The ‘3 Fs’ of constipation

Article by Dr Manasa S, B.A.M.S

Constipation is a medical condition wherein a person has difficulty in passing stools or there is infrequent bowel movement. Generally a person is said to be constipated when the bowel movements result in dry stool, small amounts of hard stools, usually fewer than three times a week.

Mechanism of how constipation is caused

As the food moves through the large intestine, the intestine absorbs water while forming the stool. After the stool formation, the intestinal muscles contract and push the stool towards the rectum for the final evacuation through the anus. By the time the stool reaches the rectum most of the water is absorbed thus making the stool solid. When the movement of the large intestine is slowed down or sluggish, the stool passes down the colon too slowly resulting in too much water being absorbed from the stool. This makes the stool hard and dry.

Causes of constipation

There are plenty of causative factors for constipation. The common causative factors are enlisted below –

• Not enough fibres in diet
• Not enough liquids
• Lack of exercise
• Irritable bowel syndrome
• Certain medications which alter the bowel movement and water absorption from the food which passes through the colon
• Changes in habits or lifestyle
• Ignoring the urge to have a bowel movement
• Overuse or improper use of laxatives
• Disorders associated with normal functioning of intestines

Common symptoms of Constipation

• Passing of hard stools
• Reduction in the stool frequency, fewer than three times in a week
• Difficulty in passing of stools
• Strain while passing the stools
• Bowel movements may be painful
• Feeling of incomplete emptying after defecation
• Feeling bloated
• Abdominal pain

Chronic Constipation – If these symptoms of constipation persist for three months or longer, then it is considered as chronic constipation. Chronic constipation needs a thorough evaluation to identify the cause and to put an insightful treatment line up in place.

Right time to see the doctor

Consider seeing your doctor as soon as possible in the below mentioned conditions –

• Symptoms lasting for three months or more than three months
• Symptoms makes it difficult to carry out day today activities
• Per rectal bleeding or blood on toilet tissue
• Stool colour turning to black or traces of blood in stools
• If there are any unusual changes in shape or smell of the stools
• Abdominal pain that is not subsiding
• Unexplained weight loss

Risk factors involved in chronic constipation

Factors which are involved in chronicity of constipation include:

• Being an over adult
• Being a women
• Having little or no physical activity
• Suffering from mental health conditions such as depression or an eating disorder

Why constipation needs a prompt treatment protocol?

Though at a superficial level the constipation looks like a simple condition, it can lead to many complications if not evaluated and treated properly and promptly. The complications are as mentioned below –

• The tissues around the anus get swollen causing ‘haemorrhoids’
• Tissues around the anal region may break or tear leading to ‘anal fissure’
• Hard and dry stools backed up into the colon may lead to faecal impaction
• Rectal prolapse

Importance of 3Fs in the prevention and control of chronic constipation

The 3 Fs related to chronic constipation is –

1. Fluid,
2. Fibre and
3. Fitness

In the reminder of this article let us understand the relevance of each of these ‘Fs’ one by one –

1. FLUID

Regulation of the body temperature, keeping the joints lubricated, deliver of nutrients to each cell, proper functioning of organ system and proper bowel movements are some of the important functions of water. A good hydration also improves sleep and many functions of brain and nervous system.

The human body is composed of 60% of water. It is commonly recommended that drinking of 2 to 3 litres of water is necessary for all vital activities of the body. Adequate hydration varies from individual to individual and it also depends on the geographical region of the person and certain medical conditions wherein there is excessive elimination of water from the system.

