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The digestive system is pivotal. Diet and exercise can both help to keep it in good shape
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Constipation is considered an old person’s problem but today’s urban lifestyle has made it a common gastrointestinal issue among all age groups. According to the findings of a survey released in June by pharmaceutical firm Abbott and global market research agency Ipsos, 14% of people in urban India suffer from chronic constipation.
The survey included 3,500 individuals in six cities—Mumbai, New Delhi, Lucknow, Kolkata, Hyderabad and Coimbatore.
Ashish Bhanot, a senior gastroenterology surgeon at Apollo Spectra Hospitals in New Delhi, sees around 15-20 patients a week who suffer from constipation. There is no one standard textbook definition for constipation, but, says Dr Bhanot, fewer than three bowel movements a week are definitely indicative of it. “It is important to remember that what’s ‘normal’ is different for different people. Some people go three times a day, others three times a week. Both situations are normal," he says.
In some cases, people self-medicate, using over-the-counter laxatives. This, however, can turn a non-issue into a big issue in the long run—slowing down a person’s metabolism, preventing the absorption of nutrients or leading to laxative dependence, with the body losing the ability to produce bowel movements on its own, without the aid of laxatives.
Yet ignoring the problem for too long can result in painful anal fissures (tears) and piles. What’s less commonly known is that severe constipation can lead to the release of toxins into the bloodstream. Your liver, kidneys, lungs and lymphatic system, even skin, then need to get rid of more waste than usual. “A clean colon means more good nutrients in your blood, so everything works better, from digestion to skin," says Dr Bhanot.
He says you should see a doctor if you have fewer than three movements a week and this lasts more than two weeks, or if there is a sudden decrease in the number of bowel movements. “Also, consult a doctor if you have blood in your stool, or pain while passing one."
Get the right fibre
What you eat matters, especially how much and what kind of fibre you take. “There are two main types of dietary fibre: insoluble and soluble. Insoluble fibre increases a feeling of fullness, stool size and bulk, and helps reduce constipation and piles. It is found in wheat bran, most wholegrain cereals and vegetables. Soluble fibre forms a gel and acts like a stool softener. It is found in all fruits, oats and barley," says Seethalakshmi Ravishankar, a senior dietitian at the PD Hinduja Hospital in Mumbai. A bowl of fresh salad can be a good source of insoluble fibre.
Most people eat only 5-14g of fibre daily, whereas the Indian Council of Medical Research recommends an intake of 40g of fibre daily. You could get this, for instance, from two figs with oat porridge and wheat bran, plus a guava, for breakfast; or two-three rotis made with atta flour that has wheat bran in it, a katori (bowl) of dal and 100g of almost any sabzi for lunch; and an evening snack of fruit chaat. “If you don’t want to crunch numbers, just go for wholewheat flour for rotis, opt for brown rice, eat oats (even millets such as barley and bajra, or pearl millet) for breakfast, get five servings of fruits and vegetables and two of pulses each day, and you won’t go wrong," adds Ravishankar. One serving equals one medium-sized fruit/one katori of cooked vegetables/pulses.
“Okra is a particularly good bet as it contains constipation-fighting insoluble fibre, as well as vitamin B6 and folate, both of which help keep the digestion humming along just fine," says Karuna Chaturvedi, a dietitian at the Jaypee Hospital in Noida, adjacent to New Delhi.
Prunes are a big help too, packed as they are with insoluble fibre and natural laxatives sorbitol and dihydrophenylisatin. In fact, the results of a randomized clinical trial, published in 2011 in the journal Alimentary Pharmacology And Therapeutics, show that prunes are more effective, safe and palatable than psyllium for the treatment of mild to moderate constipation.
“Even amla (Indian gooseberry), being high in fibre, helps in regularizing bowel movement. It also stimulates the secretion of gastric juices and thus has a positive effect on digestion," says Chaturvedi.
But make sure that you increase your fibre intake slowly to avoid gas and bloating. It is also important to get enough water. Drink at least two-three litres of water in a day.
Get enough magnesium
Magnesium is not just a mineral that’s essential for heart health and immunity, it also plays an important role in muscle function. And as our digestive system is essentially one long muscle, there’s a correlation between magnesium deficiency and constipation. “Magnesium actually attracts water in the colon (softens stools) and also helps relax the muscles in the intestines (helping establish a smoother rhythm that prevents constipation). Dark leafy greens, pumpkin seeds and soya are a good way to get enough magnesium," adds Chaturvedi.
“The RDA (recommended dietary allowance) for magnesium is 400mg for men, and 250-280mg for women," says Ravishankar.
An imbalanced gut
Sometimes, the balance between good and bad bacteria in the gut gets skewed. Antibiotics, stress or binge-eating can all lead to this. Good bacteria in the gut help break down the food we eat.
Home-made curd is an excellent source of probiotics. “Here, probiotics, the ‘good’ bacteria, can help restore the balance (of good bacteria) and get our digestive tract working again. Fermented foods can be a big help too," says Ravishankar.
Avoid foods with high fat content during dinner. “Eating a heavy meal before sleeping or eating high-fat meals within 4 hours of bedtime is a common cause for constipation as the rich meal and sleep together slow down digestion," warns Chaturvedi.
The stress connect
Stress tends to be a constant—but it’s unhealthy when it starts affecting your body adversely: The pulse quickens, blood flow increases, the pain threshold drops, and the gut is affected too.
“What happens is that ongoing low-level stress and anxiety suppress the gastrocolic reflex (an unconscious action by the gastrointestinal tract that precedes a bowel movement) and also slow down (sometimes even stop) the digestive juices which are needed for the breakdown of food. Secondly, a very high stress situation sometimes causes diarrhoea that, in turn, disrupts bowel movements and leads to constipation," says Deepak Lahoti, head of department and senior consultant, medical and interventional gastroenterology, Max Super Speciality Hospital, Patparganj, New Delhi.
Trying to tackle stress with alcohol abuse or anti-depressants could lead to gut imbalance.
“Alcohol even dehydrates stools and suppresses intestinal peristalsis all at once, so it can contribute big time," adds Dr Lahoti.
To reduce stress, try meditation and yoga; relaxation techniques help too, says Dr Lahoti. “Acupressure and massaging the abdomen may help relax the muscles that support the intestines and get your bowels moving too."
Exercise
Often, lack of physical activity can contribute to constipation. “Exercise, even if the bare minimum, can help make your bowel movements more regular and help reduce stress. Even a 10- to 15-minute walk a couple of times a day helps. So does stretching or yoga," says Dr Bhanot.
Hidden problem
If increasing fibre and water in the diet doesn’t help, there could be a hidden problem. “It can indicate a poorly functioning thyroid gland or diabetes, or may even be a side effect of some medications like calcium and iron supplements and blood pressure medications. Sometimes, it could even be a symptom of underlying colon cancer," warns Dr Bhanot.
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