Why am I so constipated?

09 August 2016

Question

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...

Chris - It sounds uncomfortable doesn't 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 we're talking whether it's dogma or dog muck.

I'm going to read you some statements and you have to tell me whether you think it's true or false. So everyone's 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 - I'd say on average.

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

Matt - Well, I've 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 we're 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 - I'd say fiction.

Chris - Giles?

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

Chris - Yes, it's a fiction. There's no evidence that toxins accumulate when bowel movements are infrequent or that constipation actually leads to disease.

Kat - I'm sucking at this - I really am.

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

Giles - If half the population don't poo once a day, I'm going to say fact.

Chris - Kat?

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

Chris - Fact. Matt?

Matt - Fiction.

Chris - Matt's pretty emphatic about that!

Eleanor - Yes, I'm going to go with fiction as well.

Chris - It's 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 that's what our listener says. She's exercising, she's eating..

Chris - That's the question I'm asking you - is that true or is it fiction?

Kat - Oh. Well clearly it's 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: Parkinson's disease; classically people who have Parkinson's 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 people's 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 don't need to worry. So you're alright Kat. You're OK.

Sorry Matt.

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 'annaly retentive' for good reason, which is: they're busy doing something else and they think I won't go - I could go, but I won't go because I'm busy with this. And that's 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, you're 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 they've got something wrong, so they start taking lots of laxatives, and the laxatives make them go but then they become laxative dependent . And it's 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 it's not so much how often you go that's the problem, it's if something changes. And what doctors like me are interested in (not at parties) but if you come to seek my advice professionally is, we're asking you not how often do you go but have you noticed any change. Because what's normal for you; we're all different; everyone has their own sort of bowel habit, but it's when it changes all of a sudden having previously been established. That's 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 don't panic unless something has suddenly changed.

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

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