When You Want to Go, But Can’t

Do you have piles of magazines in your bathroom? If so, that might be an indication that you’re spending a little too much time on the commode. How you start your day, however, can help you get things moving in the right direction more quickly.

“Something as simple as walking contracts the abdominal muscles, which increases pressure in the abdominal cavity and facilitates movement,” explains gastroenterologist Kevin Ghassemi, MD, UCLA Department of Digestive Diseases. “Caffeinated beverages – hot or cold – stimulate the colon to move things more readily.”

Either of these two choices can be done individually or together. In addition, an evening dose of fiber can also assist in the morning routine.

Eight Glasses of Water a Day

The general recommendation is to drink at least eight glasses of water daily. If you exercise, you will need more. As people age, their sense of thirst diminishes, and that can lead to constipation problems. “Some people may drink a lot of water and ask why it isn’t helping,” says Dr. Ghassemi. “If you just drink a lot of water but don’t have adequate fiber intake, the small intestine absorbs most of the water before it even gets to the colon.

Fiber and Water: Better Together

Constipation is most commonly due to dietary changes or insufficient water and fiber combinations. “Fiber bulks up the stool, and bulkier stool is softer and easier to pass,” says Dr. Ghassemi. “But if you don’t drink enough water, you’re not able to move that stool through the colon quite as easily.”

Fiber comes in two forms: soluble and insoluble. Both are needed for proper digestion and elimination. Most plants contain both kinds of fiber. Here’s the difference between them. Soluble fiber helps you absorb nutrients from foods. It attracts water and forms a gel-like consistency, which slows down the digestive process. Foods that have a lot of soluble fiber include oat and rice bran, nuts, lentils, citrus fruits, strawberries, apples, potatoes and peas.

Insoluble fiber adds bulk to the stool and can help move food through the digestive tract faster. Foods that contain higher amounts of insoluble fiber include whole-grain cereals and breads, seeds, and the skins of most vegetables and fruits.

When it comes to fiber, most people simply don’t get enough. The average Western diet generally contains about 15 grams of fiber a day or less. It’s recommended that women consume at least 25 grams daily and men 35 grams per day from dietary and/or supplemental sources. If you are on the low end of the daily fiber scale, increase gradually by five grams per week. Too much fiber added too quickly can cause a lot of bloating and cramping.

Prunes, Psyllium and Probiotics

According to a number of studies, prunes or prune juice, that age-old remedy, is still a very effective one. Of note were two studies that included middle-age women with mild-to-moderate constipation. In one trial, women consumed six grams of fiber from either psyllium (an over-the-counter laxative product) or a modified bowel recipe which consisted of one cup of unprocessed bran, one cup applesauce and a quarter cup of prune juice. Both groups had similar improvements, but the bowel recipe group showed a greater improvement in straining. Another trial compared prunes to psyllium. Both study groups consumed six grams of fiber. Prunes improved spontaneous bowel movements and stool consistency but there was no difference in straining outcomes. An analysis of probiotic trials suggested that probiotics, specifically, lactobacillus casei, bifidobacterium lactis and escherichia coli, may be helpful with stool frequency and consistency.

Factors That Contribute to Constipation

In addition to poor dietary choices and not enough water, some medications can cause or contribute to constipation. These include:

  • Long-term use of opioids
  • Calcium channel blockers, typically prescribed to control blood pressure
  • Calcium supplements
  • NSAIDs including Aleve and Motrin
  • Anticholinergic agents used to treat conditions such as asthma, gastrointestinal cramps, sleep and depression.

If you suspect medications, talk with your doctor before stopping or altering your medication intake.

Constipation is defined as having fewer than three weekly bowel movements. It’s chronic when there’s difficulty for several weeks. For most people, simply adding fiber in the evening, a morning walk, or cup of coffee may be enough to stimulate the body’s natural predilection for a morning constitution.

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