Science has proven that good health and mood are related to good bowel function. A common functional problem of the digestive system that affects a large percentage of the population is constipation.

The following article will help you understand the causes of constipation and how changes in your diet and lifestyle can help treat it.

• What is constipation?
• What causes constipation
• Dealing with constipation

Constipation is a very common phenomenon worldwide, as many people suffer from it. Although it is not considered a disease, constipation can be described as a condition that causes intense discomfort and distress. It may be linked to medical conditions, but most often it is related to non-pathological factors such as modern lifestyles.

Although constipation affects people of all ages, in this article we will focus on constipation in adults.

What is constipation?

The term constipation refers to a decrease in the frequency of bowel movements and/or difficulty passing stool, with stool usually being hard due to reduced water content.

Constipation is used to describe a variety of symptoms, including hard stools, excessive pressure, infrequent bowel movements, bloating, and abdominal pain. The Rome IV criteria consider functional constipation to be present when two of the following criteria have been met in the last three months, with symptoms beginning at least six months prior to diagnosis.

Epidemiology

Constipation is a common symptom among people of all ages, with a higher incidence in older ages and during pregnancy. The prevalence of constipation is 15% in the general population, with a higher ratio of women to men and a higher prevalence in the elderly, especially those over 65 years of age.

The severity of constipation varies from person to person, while most people experience short periods of constipation during their lifetime, including possibly after surgery, others have constipation as a chronic long-term condition that can significantly affect their quality of life.

According to a study conducted in 2006 by the Hellenic Foundation of Gastroenterology and Nutrition (EL.I.GAST.) [4], Constipation affects 16% of the adult population. and 20% of the population (one in five Greeks) has experienced constipation at least once in the past.

Women have higher rates of constipation than men (approximately 7 out of 10 people with constipation are women). Higher rates of constipation were found in people aged 45+ and especially between 60-64 years old, with a rate of about 1 in 4 participants.

What causes constipation

Causes and types of constipation

As mentioned above, constipation is not classified as a disease, but rather a symptom [5]. There are many possible causes of constipation in adults, such as diet, genetic predisposition, colon function (motility and absorption), as well as lifestyle factors (physical activity, medication).

The causes of constipation can be divided into primary (idiopathic), related to problems with the functioning of the large intestine (slow passage or obstruction of the exit, leading to malfunction of the defecation process), and secondary, related to organic diseases, systemic diseases, or medication use.

In summary, the following list includes factors that have been associated with the onset of constipation. These factors are:

• low dietary intake of fiber or a sudden change in our diet/routine
• insufficient water/fluid intake (dehydration)
• sedentary lifestyle (lack of physical activity, spending several hours a day sitting or lying down)
• inability to respond to the urge to defecate
• drug side effects
  • analgesics (such as opioids and non-steroidal anti-inflammatory drugs)
  • antacids (such as those containing aluminum)
  • anticholinergics (such as antidepressants and antipsychotics)
  • antihypertensive drugs (such as calcium channel blockers)
  • diuretics
  • iron supplements
  • abuse of stimulant laxatives
• Metabolic and endocrine disorders: diabetes mellitus, hypothyroidism, hyperthyroidism, hypercalcemia, hyperkalemia, panhypotension, pheochromocytoma, uremia, celiac disease, hormonal changes during pregnancy and menopause
• irritable bowel syndrome
• psychological disorders: depression, anxiety, eating disorders
• neuropathies: Parkinson's disease, spinal cord injury, multiple sclerosis, diabetic neuropathy, cerebrovascular disease, Hirschsprung's disease, spinal cord injury, paraplegia
• myopathies: scleroderma, amyloidosis
• structural disorders: colon cancer, colon strictures, rectocele, rectal disorders, intestinal pseudo-obstruction.

Constipation in old age

Constipation is a common problem that affects older people, which is understandable when you consider the reasons mentioned above. Older people usually follow a diet low in fiber, as they prefer foods with a soft texture due to a lack of teeth and/or appetite.

In addition, older adults tend to reduce the amount of fluids they consume, and their independent mobility is limited, resulting in reduced physical activity and access to the toilet.

In the elderly population, colonic motility decreases as aging affects the structure and function of the enteric nervous system [8]. In addition, constipation often occurs as a symptom due to the use of medications or diseases mentioned above.

