All bunged up and nowhere to go - 2009

Micki Rose gives her top tips to get you going if you suffer from chronic constipation.

My name is Michaela Rose and I’m obsessed with bowels. There, I’ve said it. Better out than in. I’ve often been caught by my other half reading Better Bowel Management in bed hidden behind the pages of Woman & Home. Not very romantic, I’ll admit, but it is so fascinating!

Seriously, it doesn’t matter what someone comes in to see me about, as a naturopathically-trained nutritionist, I will always look to the bowel first. Health really does start with the bowel and, as anyone who has ever suffered from chronic constipation knows, it is no joke.

It is important if you suffer from bowel problems, especially if you see black stools or blood, to get yourself checked out by your GP. Not doing so is daft. They won’t be fazed, so there’s no need to feel embarrassed. For the purposes of this article, I’m going to assume you’ve checked that constipation isn’t a side
effect of any drugs you’re on, that nothing untoward has been found and there’s no evidence of colitis, Crohn’s, inflammatory disease, coeliac disease, MS, Parkinson’s or cancer. So I am talking here about idiopathic constipation; in other words, no-one knows what’s causing it.

What exactly is constipation?

It might seem obvious, but it isn’t as straightforward as it seems. I long ago stopped asking the question: ‘How are your bowel movements?’ because all I ever got back was ‘fine’. People often think they are having
‘normal’ bowel movements, but it turns out that what may be normal for them is certainly not what I would call healthy.

Experts disagree, but, to a naturopath, you are constipated, or certainly too sluggish, unless you’re going once or preferably twice a day. If you think about it, we are simply a long tube with a mouth at one end and a bum at the other. If you put food into one end three or four times a day, it should come out the other end very regularly too, albeit not as much of it, so twice a day is about right for most people if they are digesting well. Consider a baby – what goes in one end certainly does come out the other end with alarming regularity. So, to me anyway, it simply doesn’t seem right for someone only to be going every three or four days.

Perhaps you think you are just ‘made like that’ and there could be a genetic issue in your family. But I can count on one hand the number of people I’ve seen over the years who didn’t actually achieve daily bowel movements, so this is very rare. Maybe you just inherited the family lifestyle and diet.

You could have what’s termed a ‘lazy’ bowel where the peristaltic muscle movement is slow. This usually happens when there is a lack of fibre for the muscle to push against or a too-heavy bowel wall covered in faecal matter. You’d be tired if you had to deal with that!

Laxatives can make a bowel lazy, or there may be a more serious problem with nerve signals to bowel muscle not getting through, which is why issues such as MS need to be ruled out. It could be part of a more pervasive problem with connective tissues. Are your muscles weak everywhere? If so, you may need to get some help to improve collagen levels and the general health of your muscles.

Other symptoms of constipation might seem less obvious: headaches, a coated tongue, bad breath, tiredness, mental fogginess and even mild depression. These are mostly related to the build up of toxins in the bloodstream resulting from faecal matter hanging around too long in the gut. Constipation is draining, to say the least. The longer matter stays around, the more water and soluble toxins are absorbed back into the body and the worse you tend to feel. What you get out the other end then is dry, pellety, hard stools which are difficult for your peristaltic muscles to push through.

What’s ‘normal’?

As Brits, it’s still pretty taboo to air our bum issues, so most people I talk to are unaware of what a normal stool actually is. It should be formed, like a sausage, mid-brown and easy to pass. If it’s pellety, weedy, dark, mucusy or even mushy, then the likelihood is that you have some form of constipation. You could be going a couple of times a day, but if your stools are altered, you could still be constipated and be simply pushing more of the older stools out each time whilst fresh stuff is building up behind them.

Mushiness is not often considered to be constipation, but it can be. It may mean the body has had to liquefy some waste matter to get it through the tube, which may be blocked by faecal matter adhering to the walls and narrowing the route. This is bad because matter can then get trapped in nooks and crannies or diverticular pockets, start to putrefy and become infected, causing diverticulitis. Alternatively, the toxic gases build up, causing bloating and then foul-smelling wind. To a naturopath or nutritionist, it’s vital for short and long-term health to get this sorted out.

So, to re-cap, we’re looking for easy-to-pass, formed, sausage-like, mid-brown stools at least once every day. So how to achieve such coveted bowel movements? Here are my top tips, but, as always, please talk to your health professional or GP before trying them out.

