There are certain things you’re not supposed to talk about in polite company. Politics. Religion. Your bowels. It’s that last one that really gets people going, which is funny considering they’ll have totally pooed that very day.
Or, at least, they should have done if they’re not horribly constipated – another thing you’re really not supposed to tell people. Which is mad considering constipation affects around 12% of the UK population.
Around January, the Google searches for constipation are at a year-long high thanks to the excesses of Christmas and the effect this has on your ability to go to the toilet.
But it seems winter as a whole is a tricky time for your, erm, hole. You’re indoors. You’re more inactive. You may be comfort eating a little more than if you were gallivanting outside in the disappointing UK sun.
But what is constipation? Is it as simple as ‘eat more raisins’? And, more importantly, why does it affect way more women than men? We asked Dr Nick Read, resident medical advisor for the IBS Network, to tell us everything we need to know about constipation, but were afraid to ask.
You and those bowels you’re too embarrassed to talk about are very welcome.
What is constipation?
Seems simple, but it’s a lot more convoluted than you’d first think. ‘Constipation is a loose term,’ says Dr Read. ‘People have tried to define it by saying that if you go to the loo less than twice a week, you’re constipated from a medical point of view. Or if you pass consistently hard stools, have to strain, or pass less than a certain volume per week.’
Unless you can weigh all your crap on a scale, that last one isn’t hugely helpful, but what is helpful is that constipation is something that’s different for everyone. If you feel, as Dr Read puts it ‘stuffed up, bunged up and uncomfortable’ and you haven’t been to the loo for a significant amount of time time for your normal loo cycle, then you’re constipated. Just don’t go running to your GP immediately.
‘Doctors say that if you go less than twice a week and have been struggling for about three months, then it can be taken seriously by them,’ he says. ‘First, it’s about lifestyle changes.’
Why do I get constipation?
It’s a question that requires multiple answers. Adult constipation tends to overwhelmingly affect women – Dr Read reckons up to 90% of sufferers are female – and the reasons are a mixture of physical, dietary, and emotional. Firstly, lets look at your big ole period. Obviously.
‘People talk about the effect that the sex hormones progesterone and oestrogen have on the bowel and tract, making them rather sluggish,’ says Dr Reed. ‘The female body releases these during the menstrual cycle, and when the uterus sheds its lining it releases prostaglandins, which go into the bloodstream and stimulate the bowel.’
Which is why those with sensitive colons might find that they get diarrhoea during their actual period, and constipation a week or so after it’s over, when the progesterone and oestrogen have started getting pumped out again.
The way you grew up greatly affects your loo habits too. If your parents put a lot of pressure on you during the potty training years, you might find yourself struggling in later life.
‘Patients tell me about parents who would say, “You will sit on this potty and you will go”. It seizes them up and can do for life,’ says Dr Reed.
And sometimes it doesn’t even matter about your diet; IBS and many bowel problems are often heavily affected by mental or emotional issues, so it’s important to work through these sorts of problems as well as the classic ‘getting enough fibre’.
Case in point: the fact that people will often get constipation when they go abroad.
Why do I get constipation when I’m abroad?
‘It seems bizarre how our mind and body work together, but a lot of people find they have trouble going to the toilet when they go abroad, and that’s for purely mental reasons. It isn’t to do with the food, often it’s because you don’t feel confident relaxing in this new toilet in this new country. Also, you physically can’t express yourself in the language,’ says Dr Read.
He also mentions pee-shyness in men, how they go to the loo together but if someone is looking at them, a guy will often suddenly not be able to go. This is the same sort of thing, tied up in an emotional state that totally governs your ability to evacuate waste.
And for women, pooing could be tied up with gender inequality. Read on…
None of the above applies to me, so why do I have constipation?
Like Dr Read said before, your colon is totally tied up with your brain and vice versa: which is why those with IBS find it gets worse during times of stress. And not severe stress either; it could be anything from a major tragedy to missing a bus you quite wanted to be on.
‘Constipated people often say they feel stuck and they might be trapped in their work or in their lives. A lot of women have this feeling because, despite all that’s happened in the last 100 years or so, it’s still sometimes difficult for women to express themselves,’ he says.
‘In their jobs, in their relationships, they’re often more stressed and unable to talk about it. My job now is basically a psychotherapist, trying to help constipation sufferers – especially women – talk in order to ease their digestion.’
