Talking about bowel habits is not something we often do but if constipation is affecting your life it can be quite uncomfortable and even upsetting. Thankfully there are plenty of ways to ease the problem without resorting to pharmaceutical laxatives. Constipation is usually defined as a change in daily bowel patterns, particularly a decrease in the number or consistency of bowel movements, or pain or difficulty passing stools
Prebiotics and probiotics
Previously (in August) I wrote extensively about prebiotics, probiotics and synbiotics with regards IBS (irritable bowel syndrome). Unsurprisingly these same agents work very well in the prevention and treatment of constipation. By positively changing the bacterial makeup of the gut they help to keep the digestive system functioning efficiently. Prebiotics also act as a source of fibre, which adds bulk to stools and absorbs water to help eliminate waste efficiently and painlessly.
As you will probably be aware, there are many yoghurts now available on the market which contain both pre-biotics and pro-biotics. There is evidence from recent trials (1,2) to suggest they are effective in treating constipation. A recent study (1), published in march, found that consumption of the yoghurt was associated with increased frequency of bowel movements, a reduced perception of straining effort and a reduced perception of pain associated with defecation.
Inulin, a type of prebiotic powder supplement, has been shown to increase the number of good bacteria in the gut as well as reducing constipation better than a traditionally used lactose laxative (3). A supplement containing both prebiotics and probiotics has also shown good results in the treatment of constipation (4). Taking a daily symbiotic supplements, those containing prebiotics and probiotics, may well be useful for the treatment and prevention of constipation and the efficient functioning of the digestive system. There is also emerging evidence, that I have discussed previously, which indicates that a good bacterial balance in the gut may affect the immune system of the whole body, so a daily supplement may help to keep you feeling great!
Artichoke leaf extract
As well as its usefulness in treating IBS, artichoke leaf extract seems to be helpful in alleviating constipation. One study(5) found that 71% of constipation patients experienced improvement using artichoke leaf extract for 6 weeks. If you are suffering from this uncomfortable condition you may wish to try an ALE supplement for a few weeks to see if it brings relief and normalises daily bowel habits.
Previously I have mentioned how, in the UK, we tend to fall short of the daily recommendations for fibre provision. Many of us reach only 12g/day, the recommendation is for at least 18g/day with many health professionals recommending around 25g/day. Fruit and vegetables provide lots of fibre, as well as all the other nutrients packed within them. We would all do well to reach a minimum of five portions daily. Fibre provides bulk in the digestive system, this then absorbs water making stools easy to pass and preventing constipation. A recent study(6) in children found that constipated children had significantly lower intakes of dietary fibre than non-constipated counterparts which was attributable to under-consumption of plant foods.
Regularly eating the recommended portions of a variety of fruit and vegetables may prevent the occurrence of constipation. Increasing intakes if constipation is already present may also help to ease and clear the problem. Two studies (7,8) have found that eating a couple of kiwi fruit a day is helpful in the treatment of constipation.
You may wish to consider a supplemental source of fibre as a short term measure for treating constipation. One source of fibre which seems to be helpful is flaxseeds (9,10). If you want to try this form of fibre I would recommend buying a ground flaxseed, sometimes called linseed, supplement (or grinding the seeds yourself at home), these are easier on the digestive system and the grinding will also help to release essential omega 3 fatty acids within the seeds which adds to the nutritional benefits. A table-spoonful of ground flax (about 15-25g) a day will probably help to ease constipation within a couple of days. A teaspoon a day (around 5g) could be useful in prevention or re-occurrence of constipation and may be particularly useful if you feel your daily fibre intake is habitually low.
Drinking enough (around 1.5L) water daily is important in the prevention and treatment of constipation. Water is absorbed by fibre in the digestive system and adds bulk to the waste making it easier to pass. One study (11) found that including 25g of fibre from food in the daily diet was very helpful in treating constipation and that the effect was significantly enhanced by increasing fluid intake to 1.5-2.0 litres/day. Another study (12) concluded that fluid loss (via diarrhoea and laxative use), fluid restriction, poor hydration and dehydration increased constipation. It is very important to maintain hydration to prevent constipation.
Finally I would like to suggest that if your child (up to age 10) is suffering from regular bouts of constipation it may be a good idea to ask your GP to do a test for allergy to cow’s milk. There are studies (13,14,15) to suggest that chronic constipation occurs as a result of cows milk allergy in some children. There is also a lot of anecdotal evidence to back this up. It is very important that you see your GP for the allergy test, never try elimination diets at home without the involvement of a health professional.
(1)De Paula JA et al. 2008. Effect of the ingestion of a symbiotic yoghurt on the bowel health of women with functional constipation. Acta Gastroenterol Latinoam. 38:16-25
(2)Sairanen U et al. 2007. Yoghurt containing galacto-oligosaccharides, prunes and linseed reduces the severity of mild constipation in elderly subjects. Eur J Clin Nutr. 61:1423-1428
(3) Kleessen B et al. 1997. Effects of inulin and lactose on fecal microflora, microbial activity, and bowel habit in elderly constipated persons. Am J Clin Nutr. 65(5):1397-1402.
(4)Amenta M et al. 2006. Diet and chronic constipation. Benefits of oral supplementation with symbiotic zir fos (Bifidobacterium longum W11 + FOS Actilight). Acta Biomed. 77:157-162
(5) Gebhardt R. 1996. Antidyspeptic and lipid-lowering effects of artichoke leaf extract. Journal for General Medicine. 2
(6)Lee WT et al. 2008. Increased prevalence of constipation in pre-school children is attributable to under-consumption of plant foods: A community-based study. J Paediatr Child Health. 44:170-175
(7)Chan AO et al. 2007. Increasing dietary fiber intake in terms of kiwifruit improves constipation in Chinese patients. World J Gastroenterol. 13(35):4771-5.
(8)Rish EC et al. 2002. Kiwifruit promotes laxation in the elderly. Asia Pacific Journal of Clinical Nutrition. 11(2):164.
(9)Cunnane, S. C., et al. Nutritional attributes of traditional flaxseed in healthy young adults. American Journal of Clinical Nutrition. 61(1):62-68, 1995.
(10)Dahl, W. J., et al. Effects of flax fiber on laxation and glycemic response in healthy volunteers. Journal of Medicinal Food. 8(4):508-511, 2005.
(11) Anti M et al. 1998. Water supplementation enhances the effect of high-fiber diet on stool frequency and laxative consumption in adult patients with functional constipation. Hepatogastroenterology. 45(21):727-32
(12) Arnauld MJ. 2003. Mild dehydration: a risk factor of constipation? Eur J Clin Nutr. 57(Supplement 2):S88-S95.
(13)Daher S et al. 2001. Cow’s milk protein intolerance and chronic constipation in children. Pediatr Allergy Immunol. 12(6):339-42
(14)Iacono G et al. Intolerance of cow’s milk and chronic constipation in children. New England Journal of Medicine. 339(16):1100-1104, 1998.
(15)Heine RG et al. 2002. Cow’s milk allergy in infancy. Curr Opin Allergy Clin Immunol. 2(3):217-25
Written by Ani Kowal