So why do people get constipated? Is it all due to the diet; not enough fruit, vegetables or cereal fibre? Do they have a disease affecting the motility of the colon? Are they not taking enough exercise? Is it bad habits – not enough time to go in the morning and long commutes into the city? Or is it like so many unexplained illnesses, an expression of what has happened and the way the body reacts to the situations people find themselves in. Like other illnesses, many factors may contribute to constipation.
Isn’t is strange how many of us only get the urge to defaecate in the morning when we wake up or after breakfast? And even if we cross time zones and go to America for example, our bowel habit remains fixed at Greenwich Mean Time for several days before we adapt to Eastern Standard Time in New York. Even if our sleep and our meals have altered, the clock in our bowels, it seems, is the last thing to change. This might suggest breaking our daily routines by staying up late, sleeping in, or flexible shift work may not could allow this clock to settle and leave us not wanting to go when we should go and wanting to go when we can’t. Professor David Wingate, a friend and colleague, who consulted in London, once asserted to me that the people in his clinic were constipated because they left home and commuted into town on crowded trains before they had emptied their bowels and consequently repressed the urge. But if your bowel misses its train, it could be left waiting all day and the next too. Defaecation is habit forming.
Constipation is the thief of time. You need to be relaxed and patient in order to be able to go. The etymological root for laxative, laxus meaning loose, is the same as that for relaxation. Doctors often talk about having a relaxed bowel action. Relaxation favours the activity of the parasympathetic nervous system which stimulates colonic propulsion. If you are tense and in a hurry, the sympathetic nervous system arrests peristalsis and tightens up the anal sphincter. Physiological investigations of colonic function in people with constipation show a combination of colonic inertia, sigmoid spasm and paradoxical sphincter contraction.
We (and our bowels) are so much more relaxed if we are at home in familiar surroundings. Going away, staying with friends, staying in hotels, having to use public toilets can play havoc with a shy, sensitive bowel. Bowel habit is such a private function that even couples who have lived together for years may not know the details of each other’s toilet habits. Women are said to be more shy and secretive about their bowels than men. I could not possibly comment.
The medical term for a tight, resistant anal sphincter the latter is anismus, which has more (or less) than a passing connotation with vaginismus. Both may occur together and suggest a psychological prohibition. No entry and no exit! But might there be a further connection? Professor Douglas Drossman, who had led the Rome initiative for categorisation of functional gastrointestinal diseases for 25 years, first published results showing an association between sexual abuse and constipation in the nineteen eighties. There are, however, many other reasons for the greater prevalence of constipation in young women than young men. These include dieting (anorexia nervosa is associated with constipation and much more common in young women) and also hormones. The rise in oestrogen and progesterone toward the end of the menstrual cycle and during pregnancy inhibit colonic propulsion and may cause constipation.
Symptoms do not always indicate pathology; more often than not, they express meaning. Although constipation can be a symptom of many different diseases and a side effect of effect of many different drugs, the vast majority of cases have no obvious cause or pathology. Like weeping, flushing of the face or the genital stirrings of desire, the bowels are so often the means by which emotions are expressed. It’s in the language; up tight, scared shitless are both colloquial terms for constipation. The mind and the bowel work in metaphor and meaning.
Depression is linked with constipation and has connotations of inertia, being stuck in one’s life. Entrapment features prominently in the narratives of women who are constipated. Some may be stuck in an unhappy marriage, trapped by obligations to their children and fearing the risk of poverty and loneliness if they dare to escape. One of my patients, who had been constipated for years, recovered when she divorced her husband. Another, compelled by a bullying supervisor to work for long hours at a job she found boring, found her voice and lost her constipation when she dared to ‘express’ her anger. Despite greater equality of opportunity for women, so many still live lives of obligation and entrapment.
So what can you do to encourage a normal bowel action? Well you can take laxatives every day and try to power through, though your bowel may quickly become resistant to laxatives. You can eat a healthy diet with plenty of fruit, vegetables and fibre, but this could cause more pain and bloating if you have IBS and a sensitive gut. There is another way, but it requires change and takes time. Find enough space in your life to relax and establish healthy routines. Take frequent breaks during your working day, eat regular meals, and most important, establish a regular sleep pattern. Try to live a balanced life. Sitting tensed up at work over a computer for hours on end is likely to make anybody constipated. Get up, go for a walk, get moving. If you move, then your bowels are more likely to move as well.
Morning is a crucial time for your bowels. It’s when the colon pushes things on. If you put it off and don’t give it the time it needs, you could be uncomfortable for the rest of the day and still not be able to go.
Forgive me for a personal observation, but it may help to ‘pass it on’. I am rarely constipated, but for several years now, I have adopted a morning routine that works for my bowels and for me. I wake early and write for two hours: perhaps a diary entry, a poem or a blogpost like this. This is my most creative time and I guard it carefully, encouraging the muse with a pot of black tea with lemon. Then I go for a run and a swim in the river whatever the season and the weather. A satisfactory bowel action is one of the joys of this regimen. It’s all part of mindful meditation. Job done! Yes it takes time, but we all need to find enough time to relax and be mindful in order to work effectively and be content in ourselves. Cold water immersion has a curiously rapid quick effect on my bowels and the regular cold induced thermogenesis keeps the weight off as well.
I am not suggesting that you should try this; if you did, health and safety would soon put a stop on it. The point I am making is that in such a hectic, worrying and demanding world, we must all find our own way to find the space and routine to keep our physiology regular. I am lucky. Now in my seventies, I don’t have to work. I have time to balance my life. Younger people have so many obligations to work and family that have to be factored in, but that shouldn’t mean that you can’t create enough space in the morning for ‘you’ to ‘meditate’ in a small room. Sit upright, hands on hips, relax and breathe, short inspiration, long expiration. This stimulates the parasympathetic nervous system. If you get it all right, it can set you up for the rest of the day.