘irregular’ is not the same as constipation and is not necessarily a problem. It’s only if your normal bowel habit changes for no good reason for more than a week or two, or if you notice any blood or mucus in your stools, that you should go to your doctor for advice.
Because of the straining associated with it, chronic constipation can lead to other unpleasant conditions such as piles, hiatus hernia and diverticuli – small ‘blow outs’ in the lining of the bowel which, if they become inflamed, develop into painful diverticulitis. So it makes sense to avoid becoming constipated if possible. The easiest way to do this is to increase the amount of fibre – roughage – in your diet.
Fibre, the undigestible part of cereals, fruit and vegetables, is nature’s laxative and most of us would benefit from eating at least half as much again as we do at present. The bulk it provides gives the bowel muscles something to work on and helps to speed up the elimination of food waste after the nutrients have been absorbed during digestion. Fibre swells with the water it absorbs from the gut, so this also helps to produce a soft, well-formed motion.
Many people believe that just eating a bit of extra fruit will soon cure constipation, but this is unlikely to be enough. In fact, bran, the outer husk of cereals, is the richest source of undigestible fibre – far more so than any fruit or vegetables. Wheat bran is the richest source of all.
The refining process used to produce white bread and flour, for example, removes this husk, so an easy way to increase your fibre intake is to eat more wholemeal bread flour and pastas. A daily helping of bran breakfast cereal is another excellent way and natural, uncooked bran can also be sprinkled into soups and stews. Porridge oats, brown rice, baked beans, peas, lentils and sweet corn are high in fibre too. Fruit – unpeeled is best – vegetables and nuts contain a different kind of fibre, and for maximum benefit, eat a good variety of all types of fibre-containing foods regularly.
Expectant mothers and the elderly should avoid eating large quantities of uncooked bran as it may interfere with absorption of minerals such as iron and calcium. Other types of edible fibre can be taken as required.
Contrary to popular belief, too much fibre in your diet will not give you diarrhoea. A sudden increase in fibrous food, however, may cause flatulence until the body adjusts, so it is best to make changes gradually.
Remember also that putting off going to the loo can lead to a loss of your usual bowel reflexes, which in turn will cause constipation. Always make a conscious attempt to go to the loo promptly whenever you feel the need.
Many people do rely on laxatives, and although this is not particularly harmful, it is a little unwise, especially if you take them all the time. They can interfere with the normal digestive processes and essential nutrients in the diet pass straight through instead of being absorbed into the body, where they would be of benefit. The risk of vitamin and mineral deficiencies is therefore one good reason not to adopt this practice.
If you do feel the need for laxatives in cases of short-term constipation, your pharmacist can advise you and suggest a suitable one. Laxatives go to work on the large intestine either by speeding up the progress of faecal matter passing through the bowel or by increasing its bulk. Stimulant laxatives such as senna make the bowel muscle contract to hurry the faeces along and bulk-forming laxatives such as ispaghula soak up water in the bowel to increase volume and make stools softer.
The laxative phenolphthalein is often referred to as a stimulant laxative. What happens is this. As food passes down the alimentary canal, the stomach and small intestine require water in order to digest it. At this stage, the contents of the alimentary tract are fluid. There is a water conservation mechanism in the colon, where excess water is reabsorbed into the body, and this can cause constipation. The stimulant effect of phenolphthalein is that it stimulates the onward squeezing movements of the colon, which hampers water absorption because the bulk within the colon is moved on too quickly.
Other laxatives contain liquid paraffin, a lubricant which makes the faeces softer and easier to pass. These should not be taken less than two hours after a meal, since there is a theoretical risk that the liquid paraffin content could interfere with the absorption of some essential vitamins.
If your bowels are very sluggish, your doctor or pharmacist may recommend extra fibre in the form of tablets, or pleasant fruit-flavoured drinks, such as Fybogel or Regulan, made from the husk of the ispaghula plant. Plenty of watery drinks and some daily exercise will also help to keep the bowels moving.
So if you often find yourself resorting to laxatives, first check with your doctor that there is no underlying medical cause for your constipation – an underfunctioning thyroid gland is one possibility – and ask if a higher fibre diet would help you. If, with your doctor’s agreement, you then start to eat considerably more of the foods I have mentioned, you should soon find you are saving money on laxatives and can spend it more enjoyably and healthily on food! You may even lose some weight, too – fibrous foods are filling but usually low in calories and therefore slimming!
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