Detailed description of importance of ‘well hydrated body’

1. Helps in the proper secretion of saliva – Water is the main content of saliva and saliva forms an important element in the digestion of the food. It helps in keeping the oral cavity moist and healthy.
2. Helps in proper digestion – Since the digestives enzymes, fluids and chemicals involved in the process of digestion, absorption and assimilation contain water, and regular hydration is needed for them to function properly. If the digestive functions are proper then absorption of food also takes place properly and bowel movements too happen properly. So, good digestion followed by good absorption of digested food helps in the prevention of constipation.  
3. Regulation of the body temperature – Staying hydrated is important in maintaining the temperature of the body.
4. Protection of joints, spinal cord and tissues of the body – Enough fluid in circulation helps in the lubrication of joints and spinal cord and also helps in the normal functioning of the cells and tissues.
5. Helps in the excretion of body wastes through perspiration, urination and defecation – Body uses water to sweat, urinate and to defecate. Body requires enough fluid balance to have a regular bowel movement and thus prevents constipation.
6. Helps to maximise physical performance – Drinking of water during physical activity is utmost important and is also a necessity since most of the fluid reserve is used up while in activities in the form of sweating. Physical activity especially endurance training or high intensity sports activity needs a back up of adequate hydration as dehydration after rigorous activity may cause severe medical emergencies.

Practical tips for keeping adequately hydrated –

• Ideally one should give a kick start to his or her morning by drinking a glass of warm water,
• One should carry a water bottle whenever going out and make sure to keep it refilled as and when it empties,
• One shall avoid sugared and carbonated drinks to avoid burdening the body with empty calories,
• Parents should make sure that their kids also get adequate quantity of water and other fluids as and when needed

Ideal conditions and candidates wherein extra caution should be taken in terms of keeping oneself hydrated –

• One has to keep oneself properly hydrated during hot, humid and dry seasons
• Elderly persons and children should take more caution and keep themselves hydrated frequently since they tend to lose their water stores in the body quickly,
• In certain medical conditions like Diabetes Mellitus one need to be extra cautious in keeping a balance of hydration,
• People who are taking regular laxatives and diuretics also need to have a check on their hydration levels and keep taking good quantity of water, regularly because there are more changes of getting dehydrated in these conditions,

Other forms of natural and healthy hydration –

One can get natural and healthy hydration by taking one of the below mentioned things –

• Coconut water
• Buttermilk
• Lemon water
• Kanji
• Herbs infused water
• Fruits infused water

2. FIBRE

Dietary fibre, also known as roughage or bulk, includes the parts of the plant foods that our body cannot digest or absorb. Unlike the carbohydrates, fats and proteins which form the types of macronutrients which the body breaks down and helps in absorption, the fibre is not digested or absorbed. The fibres rather pass relatively intact through the digestive canal and are thrown out of the body.

Types of the fibre

Dietary fibre is divided into soluble and insoluble

• Soluble fibre – This type of fibre dissolves in water and gastrointestinal fluids when it enters the stomach and intestines to form a gel-like substance. Soluble fibre is found in oats, peas, beans, apples, citrus fruits, carrots, barley etc. These soluble fibres are found to lower blood cholesterol and glucose levels.
• Insoluble fibre – This type of fibre is not soluble in water. Insoluble fibre attracts water into the stool, making it softer and thus it is easier to pass through the rectum with less strain. Thus insoluble fibre promotes bowel health and its regularity.

Health benefits of foods rich in high fibre

• Dietary fibre increases the weight and size of the stool and softens it. A stool which is bulky is easier to pass through the colon thus decreases the chances of constipation.
• A diet rich in fibre may lower the risk of developing haemorrhoids. Studies have also shown that a high fibre diet likely lowers the risk of colorectal cancer.
• Some soluble fibre rich foods feed gut bacteria, as it is fermentable in the colon and thus helps the good bacteria to thrive longer.

Best fibre choices

• Whole grain products
• Vegetables like carrot, beetroot, cucumber, cauliflower, broccoli and green leafy vegetables like palak leaves, lettuce etc
• Fruits like avocado, berries, citrus fruits
• Beans, peas and other legumes
• Nuts and seeds like sunflower, melon, flax seeds, almonds, peanuts etc
• Other foods like coconut water, buttermilk, lemon water and green tea

Some practical tips to get enough fibres in the diet

• One should start the day with high fibre breakfast and also opt for whole grain with lots of vegetables
• Switch to whole grains
• Include lot of legumes as they are excellent sources of fibre
• Incorporating vegetables and fruits rich in fibre content
• Keeping a watch on consumption of junks or foods with high trans fatty acids and drinks and food stuffs with empty calories

3. FITNESS

The exercises which are mild to moderate have shown a considerable effect on the health of the gastrointestinal tract. It is proved again and again that physical activity is one of the most effective lifestyle tools for loosening bowels and keeping the gut health intact. Exercise helps constipation by lessening the time it takes for food to move through the intestines. This limits the amount of water getting absorbed from the stool. Thus there are very less chances of stool getting hard and dry. In addition to this, exercises speeds up breathing and heart rate and this helps to stimulate the contractions of intestinal muscles. Intestinal muscles that have a natural intact mobility help to move the stools quickly out of the system.

