Most people experience constipation in their lifetime. But what is constipation, and what can you do about it?

Constipation can be annoying and painful! It is difficulty passing a bowel movement (poo) or infrequent bowel movements. There’s no magic number for how many bowel movements you should have in a day or week. However, if you’re having less than 3 per week, you’re likely constipated. 

Other symptoms of constipation include:

• Having trouble with bowel movements
• Not having a bowel movement as often as usual
• Passing hard, lumpy stools
• Straining to have bowel movements
• Passing only small amounts at a time
• Feeling blocked, or as though you have not completely emptied your bowels
• Abdominal pain or pain with a bowel movement
• Avoidance of passing a stool (particularly in children)

Before we talk about why constipation occurs, we need to talk about what stools are. When our food travels through our digestive system, nutrients are absorbed in the small intestine and waste is moved through the large intestine with muscle contractions (peristalsis). Excess water is then removed, and the waste is temporarily stored in the rectum before it is passed as a stool or bowel movement. Water makes up about three-quarters of stools, while undigested fibre, intestinal bacteria and dietary fats make up the rest. 

Constipation can occur for a number of reasons including:

• Dehydration
• Poor gut motility causing a slower transit time 
• Medication and supplement side effects
• Metabolic and endocrine changes such as hypothyroidism and hypercalcemia 
• Neurological changes such as MS
• Pelvic floor dyssynergia
• Disturbance in the gut-brain interaction 
• Infection in the gastrointestinal tract such as H. Pylori
• Imbalance in the gut microbiome (dysbiosis)
• IBS
• Diet and food intolerances 
• Coeliac Disease

Constipation can be bad because it is not only painful but it means waste is staying in the body longer than it should be. Side effects of constipation can include fatigue, weight gain, hormonal imbalances (think acne, PMS, period pain), reduced gut health and poor immunity. There can also be complications from chronic constipation, such as faecal impaction, faecal incontinence, haemorrhoids, rectal prolapse and urinary incontinence. 

It is common to experience changes in bowel movements throughout the mensural cycle due to changes in hormonal levels – you may be familiar with harder or looser stools during or before your period. This is due to progesterone building up in the lead up to the period which can slow down the digestive system. IBS and endometriosis make it more likely to be constipated in the first few days of your cycle. Working with a practitioner like Court Garfoot Nutrition to balance your hormones can be beneficial in relieving these symptoms.

Pregnancy hormones relax the muscles and slow down the transit time of food through the digestive system, making constipation in pregnancy very common! Over 40% of women report experiencing constipation during their pregnancy, particularly in the first and second trimester. Women who experience constipation prior to pregnancy often find their symptoms are worse during pregnancy, which makes preconception care even more important! Treating constipation in pregnancy is very similar to treating non-pregnancy related constipation so make sure you’re meeting your pregnancy nutritional requirements and check out the strategies below for constipation. It may be helpful to book a consultation if you’re unsure about your pregnancy nutritional requirements. 

Need some support with your or your child’s constipation? Book a consultation with Court, Clinical Nutritionist (BHSc Nut. Med.) for one-on-one support to address the root cause of your constipation and improve your health and wellbeing.

Treatment of constipation involves a number of different strategies depending on the cause. It can include increasing stool bulk to optimise peristalsis in the intestines ensuring sufficient fluid intake for appropriate stool lubrication, supporting a balanced diet, balancing the gut microbiome and eradicating any infections in the digestive system. 

1. Toileting – Go to the toilet when you feel the urge, and make sure you have time and privacy to have a bowel movement. Avoid straining when sitting on the toilet. 
2. Exercise – Walking, swimming, cycling, yoga will ease constipation and make you feel healthier. Try to be active and get some exercise every day. 
3. Fluids – Make sure you’re hydrated and reduce your caffeine intake in tea, coffee, soft drinks and energy drinks. 
4. Foods – Eat plenty of high fibre foods (whole grain cereals and bread, fresh fruits and vegetables, nuts, dried fruits and legumes). Bran and psyllium are good natural sources of fibre and can be sprinkled over cereal. Increase your fibre intake gradually to help prevent bloating.
5. Fruit – Kiwi fruit, pineapple, mango, bananas, figs and rhubarb contain actinidin a stimulating laxative that can help relieve constipation. Pears also contain high levels of water and fibre which can help too. 

If you or your little one is still experiencing constipation, there are many practitioners who treat constipation you can reach out to including me here at Court Garfoot Nutrition, or your GP, to investigate the root cause.

Firstly, bowel movements can vary significantly between children. Breastfed babies may have a bowel movement following each feed, or only one poo each week. Whereas formula-fed babies and older children will usually have a bowel movement at least every one to three days.

Constipation is a common problem in children, particularly around the time of toilet training or starting solids. It can occur for many reasons including:

• Aren’t eating enough fibre
• Have been sick and have been eating and drinking less
• Child is too busy playing to go to the toilet
• They don’t want to use the toilet at preschool or school
• After a painful or frightening toilet experience

Signs of constipation in children can include:

• Your child to feel less hungry than usual
• Irritable behaviour
• Holding-on behaviour, such as squatting, crossing legs or refusing to sit on the toilet
• Your child looking more bloated than usual

Along with the above tips, the following can be useful when your child is experiencing constipation:

• If your formula-fed baby is constipated, you might need to change their formula
• If your child is over 18 months:
  • Encourage their appetite at meal times by reducing cow’s milk intake to a maximum of 500mL per day and avoid sweet drinks before meals.
• If your child is constipated and eats solids:
  • Make sure they have a healthy diet
  • Increasing fruit and vegetable in take might help
• If your toilet-trained child is constipated:
  • Develop the habit of sitting on the toilet regularly, children should be encouraged to sit on the toilet for 5 minutes after meals, up to three times per day
  • Reinforce good behaviour like sitting on and using the toilet, praise your child even if they don’t do a poo
  • Encourage your child to respond to their body’s urges
  • Remove fear by making sure they have a foot stool or an insert for the toilet seat
  • Having their favourite book by the toilet might make them feel more comfortable and make sitting on the toilet a positive activity
• If your school aged child is constipated:
  • It may be helpful to arrange for your child go to the toilet in the last period before lunchtime, or after eating, before playtime commences 
  • Communication with your child’s teacher may assist in establishing this routine

Need some support with your or your child’s constipation? Book a consultation with Court, Clinical Nutritionist (BHSc Nut. Med.) for one-on-one support to address the root cause of your constipation and improve your health and wellbeing.

This article is not intended to be medical advice and is purely for educational purposes.