What is constipation?

There is honestly nothing more satisfying than a good poop. On the flip side, a bad poop can ruin your day. Too hard, too soft, too sudden, not soon enough? If this isn’t ringing any bells, congratulations on being a perfect pooper! Otherwise, it is something for you to work on.

Constipation, a symptom rather than a disease is generally defined as when bowel movements occur less than three times a week and are difficult to pass. Almost everyone experiences constipation at some point in their life. The good news is, we have science on our side to smooth it out. There are a bunch of to-dos to smooth out the kinks in our digestive system and some of them are very literal.

What are the symptoms of constipation?

Constipation is a condition in which you may have

  • fewer than three bowel movements a week
  • stools that are hard, dry, or lumpy
  • stools that are difficult or painful to pass
  • a feeling that not all stool has passed

However, people can have different bowel movement patterns, and only you know what’s normal for you.

Normal bowel habits vary from person to person. While some adults normally go to the toilet once or twice a day, others may go on alternate days or once every three to four days. Sometimes, your poop is rock-hard one week and soupy the next. And what that might tell you about your gut health? And only…

If bowel movements could talk

You can use the Bristol Stool Chart to check what your stools are telling you. The Bristol Stool Chart shows seven categories of stool. Different bowel habits aside, the important thing is that your stools are soft and easy to pass – like types 3 and 4 below.

Type 1-2 indicate constipation,

Type 3-4 are ideal stools as they are easier to pass, and

Type 5-7 may indicate diarrhoea and urgency.

What causes constipation?

Constipation commonly occurs when waste or stool moves too slowly through the digestive tract or cannot be eliminated effectively from the rectum, which may cause the stool to become hard and dry. Common causes of constipation are:

  • Poor intake of fibre in the diet – such as fruits, vegetables and cereals
  • Lack of physical activity and sedentary lifestyle
  • Low fluid intake
  • Hormonal imbalance in pregnancy, hyperthyroidism, and hypothyroidism
  • Often ignoring the urge to defecate
  • Specific diseases or conditions, such as stroke (most common)
  • Problems with the colon and rectum
  • Stress, anxiety, or depression

8 ways for constipation relief

So, what to do when your bowel is acting too cool for stool? Skip the worry time. This 8-step blueprint is all you need to leverage your pooping business.

1. Water

Water is the lifeline that all people, constipated or not, desperately need to keep bodily processes going. When a person is dehydrated, the intestines are forced to extract water from stool in the colon to maintain its function. This results in hard and dry stools, indicating constipation. Well, how much water should do the trick? Try multiplying 30-40ml to your body weight to know the amount you need to drink every day.

2. Fibre

Fibre is helpful no matter which scale your stools are on. Some fibres can be classified as prebiotics that are known to nourish good bacteria in the gut. Generally, there are two main categories of fibre: soluble and insoluble fibres.

Soluble fibres – Absorb water and form a gel-like paste, which softens the stools and improves its consistency. Often present in oat bran, barley, beans, nuts, lentils and peas, as well as some fruits and vegetables.

Insoluble fibres – Add bulk to stools to help them pass quickly and easily through the digestive tract. They are usually present in leafy greens, wheat bran, and whole grains.

3. Probiotics

Probiotics are live, beneficial bacteria that naturally occur in the gut. These ‘good bacteria’, like Bifidobacterium and Lactobacillus , are essential to strengthen our intestinal function and play a substantial role in boosting immunity as 80% of our immunity lies in the gut. Incorporating more probiotic foods like tempeh, miso, kimchi, yogurt, kombucha and cultured milk drink such as Yakult, help to improve our gut microflora balance, stimulate better digestion and reduce constipation.

While the properties of probiotic are strain-specific, get to know the strain that you are consuming. Lacticaseibacillus paracasei Shirota strain is Yakult’s exclusive probiotic strain that works mainly in the digestive system. Here’s an idea how it stimulates better digestion. L. paracasei Shirota strain increases short-chain fatty acid production, reduces the pH of the colon and increases bile salt metabolism, all of which help promote the motility of the colon to relieve constipation .

4. Caffeine

Put it this way – caffeine is your classic double edge sword. Caffeine does influence your digestive system in multiple ways. A diuretic that urges urination, that makes you dehydrated in an instant which can lead to constipation. At the same time, it is a stimulant that could excite the bowel to pass stools.

For caffeine consumers, you can compensate for its diuretic effects with good hydration. This way, caffeine will serve as a digestive aid and stimulant, without causing constipation.

5. Squat on the job

Proper potty posture is great a help for those who strain when defecating or suffer from constipation. As traditional squat toilets are gradually being replaced with the sitting ones in our modern homes, make these adjustments to help emptying your bowels easier:

i. Sit with knees above hips and legs wide apart – you can invest in a squatty potty or just use a stool or even the waste basket to rest your feet on to raise the hips.

ii. Lean forward and place elbows on thighs, keep a straight line from your head to your tailbone avoiding any slumping or rounding of the back.

iii. Gently bulge your abdominals while widening your waist.

iv. Never strain or hold your breath! You can grunt, groan or even sing to help further relax your pelvic floor muscles.

6. Exercise to ease constipation

Hard, dry stools are harder to pass. Regular exercise reduces constipation occurrence by helping food to move through the large intestines quicker as it limits the amount of water your body absorbs from the stool. Sports especially aerobic exercises (ex: swimming, jogging, cycling, running, football, etc.) help to stimulate the natural squeezing of muscles in your intestines.

