Constipation is a widespread problem today. It has a number of causes and afflicts all age groups, from children to adults and pregnant women, while its incidence is somewhat higher in the elderly.
We often fail to take constipation seriously and to approach it with due attention. The fact is that in most cases constipation is caused by a poor diet with an inadequate intake of dietary fibre. On the other hand, it can also be caused by some medications, medical conditions, as well as various anatomical and physiological changes in the body. Constipation can become much more serious if left untreated. Since it can substantially reduce the quality of life, it should be treated without delay and in an appropriate manner.
The prevention, diagnosis, and treatment of constipation present a considerable challenge to patients and doctors. Treatment is primarily directed at softening the stool, stimulating bowel movements, as well as addressing relevant psychosocial factors.
While there are many accepted guidelines for managing constipation, there are also many unfounded claims. The results of studies are sometimes misinterpreted, which can lead to the worsening of symptoms and complications, as well as to additional apprehension on the part of patients and their carers.
Before we adopt any changes and drastic measures for stimulating digestion and alleviating constipation, it is wise to review the common constipation myths that remain unproven to this day.
1. Bowel movements should happen every day
Every body is different. Some people feel the need to have a bowel movement three times a day, and some feel it three times a week, which is no less normal. But while the digestive rhythm varies from person to person, difficult and infrequent bowel movements less than once a day, accompanied by a feeling of incomplete evacuation and bloating, generally constitute what is called slow digestion. And if the need for a bowel movement is felt less than three times a week, the problem is likely constipation.
2. Constipation results in self-poisoning
Some people believe that the body can absorb harmful substances from the stool while constipated, which results in self-poisoning and even death. This belief has been thoroughly refuted by science. There was never any evidence of such “potential” outcomes of constipation, and this belief can only lead to unneeded concerns and misguided approaches to the actual problem. There is no doubt that regular digestion is beneficial for the whole body and that taking care of digestive health can prevent many issues; however, the onset of some illnesses can also be influenced by other factors and is outside our control.
3. Increasing fibre intake is all that it takes
When it comes to digestion and regular bowel movements, fibre (soluble and insoluble) is often hailed as a “superfood”. However, not all fibre is alike. Studies on the effects of consuming dietary fibre have confirmed that insoluble fibre is more effective in alleviating constipation. All the same, insoluble fibre can boost the production of intestinal gas and exacerbate the condition.
Since most people fail to meet daily fibre needs in their diet, it is wise to consume more vegetables, fruit, wholegrain cereals, and other plant foods, along with more fluid. But when the intake of fibre is adequate, that is, in accordance with recommendations, its increase has no therapeutic value. Current guidelines state that we should aim to meet the recommended daily fibre intake for different age groups.
If we wish to increase the daily fibre intake, we should take care to do so gradually, otherwise the symptoms might worsen.
4. Increasing fluid intake improves digestive function
There is a widespread assumption that an increased fluid intake will improve stool consistency, thereby making bowel movements easier. Yet scientists believe that an increased fluid intake has little, or even no, effect on stool consistency. As in the case of fibre, it is important to consume enough fluid and/or foods with a high water content, such as fruit and vegetables. According to current guidelines, it is enough to maintain the recommended fluid intake for different age groups and avoid dehydration. An increased fluid intake has a therapeutic effect only for those people who meet the clinical definition of dehydration.
5. Probiotics can eliminate constipation
Probiotics are beneficial bacteria that inhabit the digestive tract. The balance of intestinal microbiota is vital for our health, but can be broken by many factors (antibiotic treatment, stress, poor diet, chronic medical conditions). Ideally, our diet should be rich in probiotics and our microbiota regularly replenished. However, since there is no conclusive evidence that probiotics eliminate constipation, their routine use in its treatment is not warranted. Although it has been shown that probiotics can prevent and cure diarrhea, there is too little evidence when it comes to constipation. An exception is the recommended use of probiotics in the elderly who are more prone to constipation. Although there is no direct link between the consumption of probiotics and constipation relief, they are nonetheless recommended for the elderly, who experience a decline in beneficial bifidobacteria due to the physiological changes caused by aging.
Since constipation can substantially reduce the quality of life, it is very important to demystify this problem. We should educate patients and point them in the right direction, help them overcome fears, and offer them clear and sensible suggestions for alleviating this problem. Education and guidance are keys to successful treatment.