Cardio exercises, running, jumping, cycling; dancing, Zumba and salsa increase the heart rate, improves the circulation to the whole body and stimulates bowel movements. Even if someone does not do rigorous exercise, just a brisk walk of 30 to 40 minutes helps in improving the gut motility.

Yoga

Practicing Yoga is beneficial to get the bowel movements proper and relieve constipation. Those yoga postures that involve stretching and bending of back and pelvic floor muscles relieve constipation.

Important Yoga poses for constipation –

• Bhujangasana – cobra pose
• Ardha Matsyendrasana – half lord of fishes pose
• Supta Matsyendrasana –
• Halasana – plough pose
• Malasana – garland pose or squat pose
• Bharadvajasana – Bharadvaja’s twist
• Dhanurasana – bow pose
• Pawanamuktasana – the wind releasing / relieving pose
• Vajrasana – thunderbolt / diamond pose
• Paschimottanasana – seated forward bend
• Anjaneyasana / Parivrtta Anjaneyasana – Crescent twist
• Balasana – child pose
• Pranayama – Yogic breathing techniques

Deep breathing exercises.

Practicing deep breathing techniques is another great way to help improve gut health and bowel movement and thus helps in keeping the constipation away.

Ayurveda Perspective

Though 3 Fs cannot be explained strictly from Ayurveda perspective, here is a small attempt to see if these factors can be considered when seen through Ayurveda lens.

1. Fluid factor and Ayurveda

According to Ayurveda, vata, mainly apana vata helps in formation and excretion of faeces. The process of faeces formation actually starts in the stomach and small intestine with the involvement of pachaka pitta and samana vata. When there is high vata in condition, dryness and roughness prevails in the colon. As a result there is excessive dryness of faeces resulting in constipation. So, vata is the main dosha which causes constipation when it is not balanced. Increase in vata also depicts reduced kapha and kapha components in the body. Water is regulated by balance of kapha in the body.

Increased intake of vata aggravating foods and indulgence in vata increasing activities, excessive fasting or starvation, seasons favourable for vata increase, and less intake of water – will all contribute to fluid imbalance in the body leading to increased dryness and roughness. This will eventually cause vata aggravation and consequently cause constipation. This also shows that proper and adequate hydration is needed to keep the doshas, vata in this case, in a state of balance.

2. Fibre factor and Ayurveda

Fibre rich foods are essential inclusions in treatment of constipation in the modern day. We do not find direct references of such foods and their utility in Ayurveda treatises. But we can take a leaf or two from the modern explanation of these foods and try to understand them from Ayurveda perspective.

Since soluble fibres act by forming gel like substances which resemble kapha, they can be considered to increase kapha properties and antagonize the dryness and roughness of vata in the colon, thus easing constipation. Most of these fibre rich foods like carrots, apples and citrus fruits have sweet and sour tastes and sweet after digestion effects, which counteract vata and ease constipation.

Master Charaka recommends Pramathi Annapana in treating the diseases caused by forcible withholding of urge for defecation, including constipation. Here he was probably hinting towards fluid replacement and fibre rich foods which are antagonistic to vata and also relieve constipation.

Fitness factor and Ayurveda

Vyayama – physical exercises have been mentioned among the dinacharya regimens in Ayurveda. Regular exercises, among many benefits, will enhance the digestive capacity in an individual resulting in proper digestion of food. When food is properly digested, faeces are properly formed. The vata too will be in a state of balance. Apana vata would excrete the faeces properly and regularly and hence constipation will not occur. Regular exercises will also enable proper peristalsis.