7. Don’t hold it in!

Sometimes, you get the urge ‘to-go’ at an inconvenient place and time. Ignoring these signals would not do much serious harm but do refrain from making it a habit. The longer your stool is held in the rectum, the more water shall be absorbed from it. The stool turns rock-hard which is now difficult and perhaps, quite painful to pass – a classic case of constipation.

Learn to predict your usual ‘to-go’ time (ex: after a meal or drinking coffee for some) to schedule your visit to the toilet without delaying it too long.

8. Medication

Medication like laxatives works by quickening bowel movement or to soften stool. Although they can be purchased over the counter at most pharmacies but use it wisely as frequent or long-term laxative could potentially decrease your colon’s muscle response. Consult your doctor to find out what is right for you.

Immediately consult your doctor if:

  • You are unintentionally losing weight
  • You have blood in the stool
  • You have severe pain during bowel movement
  • You have constipation symptoms that lasts longer than three weeks

The risk is higher in elderly people

Check on your elders at home. More often than we realise, the seniors might not be pooping very well. Due to their age, their rectal receptors are not ideally sensitive anymore, paired with weaker intestinal muscle action which makes it difficult to pass stools. Other times, there are side effects from medication use or chronic diseases.

Generally, the management of constipation in older adults does not differ much from the rest of us. Apart from 8 ways for constipation relief , scheduling toilet trips can be a valuable routine for most elderly people. Thanks to the gastrocolic reflex, our bowels are most active soon after waking up and after meals. These are optimal times to ‘have a go’ at the toilet. Depending on their range of mobility, older adults can also benefit from physical activities from walks, gardening, chores and on-chair exercises; or if one is bedridden, regular repositioning is better than none.

The risk is higher in elderly people

Check on your elders at home. More often than we realise, the seniors might not be pooping very well. Due to their age, their rectal receptors are not ideally sensitive anymore, paired with weaker intestinal muscle action which makes it difficult to pass stools. Other times, there are side effects from medication use or chronic diseases.

Generally, the management of constipation in older adults does not differ much from the rest of us. Apart from 8 ways for constipation relief , scheduling toilet trips can be a valuable routine for most elderly people. Thanks to the gastrocolic reflex, our bowels are most active soon after waking up and after meals. These are optimal times to ‘have a go’ at the toilet. Depending on their range of mobility, older adults can also benefit from physical activities from walks, gardening, chores and on-chair exercises; or if one is bedridden, regular repositioning is better than none.

Constipation remedies for children

If your child displayed hints of straining, pain and infrequent bowel movements, it is possible to rule out an episode of constipation. A change of diet or infant formula might shift the child’s stool consistency. Young children are typically nervous when starting their toilet training. For a few complex reasons, children under stress choose to hold their urge to defecate – which hardens the stool and makes constipation worse. One of the reasons could be fear of a painful poo time in previous bouts of constipation, or simply due to unfamiliarity with the toilet.

Flush away your worries, these tips might be practical to relief constipation in children.

  • Eat well
    For children that has begun weaning, caregivers are encouraged to fortify their meals with a variety of fibres and adequate fluid. Prune juice is known to have laxative and diuretic properties due to its high sorbitol content.
  • Probiotic action
    This is a good time to introduce your child to probiotics to combat constipation . Gradually serve 1 teaspoon of Yakult (diluted with water) up to 1 bottle per day if well tolerated.
  • It’s play time!
    Here’s the fun part – create more play time (ex: kicking a ball, riding a bicycle, playground time) to keep them physically active to get their bowels moving.
  • Massage it down
    Alternatively, a gentle massage on the child’s abdomen can be helpful to relax muscles of the bladder and intestines to give the extra ‘push’.
  • Toilet training
    Are they ready for the ‘big job’? Create a potty routine and celebrate little achievements along the way. After meal is a good poo time. Having a potty, or a small toilet seat that fits securely inside the home toilet seat with a step stool are equally important to allow a comfortable yet independent experience – so that they don’t hold it in.

Stuck on a dead-end? Speak to a paediatrician to know what’s best for your child. A range of stool softeners, fibre supplements or laxatives may be prescribed according to the severity of constipation.

Conclusion

Pooping is something we should all be doing. Constipation may be a temporary situation, a long-term problem or a sign of a more serious condition. When you start making simple, proactive changes to your diet and lifestyle now, it improves your overall health, well-being and happiness on a whole. See your doctor, especially if you’ve noticed a change in your bowel pattern. Do not wait until it is too late!

References:

  1. Constipation. NHS UK. (2023). https://www.nhs.uk/conditions/constipation

  2. Constipation. The Royal Children’s Hospital Melbourne. (2020). https://www.rch.org.au/kidsinfo/fact_sheets/Constipation

  3. Norman, A. (2023). Everything you need to know about the Bristol Stool Chart. Verywell Health. https://www.verywellhealth.com/bristol-stool-chart-4174964

  4. Cronkleton, E. (2023). Massage Techniques for Constipation Relief. Healthline. https://www.healthline.com/health/massage-for-constipation-relief

  5. Ee, C. (2024). Constipation in Seniors. Homage Malaysia. https://www.homage.com.my/health/constipation-in-seniors

  6. Mounsey, A., Raleigh, M., & Wilson, A. (2015). Management of constipation in older adults. American Family Physician, 92(6), 500-504.