Treating constipation

The aim of treatment is to stimulate the colon to work.

This is not an easy task because the colon is naturally a slacker. Bill Gates said that for hard work, you have to choose a lazy person – they will find a way to do it easily. But apparently, Bill Gates has never had a problem with constipation.
First, check if you are taking any medication that can cause constipation. Discuss with your doctor whether these drugs can be replaced with others that do not cause constipation.

The American Society of Gastroenterology (American Gastroenterology Association; AGA) recommends gradual treatment. This means we should first apply simpler and more natural methods.

As the first choice for stimulating the activity of the colon, they recommend drinking plenty of water, consuming enough fiber, and physical activity. For convenience, we’ll call this method WFE (enough water, fiber and exercise). Osmotic laxatives are the next step if water, exercise and fiber do not provide results.

Stimulant laxatives are the last step in the non-surgical treatment of constipation. These products are useful in the treatment and most people take them as the first step. Unfortunately, they cause the intestines to become accustomed and their effect gradually weakens. Finally, the colon completely loses its natural wavy movements and becomes a flabby bag which moves only when you take many stimulant laxatives.

How to stimulate the colon?

Exercise
The colon can drink a lot, but it’s not an athlete – it prefers to ʽtake it easyʼ. It will move only when the accumulated content stretches it or if the stomach signals that new food is arriving. While you exercise, blood flow to the colon is reduced because muscles use the blood for work. When there is no blood, the colon works even less.

After exercise, though, the blood returns back into the colon, which becomes more active than before.

This is the reason why regular physical activity helps with constipation.

Aerobic activities are the best form of exercise to prevent constipation.

Aerobic activities include walking, running, swimming, and cycling.

Weightlifting is NOT aerobic.

Water
Water is essential for life. In childhood, our body contains 75% water. That percentage in older individuals falls to 55%. The European Food Safety Authority (EFSA) recommends that women drink 2 liters of water, and men 2.5 liters every day. Water is taken into the body with beverages, as well as liquid and solid foods. All foods contain a certain percentage of water, even bread.

Even before EFSA published its scientific opinion on water, people knew how much they needed to drink. They relied on the sense of thirst, a natural system that monitors the density of blood. As soon as blood slightly thickens, we become thirsty. However, this mechanism is not perfect. The sense of thirst diminishes as we age, so at older ages, we do not feel thirsty even if the body lacks water and the blood thickens. Therefore older individuals should be careful to drink two liters of water per day, and not to drink only when they are thirsty.

When the body does not have enough fluid – water, the colon slows down its work so that it can absorb more water back into the body. When we have enough water in our body, the colon works normally. An increased intake of water above the recommended amount will not boost the work of the colon. For instance, no one can regulate defecation by drinking five liters of water per day.

EFSA recommends 2 liters of water for women and 2,5 liters for men

Fiber

• Triggers the colon
• Protects the heart
• Prevents diabetes
• Helps maintain a stable body weight

Why do we need fiber?

Fiber is needed for the colon to work normally. Fiber can not be decomposed in the small intestine, so it enters into the colon unchanged. The water is slightly reabsorbed, the fiber accumulates and stretches the colon wall with its volume. Stretching the colon wall helps to create medium intensity waves, which is the main impulse for the colon to work. Besides, it’s easier to push down the content when the colon is fuller. We can compare this with toothpaste – while the tube is full, you squeeze a little and paste comes out. When the tube is almost empty, you have to squeeze hard.

In addition to the work of the intestine, fiber is beneficial and influences other body functions: protects the heart, prevents diabetes and helps maintain a stable body weight. The effectiveness of fiber in the diet has long been recognized. Hippocrates, for example, described in 430 BC that black flour has a beneficial effect on the stool, as opposed to white flour.

How much fiber do we need?

European Food Safety Authority (EFSA) published a scientific stance in 2010 on how much fiber we need to take into our bodies daily.

For the colon to properly function, we need to eat foods that contain at least 25 grams of fiber per day.

To lower the risk of developing heart disease, diabetes type 2, and maintaining a normal body weight, we need to take more than 25 grams of fiber per day.

Dietary Guidelines Advisory Committee (DGAC) published “The Dietary Guidelines for Americans“ in 2010. They identified different daily requirements for fiber (25 grams per day for women, 38 grams per day for men, or 14 grams per 1000 kcal of food).

What did our ancestors eat?

The Prehistoric man in the Stone Age ate about 100 grams of fiber per day. His stool was large and soft. Today’s man takes 15 grams of fiber a day, and that is why his stool is often small and hard.

Colon diseases such as hemorrhoids and diverticulitis have become so frequent that we consider them to be an everyday part of life. It was not so in the old times: our ancestors ate fruits they collected, and that food was rich in fiber. They loved meat as well, but they ate it only when they caught it. The flesh of wild animals has only one fifth of fat and a higher proportion of unsaturated fatty acids when compared to domestic animals.

According to the available data, the early man did not breed domestic animals or drink milk. Their food contained only a twentieth part of the salt that we eat today. Their diet consisted of plenty of grains and little meat, sugar and salt.

Our digestive system is designed for the digestion of such foods (to absorb as many nutrients). A fiber-rich diet was sustained during the rise of Mesopotamia, Greece, Rome and European countries all up to the early 20th century.