Ways to treat constipation

As mentioned above, constipation is a multifactorial phenomenon, which, with proper monitoring, can be successfully treated and contribute significantly to the relief of constipation. The first line of treatment for constipation involves simple measures, including changes in diet and lifestyle, which are listed below.

1) Increase the amount of fiber in your diet

Epidemiological studies have consistently demonstrated the benefits of dietary fiber on gastrointestinal health through the consumption of unprocessed whole foods, such as whole grains, legumes, vegetables, and fruits. According to EL.IGAST, there should be a gradual change in the eating habits of sufferers, based on the Mediterranean diet model.

Individuals with constipation should follow a balanced diet that includes grains, fruits, vegetables, and legumes.

Dietary fiber is divided into two main categories:

• The soluble fiber They have the ability to absorb water and create a soft, gel-like substance that improves stool consistency and facilitates its passage through the intestine. In addition, they contribute to maintaining overall intestinal health, as their fermentation in the large intestine promotes the growth of good bacteria and helps maintain the balance of the microflora.
• The insoluble fiber They are not absorbed at all or are absorbed minimally by the gastrointestinal system and remain in the intestinal lumen. Insoluble particles have an irritating effect on the mucous membrane of the large intestine, stimulating the secretion of water and mucus to protect against friction. This results in an increase in both the water content of the stool (soft stool) and the volume of the stool, and facilitates the process of defecation, which relieves constipation.

What is important to remember is that fiber-rich foods usually contain both types of fiber.

The World Health Organization recommends intake 25-35 g of dietary fiber daily for adults. Despite this recommendation, the average dietary fiber intake among adults worldwide remains low, typically below 20 g per day.

Caution,

In some individuals, increasing fiber intake may cause side effects such as flatulence and bloating. Therefore, to avoid these inconveniences, the Increase your fiber intake gradually. with a parallel increase in water consumption.

It can take up to 4 weeks to see the results of increasing fiber in your diet, and some people may need laxatives in the short term while they adjust their diet. Psyllium, which belongs to the soluble fiber group and is known for its mild laxative effect, appears to be effective.

How to increase your daily fiber intake

• Make sure you consume at least five servings of fruit and vegetables during the day.
• Along with each of your main meals, ate a salad with a variety of raw vegetables. Cooking certain foods can reduce their fiber content, so choose steaming or baking where possible (e.g., broccoli).
• Consumed cooked vegetables (peas, okra, and green beans) at least twice a week as a main dish.
• Consumed legumes (beans, giant beans, lentils) at least twice a week, either as a main dish or in a salad.
• Choose unprocessed products whole grain (bread, pasta, wheat, bulgur, brown rice, quinoa), and snacks (whole grain crackers or whole grain cereal bars or muesli).
• Select unsalted nuts (walnuts, hazelnuts, almonds), seeds (chia seeds, flax seeds), fruits, and vegetables as snacks between meals.
• Consumed seasonal fruit which are eaten with their skin (apples, pears, peaches), citrus fruits (oranges, kiwis) and fruits rich in sorbitol (apples, plums, pears), which has a mild laxative effect. It is also a good idea to choose natural juices or fruit and vegetable drinks rich in fiber.

2) Intake of probiotics and prebiotics

The probiotics are symbiotic microorganisms that are part of the normal microflora of the intestine and provide health benefits (they promote health, as their name suggests). They actively contribute to balanced functioning and strengthening of the host's gastrointestinal system and the entire immune system.

There are approximately one billion bacteria in the human intestine, which, if not in balance, lead to gastrointestinal disorders. In cases of intestinal disorders, such as constipation, taking probiotics appears to be beneficial because they restore balance to the gut microbiome, help regulate pH in the colon, improve colon motility, and reduce food transit time.

In food, they are mainly found in fermented products such as Greek yogurt, pickles, fermented cheeses, and kefir (Table 2).

The prebiotics are substances (e.g., pectins, gums, cellulose) that are used as «food» by probiotics, thereby enhancing the health of the digestive system. For example, Honey contains prebiotic ingredients (oligosaccharides and inulin), thus supporting the growth of probiotics and helping to combat constipation.

Probiotics and prebiotics are found in natural foods or enriched dairy products. Alternatively, you can choose dietary supplements that combine these ingredients to help improve bowel motility and restore intestinal flora.

