Dear Doctor, I think I might be a bit bunged up!

Constipation is such a common problem, one that I hear about all the time. I think the biggest issue lies in the fact that British people really can’t talk about Poo! Do we know what’s normal? Is normal the same for everyone? And what should we be doing to keep our bowels moving and healthy?

Let’s face it being constipated can make you feel a bit s**t. Puns aside … and I do have plenty…. let me do the talking about our number twos and get it out in the open. We all need to know what normal bowel habits are and how to achieve them!

The aim of this game is to get passing soft (not runny) poo once a day without having to strain. It’s not for everyone, some people can go every other day and some people can go twice a day too. The key is it should be regular, it shouldn’t be painful or difficult to go and the poo itself shouldn’t be too hard or too runny.

I can feel you wincing at all of this already but hey it’s a natural process and it’s good to get it right!

Let’s just remind ourselves of how we know to go to the toilet, because once we understand that then the steps to getting better bowels will make more sense.

In a really simple, all you probably need to know version…The bowels are stretchy pipes. When poo makes its way to the end of the pipe, near our bottom, the stretching of the pipe tells our brains we want to go and off we go to the toilet. Once we empty the pipe, the walls collapse down and the messages to the brain stop.

Problems start when the bowel walls stop sending the correct messages to the brain. That can be for several reasons, some medications can cause it and some medical problems, but most commonly and most simply I think of it as over stretching. 

So, if you don’t have the right diet and a regular habit then the bowel walls get used to staying full. The walls start to think that this is normal, so it takes even more stretching of the walls to get a message sent to the brain. It becomes a bit of a vicious cycle. You would be surprised at just how stretchy these walls can be!

So what can you do if you’re not quite ‘normal’ in the bowels department? 
Well, diet and fluids are obvious ones but so easily avoided by us all. 

Fibre is good at bulking up your motions, giving your bowel walls that bit of a stretch, to let them know food’s on its way through. Processed foods tend not to bulk up the poo as much and so can sit around for longer, causing constipation in the long run.

Fluids are important too, we tend to think that water is just for our urine and kidneys but no its good for both number one and two. So plenty of water please!

Something that is good as an add in is Ispaghula or Psyllium husk. You can buy this from most food stores. It’s known as a ‘bulk forming laxative’ and it’s one of the first steps for prescription treatment of constipation. It works by bulking up the poo and therefore helping push it through the system. 

It’s tasteless and can be added to pretty much anything, such as water, smoothies, porridge or whatever you like. It won’t give you the runs and tends to take about 2-3 days to work. 

I know people who swear by a spoonful a day and so I thought it was definitely worth a mention. If you do try it, it’s important to be drinking plenty and not to take it before bed.

There’s lots of laxatives available over the counter like lactulose or senna. Go see your GP if you are really constipated because we have lots of options available too. 

If you are very constipated, it is good to speak to your doctor because sometimes adding certain laxatives on top of severe constipation can do more harm than good.

If your bowel habits have changed suddenly for no obvious reason, if there is blood in your poo or if you are losing weight, see your doctor for advice.

Lastly, remember the aim of the game is to go once a day and for it to be soft and painless. 

If it takes some work to get there then put that work in, because once you get regular for about four weeks… them bowel walls will start working properly again and keep you going nice and normally.

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