What truly defines the diagnosis of constipation?

A patient recently brought to me an article entitled, “What is truly regular for bowel movements?”  I find this interesting because in our field of work, we often encounter misconceptions around what constitutes true constipation. Patients come in thinking they’re constipated but when we delve deeper, the real issue is bloating, or feeling like they didn’t completely empty, rather than constipation.

Here at 5 Point PT, we treat many patients with primary diagnoses or symptoms of constipation. Here’s a rundown on the basics, as well as the different types of fiber.

The true definition of constipation according to the Rome III Criteria must include two or more of the following symptoms:

  • Straining during at least 25% of defecations
  • Lumpy or hard stools in at least 25% of defecations
  • Sensation of incomplete evacuation for at least 25% of defecations
  • Sensation of anorectal obstruction/blockage for at least 25% of defecations
  • Fewer than three defecations per week

According to my research, constipation is the most common digestive complaint in the US!

What are some of the basic causes of constipation?

  • Poor fiber intake
  • Medications
  • Metabolic/endocrine disorders
  • Neuropathic disorders

Hence, constipation can be caused by medical conditions.  It can also be caused by side effects from certain medications and simply what we are eating and not eating.

Now lets talk about fiber.

The recommended daily dose of fiber is 38 grams for men and 25 for women; the numbers go down slightly when you pass the 50 year mark. However, the population’s average intake of fiber is just 15 grams per day! Most of us do not drink enough water either, which is a major contributor to constipation.

There are TWO types of fiber: soluble and insoluble.

Insoluble fiber stays in your body for a short amount of time, and adds bulk to stool so it makes it easier to pass. Good sources of insoluble fiber include whole grains, skins of fruit and vegetables, cabbage, lettuce, onions and peppers.

Soluble fiber attracts water and slows down digestion. It maintains healthy blood sugar and cholesterol levels.  Soluble fibers also aid in keeping your body’s feeling of fullness.

Good sources of soluble fiber are psyllium (fiber supplement), oat bran, barley, nuts, seeds, beans, lentils, peas and some fruits and vegetables.

How does constipation relate to the pelvic floor?

An individual that has chronic constipation may strain repeatedly over time in attempt to have a successful bowel movement.  The additional pressure put on the abdomen from straining can contribute to weakening and damaging the pelvic floor muscles.

Things that can aggravate your digestive system:

  • Large meals – eating a lot at once may put extra pressure on digestive tract (it is helpful to eat 5 small meals throughout the day)
  • Carbonated beverages – bubbly drinks contain gas which can lead to bloating
  • Caffeinated drinks – caffeine can stimulate the intestines which can potentially make stool inconsistent
  • Skipping exercise – research shows that exercising 3-5x per week IBS symptoms can lessen dramatically

Easy Tips for Bad Habits:

  • Put your feet on a stool while you’re sitting on the toilet to elevate knees (or invest in a squatty potty!)
  • Avoid holding your breath when bearing down to have a bowel movement
  • Try not to hang out on the toilet too long!

How can you increase your fiber intake?

  • Increase slowly over days or weeks so your digestive system has time to adjust
  • Select whole fresh or frozen fruits over juices
  • Educate yourself on types of fiber and have a good mix of soluble and insoluble
  • Substitute brown rice for white rice
  • Try a new whole grain like quinoa or bulgur wheat