Science Questions

Why am I so constipated?

Mon, 8th Aug 2016

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Question

Keitumetse Mokone asked:

Please help. I'm forever constipated. I exercise at least three times

a week, I drink lots and lots of water, I eat all bran almost every

morning. I dont eat white bread. The feeling of wanting to do number

two never comes naturally (at all). Prunes and prune juice do not work. I need help with this constipation.

Answer

We put this to Naked Scientist Chris Smith...

Toilet

Chris - It sounds uncomfortable doesnít it. Well look, this is actually pretty common so I thought we could have a little quiz because, actually, you might think this is something that only everyone else suffers from but, in fact, many people do get constipated. And I thought we could have a science fact, or science fiction around constipation or, in this case, I suppose weíre talking whether itís dogma or dog muck.

Iím going to read you some statements and you have to tell me whether you think itís true or false. So everyoneís involved, no-ones off the hook.

Right, so here we go. First one:

The majority of healthy people have a bowel movement every day. Is that science fact or science fiction do you all think?

Matt - Fiction.

Giles - Fact.

Chris - Matt says fiction. Giles does every day.

Kat - Iíd say on average.

Chris - Actually itís false. Only about 50% of the normal population poo daily. How often are you going then do you think Matt?

Matt - Well, Iíve just come back from a stag do, so several times an hour!

Chris - OK. Question two:

Toxins accumulate in the intestine when bowel movements are infrequent. Is this true, fact or fiction?

Kat - Well I think weíre coming back to the handover poo here as well. But I would - it is a really good way of getting nasty stuff out, so I would say yes.

Chris - Speak for yourself Kat. Eleanor?

Eleanor - Iíd say fiction.

Chris - Giles?

Giles - I would say fiction. I think your liver probably does most of the toxin removal.

Chris - Yes, itís a fiction. Thereís no evidence that toxins accumulate when bowel movements are infrequent or that constipation actually leads to disease.

Kat - Iím sucking at this - I really am.

Chris - OK. Chronic constipation affects about half the population. Fact or fiction?

Giles - If half the population donít poo once a day, Iím going to say fact.

Chris - Kat?

Kat - Well, I seem to be getting all of these wrong so Iím going to go with Giles.

Chris - Fact. Matt?

Matt - Fiction.

Chris - Mattís pretty emphatic about that!

Eleanor - Yes, Iím going to go with fiction as well.

Chris - Itís false! It is actually very common though being constipated. About one person in five is a sufferer of regular constipation.

Kat - 20%.

Chris - 20% yes.

Right - exercise, fluids and the right foods prevent constipation. There you go.

Kat - But thatís what our listener says. Sheís exercising, sheís eating..

Chris - Thatís the question Iím asking you - is that true or is it fiction?

Kat - Oh. Well clearly itís not working for her.

Eleanor - Can there be some of genetic predisposition or something maybe?

Chris - Well, the answer is actually false. Because those things do contribute but, actually, psychology plays a very big role.

Eleanor - Really.

Chris - Also medical conditions: Parkinsonís disease; classically people who have Parkinsonís often get problems. And also people with an underactive thyroid often get problems in that department. And people who use drugs such as codeine, so painkillers they are very, very constipating.

So how do you sort his out. Well your bowel has as many nerve cells in it as your brain. In some peopleís cases it has more nerves than your brain. So actually it can learn and when people talk about habit, this actually is very true. Your bowel learns your pattern of eating and it learns when you tend to need to make space and egest stuff (throw stuff down the toilet). So get into a habit is the advice. Go to the toilet regularly at the same time, but anything between once a day and about once a week is, actually, known to be compatible with good health and most people think themselves into a state of worry when they donít need to worry. So you're alright Kat. Youíre OK.

Sorry MattÖ

Matt - I would point out that if you are really struggling - strong German lager is also highly effective.

Chris - The other thing they say is don't ignore the urge to go because there are people who are dubbed Ďannaly retentiveí for good reason, which is: theyíre busy doing something else and they think I wonít go - I could go, but I wonít go because Iím busy with this. And thatís really bad because what it does is it detunes the response of your gut, it senses stretch and it knows when you need to go and, if you blunt that reflex, youíre more likely then to store up trouble for yourself, quite literally.

Also reduce stress because psychological distress, actually, can manifest in a range of ways either going too often or not going enough.

Drinking plenty of fluids does make a difference because if you are really, really dehydrated it can make things harder and harder to go.

Also increasing dietary fibre is a good idea because that does have a promotility effect in some people.

And don't abuse laxatives because there are some people who think theyíve got something wrong, so they start taking lots of laxatives, and the laxatives make them go but then they become laxative dependent . And itís a good idea not to do that but to resort to other things.

I think that the bottom line here (excuse the pun) is that itís not so much how often you go thatís the problem, itís if something changes. And what doctors like me are interested in (not at parties) but if you come to seek my advice professionally is, weíre asking you not how often do you go but have you noticed any change. Because whatís normal for you; weíre all different; everyone has their own sort of bowel habit, but itís when it changes all of a sudden having previously been established. Thatís when we worry.

So if being a little bit constipated is normal for you, consider some of these simple things that might help to improve matters but donít panic unless something has suddenly changed.

Kat - So Naked Scientists getting to the bottom of all the important issues!

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I would try probiotics and reducing your carbohydrates/glucose intake. Diabetic neuropathy may result in chronic constipation.

If the problem persist you should consult a physician.

http://www.health.harvard.edu/blog/probiotics-may-ease-constipation-201408217377 tkadm30, Wed, 29th Jun 2016

I find that coffee (and especially espresso!) has a significant laxative effect. I don't recommend it as a treatment for a chronic problem, but it may help get things moving every now and then... chiralSPO, Wed, 29th Jun 2016



Too much dietary fiber can cause constipation ...


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435786/ RD, Wed, 29th Jun 2016

An interesting discovery.  If lack of fiber is not the cause, then something else must be. Atomic-S, Thu, 30th Jun 2016

Saccharine is an often unwanted stimulant of bowel movement also beans and coffee help. syhprum, Thu, 30th Jun 2016

Under 50, active, normal or vegetarian diet, chronically constipated: don't muck about, see a doctor.

Over 50, occasional constipation - avoid any fashionable diet, try greasy lamb stews and plenty of fruit. If you have a sedentary occupation, occasional docusate sodium (Dulcoease daytime, Dulcolax overnight) should restore normality.

If it gets painful and you haven't "been" for a week, go to A&E. It is indeed an emergency. They have some truly wonderful stuff like Picolax - a medical version of a military explosive! - that will shift the blockage before you can phone a plumber, and you will be amazed at the improvement in your mental state as well as physical. If you are prescribed Picolax at home, read the instructions very carefully and take the day off work. Believe me, it's worth it!

I was married to a geriatric nurse who specialised in this field! alancalverd, Thu, 30th Jun 2016

Plenty of fiber and say 10 glasses of water per-day might. Alan McDougall, Thu, 30th Jun 2016

From observation of babies, I would argue that the term constipation relates to the ease of passing a bowel motion, rather than the timing. In general, the longer between motions, the harder the motion and the more difficult to pass; but this is not always the case. Dr Peter Jacobs, Mon, 29th Aug 2016

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