Tips To Help Prevent Or Reduce Constipation
Written by Meredy on 3 January 2018
Constipation is a common symptom in people with cancer and during cancer treatment. Constipation means that you are not opening your bowels as regularly as normal, and it can become difficult or painful for you to pass a bowel motion. Some chemotherapy drugs, anti-sickness medications and painkillers can cause constipation. Changes to your regular routine, normal dietary intake, increased levels of stress and possibly being less active than normal, can all play a part. It is a common misconception that if you are eating less than normal, and don't feel the need or the urge to open your bowels, that there is no need to intervene. On the contrary, severe constipation can lead to problems such as overflow diarrhoea, headaches, nausea and loss of appetite, and if left, more serious complications. If you haven't opened your bowels for more than 3 days it is important to speak to your Doctor or specialist nurse for advice. If you have cancer of the bowel, or you think that your bowel may be affected by your cancer treatment, talk with your healthcare professional before considering any radical changes to your diet. Increasing the fibre in your diet may not be appropriate, and could even make your symptoms worse.

First line steps…

If you have a good appetite and are able to enjoy a varied diet, a good place to start is to evaluate your diet and lifestyle.

1. Gradually increase your daily intake of fibre: on average, most people in the UK consume about 18g of fibre a day and ideally you should be aiming towards 30g a day. Fibre is only found in food that comes from plants, such as fruit and vegetables, nuts, seeds and grains and is usually categorised into two groups. Each type of fibre helps your body in different ways, so it’s important to include both in your diet.

Soluble fibre: foods rich in this kind of fibre include oats, barley, rye, fruits like banana and apples, beans and pulses e.g. kidney beans and chickpeas, flaxseed and root vegetables such as carrot and swede. Soluble fibre dissolves in water and forms a gel-like substance in the gut. This helps to keep your stools soft and makes them easier to pass.

Insoluble fibre: foods rich in this kind of fibre include whole grains, bran, green leafy vegetables and the skins of fruit and other vegetables. Insoluble fibre bulks up your stool and acts like nature’s broom, sweeping through your bowel to get waste out more quickly and keep things moving.  

2. Drink enough fluid: as a general rule of thumb, if you are less than 60 years old then you should be aiming to take 35mls of fluid per kilogram of your body weight. So for example, if you weigh 60 kg then your daily fluid requirement is approximately 2.1 litres per day. If you are over 60 years old, aim to take 30mls of fluid per your weight in kilograms. Great choices include water, herbal teas (drink hot or cold), vegetable juices, coconut water (containing no added sugar) and de-caffeinated drinks.

3. Regular exercise: helps to stimulate gut motility and get transit moving. If you sit, constipation gets worse. Swimming is a great exercise to help alleviate constipation. Try to be as active as you can each day. 
10 top tips to improve your bowel motility naturally….

1. Flaxseed: soak 2 tablespoons of flaxseed in a small glass of water for 8 hours/ overnight then drink the seeds with the slightly gelatinous liquid either first thing in the morning or last thing at night. The combination of the soluble and insoluble fibre helps to lubricate the intestines and encourages the intestinal muscles to work more efficiently.

2. Start the day with lemon in warm water: the bitterness of the lemon increases bile, a natural laxative, and stimulates peristalsis, which helps to promote a bowel movement.

3. Add chia seeds to your diet: either as a breakfast or snack or sprinkled on salads/porridge/muesli/yoghurt. Chia seeds absorb 9 times their volume in liquid and consequently draw water into the bowel to help motility.

4. Prune, fig & apricot compote: have 1 tablespoon in the morning and 1 in the late afternoon/early evening, either by itself or with a small amount of yoghurt. If you struggle with flatulence this is not the one to go for however, as the fruit fibre may increase your symptoms to start with.

RECIPE:

• 50g dried prunes
• 50g dried apricots
• 25g dried figs
• Juice of 1 lemon

Chop the fruit into rough pieces and place in a pan with water so that it’s not quite covered. Add the lemon juice.  Simmer gently with the lid on for 10 minutes until all the fruit is soft. You may need to add a little more water depending on the type of fruit used, as some absorbs more water than others.  Once cooled, blend to a purée. Eat 1 tbsp. a day in the morning, add to yoghurt or cereal as a snack or enjoy on it’s own.

5. Epsom salt baths: add 2 handfuls of Epsom salts to a bath. Soak for 20 minutes 2-3 times a week. The magnesium acts as an osmotic laxative aiding in the resolution of constipation as well as maintaining regularity. Make sure you consume plenty of water to aid this process. This will make you very relaxed, so ideally should be before bed. Note: If you are feeling less well, for safety it is best to bathe when somebody else is at home with you, or try an Epsom salt foot soak instead.

6. Boost magnesium rich foods: examples include spinach, Swiss chard, beet greens, turnip greens, broccoli, sesame, pumpkin and sunflower seeds, barley, quinoa, brown rice, oats, almonds and cashews. Magnesium is vital for good intestinal and abdominal muscle function.

7. Include bitter foods: incomplete digestion can cause bloating and slow intestinal motility. Bitters stimulate the production of digestive secretions, helping to ensure adequate breakdown of the foods you eat. Try having a small amount of one of the following at the start of a meal: rocket, watercress, lemon juice, fresh turmeric, chicory, endive, fenugreek, rhubarb, kale and spinach.

8. Herbal teas: containing dandelion, burdock root, fennel, nettle and cloves aid digestive function. Peppermint and liquorice tea can also be helpful. If you have high blood pressure limit yourself to 2 cups of liquorice tea per day, as liquorice can raise blood pressure in some people.

9. Try resting your feet on a low stool: while going to the toilet, so that your knees are above your hips; this can make passing stools easier.

10. Stress management: your gut and brain are intrinsically linked and if you are stressed or anxious, this will have a negative effect on your digestive system. Taking a walk outside, deep breathing techniques, meditation, exercise and massage therapy are all good ways to de-stress.

Are there any nutritional supplements that will help to alleviate constipation? Yes – there are. Some basic examples include psyllium husk, slippery elm and inulin, but there are many more that can be considered depending on your particular situation. For your safety and for supplements to be as effective as possible, recommendations should be given following an in depth assessment of your individual circumstances by a qualified practitioner.

Meredy Birdi

BSc (Hons) Dietetics, NT Dip, mBDA, mBANT, mNNA, HCPC Registered, CNHC Registered
Meredy is a Registered Dietitian, Nutritional Therapist and Health Coach with more than 18 years experience supporting the nutritional and emotional needs of people with cancer. 
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