3) Avoid foods that worsen constipation

Contrary to what has been mentioned so far, there are also foods that contribute to the onset of constipation and/or exacerbate it. These foods should be avoided for better bowel function, especially when the problem is acute. The most common cause of constipation is a diet low in fiber and high in fat. More specifically:

Processed foods

It is well known that processed foods are high in fat and low in fiber, a combination that can slow down digestion and lead to constipation when we frequently consume large amounts of processed foods.

The ready meals (such as frozen, pre-cooked meals) usually contain preservatives, unhealthy fats, and salt, which make digestion difficult and worsen constipation. In addition, the way these ready-made meals are prepared and frozen leads to the removal of any dietary fiber they may have originally contained.

Specifically, foods such as processed meat (souvlaki, gyros), pizza, and hamburgers are high in fat and salt, which reduce the water content in the intestines and hinder bowel movement, so they should be avoided by people with constipation. In addition, these individuals should avoid fried foods due to the fats they contain. Fried foods are difficult to digest and often lead to bloating and constipation.

Furthermore, in processed foods we also find processed carbohydrates which help preserve packaged foods. The intestine does not have the necessary enzymes to break down these processed carbohydrates, resulting in gastrointestinal problems such as bloating, constipation, diarrhea, and gas. These processed carbohydrates are found in processed doughs rich in sugar, such as various breads, pasta, cookies, and crackers.

Many studies have shown that There is a lower risk of constipation when there is a high intake of dietary fiber.. Whole grain products come from unprocessed cereal grains, where the bran and germ of the grain have not been removed. The bran of the grain contains fiber that promotes proper bowel function.

Therefore, individuals suffering from constipation can benefit from gradually reducing their intake of processed carbohydrates (white bread, white rice, and white pasta) and incorporating whole grain products into their diet.

Caffeine and alcohol

Consuming caffeine and alcohol leads to dehydration, which hinders bowel movement. The effect of caffeine and alcohol varies from person to person. When you drink a lot of coffee during the day, caffeine can have a diuretic effect and dehydrate you, making constipation worse. However, caffeine can also act as a stimulant, causing diarrhea in some people.

Specifically for alcohol, this also causes increased urination and dehydration, worsening constipation, while in others it can cause diarrhea. The best thing you can do is drink water to keep your body adequately hydrated, which will help treat and prevent constipation.

Dairy products

Full-fat dairy products (milk, cheese, yogurt, cream, etc.) do not contain fiber and They have a high fat content, which slows down digestion and reduces bowel motility, exacerbating constipation.

In addition, the enzyme lactase is necessary for the breakdown of dairy products by the body. Lactase is an enzyme found in the villi of the small intestine, whose main function is the hydrolytic breakdown of the disaccharide lactose, which is the main sugar in milk. People with lactose intolerance have a deficiency of this enzyme, and consuming dairy products will lead to gas production and worsening constipation.

High consumption of unfermented dairy products with a high lactose content, such as fresh milk, can cause bloating, which will exacerbate the problem of constipation. However, you can consume kefir, probiotic yogurt containing live cultures, lactose-free milk, and hard cheeses.

Foods containing gluten

Gluten is a protein found in grains such as wheat, barley, and rye. Many people are gluten intolerant and often suffer from chronic constipation. Specifically, Celiac disease is the most serious form of gluten intolerance.

In this disorder, gluten consumption triggers an immune response in the body, causing inflammation and damage to the small intestine and hindering the absorption of nutrients from food. As food travels through the digestive tract, the intestinal villi cannot fully absorb the nutrients in food and often absorb extra moisture from the stool.

This leads to hard stools and constipation [14]. Avoiding gluten can help relieve symptoms and heal the intestine in people with this disorder. However, people with celiac disease who follow a strict gluten-free diet may experience constipation, as the diet involves reduced fiber intake, which leads to reduced stool frequency [14].

Furthermore, non-celiac gluten sensitivity (NCGS) is a combination of gastrointestinal symptoms similar to irritable bowel syndrome (IBS), such as abdominal pain, bloating, diarrhea, or constipation [15]. Individuals with this condition do not have gluten intolerance but appear to be sensitive to it.

Individuals who experience such symptoms (such as constipation) after consuming gluten should consult their physician for a medical diagnosis before eliminating gluten from their diet.

4) Schedule your meals at fixed times

Make sure you have a fixed schedule based on which you will consume your meals daily. When you consume your meals at fixed times during the day, it is very likely that you will also regulate your bowel movements at fixed times.