In the last hundred years, significant changes occur in developed countries: meat, milk, salt and sugar intake increases and grain fiber intake decreases. Alas, our digestion system did not change, so the colon is still expecting fibers. It does not know that we are now civilized and that we buy loads of fat, sugar, meat, and very little fiber at supermarkets.

What is fiber?

Fiber is actually of the cell wall of plants that digestive enzymes cannot break down. It is found only in plants. Meat, milk and eggs do not contain it.

There are two categories of fiber: soluble and insoluble. Insoluble fibers are cellulose, hemicellulose and lignin. They are found in bran and in fruit peels and vegetables. Soluble fibers are pectin, gum and mucins. They are found in psyllium, juicy parts of fruits, beans and lentils.

How much fiber does each foodstuff contain?

The table shows how much fiber there is in 100 grams of food. Not all plant foods are equally rich in fiber. Cucumbers, for example, contain 0.6 grams, and lettuce 0.7 grams. It’s easy to calculate that you have to eat a pound of cucumbers to ingest six grams of fiber or a pound of lettuce to ingest seven grams of fiber. Whole grains and dried fruits are the richest in fiber. Popcorn is also good because it is prepared from whole grain corn.

Food suplements

There are dietary supplements that contain fiber, such as preparations with psyllium or bran as natural sources of fiber.

Why do we even need these supplements? We need these supplements because many people don’t like vegetable food, especially children.

How many of us would choose leeks instead of kebabs or burgers and fries?

How many of us would eat carrots for dessert instead of apricot pies? Nutritional supplements with fiber are for those who prefer to eat meat, potatoes and sweets. For those who love fruit and vegetables, supplements are not required.

Not all fibers have equal value: research shows that soluble fibers are more efficient in regulating digestion. Psyllium seed husks are seed portions of the Plantago ovata plant. Therefore, in the colon they soften the stool and increase its volume. Increasing stool volume stretches the wall of the colon and stimulates medium intensity waves. The process of fiber arriving in the colon, swelling and stimulating the colon wall to move is a slow one. That’s why soluble fiber needs more than 24 hours to be effective. The colon reabsorbs the water we drink into the blood.

Water is absorbed by psyllium and creates a gel, which the colon cannot reabsorb.

EFSA has published a scientific opinion for psyllium based on the evidence of effectiveness.

Psylliumis a rich source of fiber and it is effective in softening the stool.

Osmotic Laxatives

Osmotic laxatives do not break down in the small intestine, and in the colon they soak in water and prevent its reabsorption. That is how they soften the stool and increase its volume. Waves of medium intensity appear in the colon and the softer stool moves much easier.

Osmotic laxatives need more than 12 hours to be affective.

On the Croatian market, the best known osmotic laxative is lactulose. It consists of two sugars: fructose and galactose. Lactulose is not degradable in the digestive tract and is not absorbed into the blood. Bacteria in the colon process lactulose into organic acids which in the colon absorb water and soften the stool.

Wavy movements are generated in the colon which accelerates the transport of the content through the digestive system. Only 3% of lactulose is reabsorbed from the intestine so it does not affect the sugar levels in the blood. There is no data that prove that it is harmful during pregnancy or lactation. Lactulose motivates the intestine in a natural way, does not cause habituation, and it can be taken over a longer period of time.

Lactulose is on the list of the essential medications of the World Health Organization. Medications on that list are safe to use and are required for a minimum of health care.

Stimulant Laxatives

Stimulant laxatives act directly on the wall of the colon and stimulate waves of high intensity. They are very effective. The waves of high intensity move content through the colon, and people often perceive them as strong cramps.

These laxatives can cause diarrhea because the content passes through the colon too fast and there is not enough time for the absorption of water. Stimulating laxatives are used to reduce clogged stools. Their long term use for treating constipation is not recommended because it decreases the natural function of the colon and causes habituation. The colon loses its natural waves, and over time it needs more and more stimuli to function properly.

Stimulant laxatives resolve constipation quickly and effectively, after only eight hours. It is therefore people’s first choice for constipation, but also as a therapy for long-term treatment, which is not a good decision.

One of the most famous natural stimulant laxatives is the plant senna. It is often recommended as the first step in the treatment of constipation because the professionals view is that natural products are healthier than synthetic. In most cases they are, but senna is an exception. Another synthetic stimulant laxative is bisacodyl.

Persistent Constipation

Persistent constipation is a condition where even laxatives don’t help. Possible causes are:

• long-term usage of stimulant laxatives
• slow transit through the colon
• disorder in stool ejection

Long-term use of stimulant laxatives causes habituation of the colon, which then loses its spontaneous waves. The goal of treatment is to gradually introduce the WFE method (water, fiber and exercise). Taking stimulant laxatives should be reduced gradually. They should not be stopped immediately because the colon will not move without them. Instead of stimulative laxatives, it is necessary to take osmotic laxatives. Habituation of the colon does not happen in a few days and it is not cured in few days. It takes persistence and patience.

If you took stimulant laxatives for a while without resolving constipation, you should check whether you have a stool ejection disorder or a slow colon. You can read more in the “Which tests you should do“ section

Stool ejection disorder is treated with biofeedback therapy. With a slow colon, it may be necessary to surgically remove part of the colon.

• What is constipation?
• What causes constipation?
• Treating constipation
• Constipation in pregnancy