So, in all seriousness, gender inequality might be causing your constipation. Or being stuck in your job, stuck in a relationship, or feeling really stressed out. Nobody quite knows why this link between expressing yourself out of the bathroom and physically expressing yourself within it is so strong, but it’s certainly not to be dismissed.
What foods are good for constipation?
Fibre. Getting enough of it. And also, making sure it’s insoluble. ‘Un-absorbable, insoluble carbohydrates are good for constipation. A lot of fruit, a lot of vegetables, a lot of cereal fibre won’t be digested completely,’ explains Dr Read.
‘They’ll go straight to the large intestine where they not only feed the bacteria there, but add bulk. And the more bulk you have, the easier it is for the colon to push the stool down. It will also lubricate the walls to make sure it can push food through properly.’
Oh, sorry, were you eating?
Insoluble fibres are easily Google-able, but for starters here’s a big ole list:
Whole wheat flour, whole wheat bread, whole wheat cereal
Whole grains, whole grain breads, whole grain cereals
Beans and lentils
Berries (blueberries, strawberries, blackberries, cranberries, etc.)
Grapes and raisins
Peaches, nectarines, apricots, and pears with skins
Oranges, grapefruits, lemons, limes
Dates and prunes
Greens (spinach, lettuce, kale, mesclun, collards, arugala, watercress, etc)
Whole peas, snow peas, snap peas, pea pods
Onions, shallots, leeks, scallions, garlic
Cabbage, bok choy, Brussels sprouts
Sprouts (alfalfa, sunflower, radish, etc.)
Any raw food that feels rough, stringy, has a tough skin, husk, peel, pod, or seeds contains a good amount of insoluble fibre. And eating all of these will really, really, help with constipation.
How do I stop the bloating?
When you’re constipated, you’re bloated because your stomach is full of food. When you eat insoluble fibre, this can help get the food moving, but some of the foods on the above list are also known to cause bloating in especially sensitive colons. They contain certain carbohydrates, called FODMAPs, that aren’t digested, so go down into the large intestine to be fermented, carrying fluid with them.
Here’s a full list of FODMAPs, and low FODMAP foods, but sometimes you just need to focus on getting your bowels moving again, rather than worrying about looking like a beach ball for a few hours.
‘If you’re constipated, have your beans, have your onions [which are FODMAP foods], because it’ll help you to go,’ advises Dr. Read. ‘But balance it out. Take fruits like prunes – prune juice will get you going. And while a certain amount of those prunes will be fermented, so could cause bloating, just make sure you have a glass but not the whole carton.’
Good advice, as anyone who has ever had constipation will know, it's tempting to buy four bags of prunes and wash them all down with a huge jug of water. Don't do this. They will rehydrate in your stomach and you’ll go to hospital and get laughed at by a doctor.
I know this because my friend at uni did it and yes, it was hilarious but yes, she was in pain for about a week and the end result was nothing short of horrific.
What can I do to ease constipation?
Depending on what the cause is – emotional or physical – there are varying things you can do. Lifestyle is always the first option, whether that’s dealing with things from your past, getting your present out of the rut it’s stuck in, or looking at the amount of insoluble fibre you’re eating.
Regular exercise and hydration is also key to keeping things moving, with studies having found that a lack of water equals lack of pooing.
In terms of exercise, one morning jog can really help kickstart your digestion. ‘The effect that running or swimming or exercising have on the bowels is something to do with the stimulation of the autonomic nervous system,’ says Dr Read.
‘When your parasynthetic nervous system is stimulated, your bowel is relaxed, and you will go. If you’re uptight, and you haven’t got means of relaxation because you’ve been working all day long, you won’t go.’
Avoiding constipation-creating foods will also prevent future attacks, things like potatoes, meat, rice and eggs are all common culprits due to their lack of fibre.
Yes, constipation can be a really embarrassing, really uncomfortable problem, especially considering you can’t often tell anyone about it because they look at you weird, but hopefully now you’ll at least have the tools to be able to fight it.
As Gandalf once said: YOU SHALL PASS (STOOLS). Well, he might as well have done.
Like this? You might also be interested in:
Follow Stevie on Twitter @5tevieM
This article originally appeared on The Debrief.