Your meals should have high fiber content especially during periods when constipation is a problem. Include whole grain breakfast cereals in your breakfast, at least 5 servings of fruit and vegetables a day, and legumes at least 3 times a week.

Breakfast for constipation

A good breakfast for people with constipation can include whole grains. You can also increase the fiber content of your breakfast by adding seeds such as flaxseed, chia seeds, or psyllium husk. flaxseed. Furthermore, You can add fruits such as kiwis, apples, figs, plums, and oranges to your cereal bowl or yogurt.

Η oats is one of the best foods and, when combined with yogurt and honey is an excellent breakfast choice. Two very beneficial options are kefir and ariani, which can help relieve constipation.

5) Increase your daily fluid intake

Hydration plays a key role in combating constipation. Adequate fluid intake (approximately 2 liters per day) is also important, especially when following a high-fiber diet or taking fiber supplements [1].

Adequate fluid intake ensures that the body and, consequently, the stool are sufficiently hydrated. At the same time, it enhances bowel motility, helping it to make peristaltic movements and facilitating the process of defecation.

Make sure you drink at least 8-10 glasses of fluids a day. These fluids can include drinking water, juices, and foods such as soups, but not soft drinks. Fruits and fruit juices (with a high sorbitol content, such as apple, prune, and pear juices) can help treat and prevent constipation.

Also, to treat constipation

Some additional tips that help treat constipation beyond the dietary changes mentioned above are related to general lifestyle.

6) Improve your toilet routine

In practical terms, this means:

• Make sure you use the toilet in places where you feel comfortable. comfortably
• dedicated sufficient time so that not to feel any pressure or rush when you are in the toilet
• do not ignore the reflex of defecation, which is usually more intense after waking up in the morning and after eating meals
• Try to break habits such as getting distracted by your cell phone and ending up spending a lot of time in the bathroom unnecessarily.

• check it your body posture when sitting on the toilet. Often, the process is facilitated by placing our feet at a higher level than the floor and the use of a low stool is recommended in order to position the knees above the hips.
• do perineal massage (abdominal massage). Scientific studies have shown that it helps break down stool and relax the anal canal, making it easier to pass stool.

7) Increase your activity

As mentioned above, lack of physical exercise can contribute to constipation. Therefore, you should, avoid a sedentary lifestyle and incorporate daily walking or running into your routine. Physical exercise increases blood flow to all organs of the body, including the digestive tract, accelerating metabolism and thus helping to activate and increase bowel motility.

So make sure you incorporate exercise into your lifestyle and increase your daily activity (moderate physical activity for 30-40 minutes at least 3 times a week). You can start your day with some form of exercise, such as walking, running, cycling, swimming, yoga, etc.

In addition, exercise helps reduce stress, which has been linked to various gastrointestinal disorders, such as irritable bowel syndrome and constipation. Techniques such as yoga, breathing exercises, or meditation can help reduce stress.

8) Use of medication

If changes in your diet and lifestyle do not help, then you should talk to your doctor (physician, gastroenterologist) who can recommend the use of an appropriate laxative. The use of medication helps relieve constipation.

There are laxatives that aim to increase stool volume (such as fiber supplements), while some laxatives increase bowel motility by stimulating the contraction of intestinal muscles to push intestinal contents toward the anus. Long-term use of laxatives belonging to the second group should be avoided as it leads to intestinal inertia and ultimately ceases to be an effective solution for relieving constipation.

Furthermore, it is important Consult your gastroenterologist or pharmacist before consuming any supplement or herbal tea that guarantees relief from constipation.

Communicate with your doctor

Although constipation can be treated through diet, with lifestyle changes and/or medication, it is important to contact your doctor if constipation lasts for more than 3 weeks and/or is accompanied by other symptoms such as pain and lack of bowel movements for a few days.

Furthermore, if you have any additional symptoms such as blood in your stool, fever, weight loss, or fatigue, this is a sign of a more serious underlying disease and you should consult a specialist. The gastroenterologist will perform the appropriate tests and recommend a personalized treatment approach after evaluating your symptoms and the pathophysiology of your constipation.

In conclusion

There are several factors that can contribute to the development of constipation, including a diet low in fiber and fluids, modern lifestyle, side effects of certain medications, and underlying medical conditions.

People can successfully treat constipation by making changes to their diet (consuming fiber, staying hydrated) and lifestyle (exercising). However, medication may also be required to manage constipation in some individuals.

By Angeliki Vounta, Nutritionist – Biologist