Constipation

CONSTIPATION IS LIKE . You wait for something that just won’t . And, still you have to use a lot of force. Sometimes, in return for all that effort, you get no more than • • •. Or it works, but not very often.

Between 10 and 20 percent of people in the United States are constipated. If you want to join this club, you must fulfil at least one of the following conditions: bowel movement less than three times a week; particularly hard stool a quarter of the time, often in pellet form (• • •), which is difficult or impossible to pass without help (medication or tricks); no satisfying feeling of emptiness on leaving the toilet.

Constipation results from a disconnect between the nerves and the muscles of the gut when they are no longer working toward quite the same goal. In most cases, digestion and transportation of food through the system are still working at normal speed. It is not until the very end of the large intestine that disagreement arises as to whether the contents need to be expelled right away or not.

The best parameter for assessing constipation is not how often you need to go to the toilet, but how difficult it is. Time spent sitting on the toilet is supposed to be a time of splendid isolation and relaxation, but for those whose experience is not so laid back, it can be a troubling time. There are various levels of constipation. Temporary constipation can be due to traveling, illness, or periods of stress. More obstinate constipation can indicate more long-term problems.

Almost half of us have experienced constipation when traveling. Particularly in the first few days of a trip, it is often difficult to go properly. This can be due to a variety of reasons, but in most cases it boils down to the simple fact that the gut is a creature of habit. The nerves of the gut remember what kind of food we prefer and at what time we prefer to eat it. They know how much we move around and how much water we drink. They know whether it is day or night and what time we usually go to the toilet. If everything goes according to plan, they complete their tasks without complaint and activate our gut muscles to help us digest.

When we travel, we have a lot on our mind. Did we pick up our keys and turn off the iron? We might remember to take a book or some music to keep our brains happy, but there is one thing we always forget—that creature of habit, the gut, is also traveling with us and is suddenly torn from its familiar routine.

We spend the whole day eating prepackaged sandwiches, strange airplane meals, or unfamiliar spices. At the time we would normally be enjoying our lunch break, we’re stuck in traffic or waiting at the check-in counter. We drink less than normal, for fear of having to go to the toilet too often, and dehydrate even more during the flight. And, as if that weren’t enough, we might also have to face a big fat bout of jetlag.

All this does not go unnoticed by the nerves of the gut. They can get confused and put the brakes on until they receive a signal that everything is normal and they can start work again. Even when the gut has done its work despite the confusion, and signals to us that we should seek out the toilet, we add to its woes by suppressing the urge because it happens not to be a convenient time. Also, if we’re honest, travel constipation can often be caused by the “not my toilet” syndrome. Sufferers of this syndrome simply dislike doing their business in unfamiliar toilets. Their biggest challenge is posed by public conveniences. Many people use them only when it’s absolutely necessary, construct elaborate seat sculptures out of toilet paper, or crouch what feels like miles away from the toilet bowl. But even all that doesn’t help those with a serious case of “not my toilet” syndrome. They simply cannot relax enough to finish the work their creature of habit has begun. When that happens, a holiday or business trip can become a rather unpleasant experience.

THERE ARE A FEW little tricks that can be useful for people with brief or mild instances of constipation. These tricks can lower inhibitions and help get things moving in the bowel department.

1. There is a certain foodstuff we can eat to nudge the gut wall into action: fiber. Dietary fiber is not digested in the small intestine and can knock on the wall of the large intestine in a friendly way to say there is someone here who wants to be shown the way out. The best results are produced by psyllium seed husks and the rather more pleasant-tasting plum. Both contain not only fiber, but also agents that draw extra fluids into the gut—making the whole business smoother. It can take two to three days before their effect is felt. So, you can start eating them either a day before your trip or on the first day—whatever feels safer. Those with no plum compartment in their suitcase can buy dietary fiber in tablet or powdered form from their pharmacy or drug store. One ounce (30 grams) is an appropriate daily dose of dietary fiber.

There are two kinds of fiber: water-soluble and insoluble. The latter is better at stimulating movement through the digestive system, but it can often cause stomachaches. Water-soluble fiber does not provide quite such a powerful push, but it does make the contents of the gut softer and easier to deal with. Nature’s design is rather clever: the skins of many fruits contain large amounts of insoluble fiber, while the flesh of the fruit contains more soluble fiber.

Consuming dietary fiber is little help if you do not also consume sufficient fluids. Without the presence of water, fiber binds together in solid lumps. Water makes them swell up into balls. This gives the bored gut something to do while your brain enjoys the in-flight entertainment.

2. Drinking more fluids can only help those who don’t already drink enough. For those who do, drinking even more will not bring about any improvement. But it is a different story if the body gets too little fluid. The gut reacts by extracting more water from the food passing through it. That makes the feces harder. Small children running high temperatures often lose so much body fluid through sweating that their digestive system grinds to a halt. Air travel can cause the body to lose similar quantities of water, even without sweating. The air in the plane is so dry that it extracts fluid from our body without our even noticing. The first sign we have of it is an unusually dry nose. During air travel it is a good idea to try to drink more than normal to keep the water in your body at a normal level.
3. Don’t put yourself under pressure. If you need to go to the toilet, just go—especially if you are a creature of habit like your gut and usually go at an appointed time. If you normally go to the toilet in the morning but suppress the urge because you’re traveling, it is as if you have broken an unspoken agreement with your gut. You gut likes to work according to plan. Pushing digested food back into a holding pattern even just a couple of times trains the nerves and muscles to operate in reverse gear. That can make it increasingly difficult to change gears back again. This is compounded by the fact that the longer the feces stay in the gut, the more time the body has to extract fluid from them, making the business ever harder. A couple of days of suppressing the urge can lead to constipation. So, if you still have another week of your camping holiday to go, you’d better get over your fear of the communal toilets before it’s too late!
4. Probiotics and prebiotics—living, beneficial bacteria and their favorite food—can breathe new life into a tired gut. It is a good idea to consult your pharmacist about this or turn to the sections on probiotics and prebiotics later in this book.
5. Take more walks? That is not always a successful strategy. A sudden decrease in exercise can cause the gut to slow down, it’s true. But for those who already exercise enough, more movement will not help them attain digestive nirvana. Tests have shown that it takes extremely strenuous exercise to achieve a measurable effect on the movement of the gut. So, unless you are planning to engage in some kind of power sport, forcing yourself to take an extra walk will have little effect—on your ability to go to the toilet successfully, at any rate.

THOSE WITH A taste for the unusual might want to try the rocking squat technique. Sitting on the toilet, bend your upper body forward as far as possible toward your thighs, then straighten up to the sitting position again. Repeat this a few times and it should begin to work. No one watches you while you are on the toilet and you have a moment of free time, so what could be a better opportunity for an unusual experiment?

HERE ARE SOME strategies for times when household remedies and rocking on the toilet fail.

In more stubborn cases of constipation, the nerves of the gut are not just confused or sulking, they are in need of a bit more support from their owner. If you have tried all the little tips and still don’t leave the toilet singing a merry tune, it may be time to rummage in another box of tricks. But you should only do this if you already know the reason for your problem. If you don’t know the precise cause of your constipation, you cannot choose the right remedy.

If constipation comes on very suddenly or lasts for an unusually long time, you must consult your doctor. The problems may stem from undiagnosed diabetes or thyroid problems, or you may just be a natural-born slow transporter.