Constipation is a common health concern for many women, impacting various aspects of well-being, including mood, energy, skin, and sleep. It is frequently attributed solely to insufficient water or fiber intake, but according to clinical naturopath Emily Carlstrom, achieving regularity involves more comprehensive factors.
Defining Constipation and Normal Bowel Habits
Carlstrom clarifies that constipation extends beyond infrequent bowel movements, encompassing symptoms like hard, uncomfortable stools or a feeling of incomplete evacuation. Many women mistakenly perceive these symptoms as normal.
Research indicates that normal bowel habits can range from three times daily to three times weekly. However, Carlstrom states that most women report feeling optimal with at least one easy, complete bowel movement per day.
Indicators of potential constipation issues include straining, hard stools, incomplete evacuation, infrequent movements, or a reliance on substances like coffee or laxatives to facilitate bowel movements.
Overlooked Causes of Constipation
While hydration and fiber are relevant, Carlstrom emphasizes other significant factors often overlooked:
- Stress: Chronic stress can trigger a "fight or flight" response, reducing blood flow to the gut and slowing digestion.
- Gut Microbiome Imbalances: Disruptions in gut bacteria can affect bowel function.
- Hormonal Fluctuations: Changes throughout a woman's life cycle can impact regularity.
- Gut Motility Issues: The digestive system may not be moving efficiently.
Additional contributors include inadequate calorie intake, skipped meals, insufficient healthy fats, and consistently ignoring the urge to defecate, which can retrain the bowel. Travel can also induce constipation due to altered routines, sleep patterns, stress, dietary changes, and reduced hydration, often exacerbated by the stress of organizing trips and reluctance to use unfamiliar bathrooms.
Hormonal Influences on Bowel Habits
Hormonal changes at different life stages significantly affect gut regularity:
Pregnancy
Elevated progesterone levels relax smooth muscles, including those in the bowel, slowing digestion. Iron supplements, frequently prescribed during pregnancy, are also a common cause of constipation, with some forms being harsher on the gut than others.
Perimenopause and Menopause
Fluctuating hormone levels during perimenopause can lead to unpredictable bowel habits. After menopause, reduced estrogen levels can slow digestion, even in individuals previously experiencing regular bowel movements.
These changes are common, but they are not necessarily conditions women must endure without intervention.
The Role of Probiotics and Fibre
Probiotics
Probiotics can support regular bowel movements, but their effectiveness is strain-specific. Carlstrom highlights Lactobacillus plantarum 299v (a strain used in SolBiome Multi+ Probiotic) for its clinical research demonstrating efficacy in reducing IBS symptoms, including constipation, within four weeks for many participants. Probiotics can enhance gut motility, improve stool consistency, and mitigate low-grade inflammation. Consultation with a healthcare practitioner (GP, dietitian, or naturopath) is recommended for selecting the appropriate strain and therapeutic dose. Benefits may be observed within four to twelve weeks, with a recommended minimum of three months of daily use for full effects.
Fibre
While essential for gut health, excessive fiber intake can sometimes worsen bloating and constipation, particularly in individuals with gut motility issues or microbiome imbalances. Effective fiber function relies on adequate water, movement, and the presence of specific gut bacteria. Gradual fiber increase, focusing on diverse plant-based sources, is advised to promote a healthier and more diverse gut microbiome.
Daily Habits for Regularity
Simple lifestyle adjustments can significantly influence bowel regularity:
- Routine: Eating meals at consistent times helps regulate digestion.
- Nervous System Regulation: Practicing calming techniques, such as three deep belly breaths before meals, can shift the body from a "fight or flight" state, supporting digestion.
- Movement: Regular physical activity is beneficial.
- Intermittent Fasting: Avoiding constant snacking allows the migrating motor complex, a "housekeeper" for the gut that moves undigested food and bacteria through the digestive tract, to operate effectively during fasting periods. Allowing a three-hour gap between meals can support this natural cleansing process.
Foods That May Provide Quick Relief
For food-first options to manage constipation, the following are suggested:
- Kiwi Fruit: Consuming two kiwi fruits daily, preferably at night and with the skin if possible, has been shown to improve constipation and may aid sleep.
- Ground Flaxseeds: Two tablespoons daily can add bulk to stool and stimulate bowel movements, also serving as a plant-based source of omega-3s.
- Chia Seeds: These must be soaked (e.g., in water or as a pudding) before consumption, as raw chia seeds can absorb water from the bowel and potentially worsen constipation.
Combining these with adequate fluid intake, daily movement, and consistency can lead to improvements within days to weeks.
When to Seek Medical Advice
While common, certain constipation symptoms warrant medical evaluation by a GP. These include:
- New, sudden, or worsening constipation
- A family history of bowel cancer
- Accompanying symptoms such as blood in the stool
- Ongoing severe abdominal pain
- Vomiting
- Fever
- Unexplained weight loss
- Anemia
- Persistent fatigue
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