We thought seeking out information about avoiding constipation from dietitian and expert in the field Dr Megan Rossi would be a good idea under current circumstances. We do not need to delve too deeply into why. Suffice it to say it seemed like the change in habits and likely drop in physical activity almost the entire population is currently experiencing might lead to some changes in bowel habits.
That, Rossi explained, isn’t the half of it. “It’s also about things like the gut-brain axis – stress can change bowel habits. In fact, the cause of constipation of most of the people I see in clinic is actually stress-related. Stress makes some people have diarrhoea, but there is a group of people whose constipation gets worse with stress.”
Rossi also highlighted that constipation is very common, but the good news is that you don’t need to live with it. “There are heaps of strategies,” says Rossi. “It's just about finding the one that’s right for you.” For instance, mindfulness exercises can help with stress, and there are plenty of mindfulness apps to try.
Rossi helpfully detailed a number of techniques and tips in her book Eat Yourself Healthy, but obviously couldn’t convey all the details. Rossi’s book is available online through Amazon’s Kindle reader. The flow chart on how to address constipation and the gut-directed yoga flow, in particular, may be worth the price of purchase alone.
Before any of that, here’s Rossi on what can cause constipation, how to remedy it and when it’s worth consulting a doctor (not in person for now, of course).
What is constipation?
People’s perception of constipation can differ. For some people it’s how often they actually go, whereas for others if they need to strain they call that constipation. Other people might be wanting to open the bowels and it doesn’t all come out.
What doctors know as functional constipation is people who open their bowels fewer than three times a week, combined with another factor, like straining.
Is constipation likely to become more of an issue in the current “lockdown” circumstances?
There are many different triggers for constipation. Obviously, physical activity’s decreasing and we know that activity can help move the bowels, so it can help prevent constipation.
Then there’s the stress element. There’s a constipation-predominant type of irritable bowel syndrome that has a lot to do with stress. If people are experiencing mental stress and anxiety that can in turn cause their bowels to essentially shut up shop and not move as effectively.
Any change in habits and routine can throw the bowels. That's why when people go on holiday they often struggle with a bit of constipation because their eating routine is out of whack and their safe place of the bathroom is different.
Another issue can be when people have a phobia of opening their bowels in a communal toilet – especially when we’re house sharing, and there might only be one bathroom.
Is it important to deal with constipation rather than ignore it and hope it goes away?
Constipation can be hugely debilitating if people are blocked up for more than a week or two. There are excruciating physical symptoms. The NHS England 2017-2018 report said that constipation cost the government £162 million for that one year, and 196 people a day were actually admitted to hospital because of severe constipation.
Outside of coronavirus it affected up to one in seven adults and up to one in three children. With corona maybe it could be more, but we don't know yet.
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What can people do to lower the risk of developing constipation in the current situation?
If you’re sitting down all day and not moving, then spending at least 30 minutes doing something like power walking can help. Or try something like the gut-directed yoga flow [in Rossi’s book], which can help stretch and contract your gut muscles to help them get moving.
In terms of the dietary factors, getting enough fluid in – so around two litres a day, depending on the individual – and also plenty of dietary fibre. That comes from plant-based food groups, so things like wholegrains, nuts, seeds, fruit and veg, and we know that the fibre from wholegrains in particular is quite good for helping move the bowel.
Eating 50g of prunes a day can really help increase people’s bowel movements if they're struggling with constipation. Equally, one green kiwi fruit a day. But it’s 50g or the kiwi fruit – just once a day, for a week. If it’s going well, you double it, so 100g of prunes or two kiwi fruit a day for three weeks. Both strategies have been shown in clinical trials to help move people’s bowels. Flaxseed or psyllium husk added to breakfast can also help get the bowels moving a little bit more.
The flow diagram in my book can be really helpful for people who have constipation to identify what strategies are right for them. There are various simple recommendations – more fibre, more water, move more – but actually, it will depend on the individual and their trigger.
For the people who’ve got a toilet phobia, more fibre could make the constipation worse. What they need to do is overcome that fear and in the book I’ve got a “poop-pourri” recipe. It’s super-simple and people can make it at home. It’s just adding essential oils to a bit of detergent and alcohol – vodka or something – and you spray it in the toilet beforehand to trap all the smells under the water. It sounds hilarious but it works incredibly well. I’ve used it for so many of my patients who have a fear of going to the toilet, whether they’re at work or somewhere like that, and they hold it back which causes more issues.
At what point do you think people should get in touch with their doctor?
If it’s a one-off sort of thing, then they can probably just use an over-the-counter treatment. It’s hard to make these recommendations at the moment – we don’t want to be clogging up the NHS with issues of constipation. I think if you can self-manage for a month, try to do that, but if it’s any longer then it might be worth a call.
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Jonathan Shannon has been the editor of the Coach website since 2016, developing a wide-ranging experience of health and fitness. Jonathan took up running while editing Coach and has run a sub-40min 10K and 1hr 28min half marathon. His next ambition is to complete a marathon. He’s an advocate of cycling to work and is Coach’s e-bike reviewer, and not just because he lives up a bit of a hill. He also reviews fitness trackers and other workout gear.