Have A Clearout

To get a good foundation for the future, you need to get rid of the rubbish that’s already there. There are many ways of doing this and it is best to work with a professional to help you manage the toxins that will inevitably assail your liver in the process. A good bowel and liver cleanse normally takes about 6–12 weeks, but it’s time very well spent because, without this stage, you’re unlikely to solve the problem longer term.

I choose a colon-cleansing product with plants such as berberis, fennel, ginger and raspberry leaf combined with psyllium husks, garlic, slippery elm and bentonite clay, which is the mix used traditionally by naturopaths. Combine that with a liver support formula and some good probiotics.

Some people opt for colonic irrigation. This is a way of washing out the lower bowel and can help shift impacted material. However, it doesn’t always solve the reason for the constipation in the first place so I normally recommend it only in addition to the method I’ve outlined when the stuck matter needs a literal push with water.

Ditch the wheat and dairy

At least for a while. Many people have issues with these two foods. You may not be intolerant to them, but that doesn’t stop wheat bunging you up with all that gluten or dairy causing more mucus production in the gut. A dairy and wheat-free holiday is often just what the bowel doctor ordered. Combine this type of diet with the detox above and you have the prescription that normally sorts most bowel issues. After the detox period, try each food again carefully and see what happens to your gut over the next few days; you’ll soon see if they are implicated in your chronic bowel problems. I have to say, they usually are.

Improve Your Diet

Coming off wheat and dairy often forces people to think about eating in a different way. This is a good thing. Aim for more pulses like chickpeas and lentils, ground and whole seeds and nuts, steamed veg and a small amount of fruit. People will often go mad on fruit on a detox or if they need extra bowel help, but much fruit can cause cramping and feed undesirable yeasts or bacteria that are thriving in the putrefactive gut. A small amount of fruit juice in the morning, or hot water with liquid chlorophyll, can often help though, as can apples or, even better, a few dried figs.

Many people swear by linseeds. A tablespoon or more of whole linseeds per day sprinkled into your porridge, smoothie or soup will act like a kind of broom through the bowel and help to dislodge stuck waste matter. They absorb tons of water and provide fibre and bulk for the bowel to push against.

Short grain brown rice really helps too so try to eat it often, perhaps as rice pudding, rice salad or a handful added to soups. And don’t forget the all-important need for water in the gut. No water equals dry hard-to-pass stools.

Acid and enzymes

You can have the best diet ever, but what happens if you’re not actually digesting it? This is at the heart of many chronic constipation problems.

As we get past our 40s, or if we have been under acute stress, our stomach acid production can slow down substantially. This can be the case even if you get regular indigestion or heartburn as, even though it sounds weird, indigestion is often caused by too little stomach acid rather than too much. Test this out when you next have indigestion by taking extra acidity as a spoonful of lemon juice or cider vinegar. I apologise if it gets worse! In my experience, the extra acid makes no difference or the problem gets slightly better. This is the first clue that you could probably do with a top-up of stomach acid and digestive enzymes.

If you don’t suffer with indigestion or heartburn, an alternative is to try taking a teaspoon of bicarbonate of soda in some warm water on an empty stomach and see how much you burp; this is not a party-trick! You are effectively putting an alkaline substance into what should be an acidic stomach. The two should meet and fizz and you should get a huge burp or lots of little ones, so stand well back! If all you get is a tiny bit of wind, it suggests that you need more acid and enzyme support. Why is this so important? Better digested food means less waste in the colon, and therefore less likelihood of constipation.

You can get betaine capsules and enzyme products from any good healthfood shop. Discuss how many you may need per meal with your health professional. The rule of thumb is to stop or lower the dose if you start getting indigestion or a warm feeling under your rib cage, which should happen eventually as your body starts to increase its natural production. Always talk to your GP if in any doubt, and don’t do this if you have a confirmed hiatus hernia.

Check your thyroid

I wish I had a pound for every time I’ve been told a person’s thyroid is ‘fine’, but on basal temperature testing, it turns out to be sluggish. Even a slightly underactive thyroid doesn’t help constipation so it’s worth checking it out. Take a thermometer to bed with you and measure the temperature in your armpit for ten minutes the moment you wake. Don’t go anywhere first, talk or wriggle about; lie still. Do this for three consecutive days and, ladies, on days two, three and four of your period is best.

Add up the three measurements and divide by three to get your average temperature. Anything under 36.6 C or 97.8 F is considered low, so work with your health professional to check this out and correct it. This can make a huge difference as an underactive thyroid is a major causes of chronic constipation.

Move it

The bowel is part of your lymphatic, or waste management, system. The lymph system is a network of lymph channels a bit like the blood system with its arteries and veins. But, unlike blood and the heart, there is nothing to pump lymph around. This is where exercise can really help: the lymph channels get squeezed by muscle movement and the lymph is shunted along.

Any exercise will help, but rebounding is thought to be one of the best. Join your kids on the garden trampoline or invest in a rebounder, a kind of mini indoor version. Otherwise any exercise whether walking, weight training, yoga or even stretching out your arms or legs if you’re chair- or bed-bound will help keep it moving.

If you have a build-up of waste matter in the colon, you can often feel heavy, bloated and full of wind. More importantly, the colon can become very heavy, contributing to a bowel prolapse or at least pressure on the other abdominal organs as it takes up more space. Massage and using gravity with a slant-board can help shift the matter and re-strengthen the bowel muscles to hold it in place.

To massage the colon, use your hands or, even better, a tennis ball. Place the palm of your hand over the ball and press firmly but not so much that it hurts. Then simply roll the ball in little circles, moving from bottom right of your abdomen, up, across under the ribs and down to the bottom left in a square, following the natural direction of the colon. Pay particular attention to the corners of the square as this is where matter can lodge. It may be a little tender at first so go gently, but you should find daily massage like this will gradually help. Any acute pain or worries, always stop and check with your health professional.

The gravity, or slant-board method can help re-strengthen slack bowel muscles and encourage the colon to get back into position, thus relieving the other organs too. Get a strong piece of wood and place one end on the floor and the other on the end of the bed or a sofa, then lie on it so your bottom is higher than your chest. If you haven't got a board, use a stack of pillows or cushions, but a harder surface is better. Do this for 5–10 minutes very regularly. It is also brilliant for encouraging blood flow to the head area so has been used for sinus, ear and memory problems too – an added bonus. Don’t do this if you have high blood pressure.

Loo habits

First, never ignore the urge to go; you can set up a habit which is difficult to break. Always allow enough time to go. Sometimes you can retrain yourself to go if you sit on the loo at the same time each day, preferably about 20 minutes after a meal, even if you don’t have the urge. Relax and sit there, don’t strain. Eventually, you may find this becomes your natural time to go.

Sometimes, people are scared to go to the loo. I have met many patients who can’t go if someone else is around because they think they may be heard. This may perhaps be because of noise – although if you follow the tips here, your noisier days should be numbered. If you’re out and about, try putting the hand dryer on or running a tap or shower to drown the sound out. If at home, make sure the radio or TV is on.

If smell is your major worry, again these tips should stop the putrefactive waste matter building up so it should soon go. In the meantime, try lighting a match and holding it around the toilet bowl; it should absorb any smells. Or, carry a tiny spray-bottle of something nice around with you to mask it. Above all, don’t worry about it; it’s much more common than you would believe, there’s much less noise or smell than you think and the reality is that everyone has to go – even the Queen on her ‘throne’!

Some people worry about hygiene in loos that aren’t their own. Don’t let that stop you going. Always carry some tissue with you and simply wipe over the seat before you use it or sit on the tissue. Experts suggest if you wash your hands with simple soap and water, keeping the soap in contact with your skin for 30 seconds, all bacterial baddies should be killed effectively and you’ll be clean as a whistle, so there’s really nothing lasting to worry about. Use tissue or your sleeve to open doors as you go out to avoid touching anything after you’ve washed your hands if you’re worried.

Lastly, positioning. Frankly, modern loos mean your knees aren't high enough for efficient evacuation. Without getting too indelicate, we were designed to squat and many people find if they have a little stool or something to put their feet on, it can make a huge difference to the shape of the colon and make things a lot easier. Another technique to avoid straining the anal region is to have your hands above your head; something about the change of position means it’s less of a push, apparently.

Hopefully, you have found at least one tip here that will help solve your sluggishness. You may need to combine several of them, or find that one simple change like eating more apples, ditching the wheat or boosting your thyroid is all you need. Meantime, I’m off with my copy of ‘Woman & Home’ to put my feet up in the loo. Now there’s a useful excuse when you need one…. Good luck!

Micki Rose is to be found at The Pure Health Clinic

More general articles on digestive health

First Published in 2009

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