Dr Leila Masson's Blog

Constipation

Constipation

Everything we put into our mouth has to come out at the other end. It should usually take 24 hours to 30 hours for food to make it through; this is called “transit time”. You can test your transit time by eating 2 teaspoons of sesame seeds mixed in a cup of water or a cup of beetroot an hour away from other foods. Note the time you eat these foods and track when the sesame seeds or red colour appear in the toilet.

Constipation slows down your transit time – the poo takes a lot longer to get moved through the intestines and out the other end. More water gets absorbed during this slower process and the poo gets harder. These hard bowel motions can hurt and take a long time to pass. The gut is a muscle and just like your leg muscles it needs magnesium and antioxidants to contract and move the poo along. This movement is called peristalsis.

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So what are the causes of constipation? Here is a short list:**

1. Dehydration

2. Too little fibre in the diet

3. Dairy can have a morphine like effect

4. Lack of good gut flora

5. Slow peristalsis (muscle movement of the intestines that moves the poo along)

6. Not enough exercise

And here is what you can do:

1. Firstly, keep in mind that medications commonly prescribed for severe constipation may be needed in the short term, but none of them address the underlying causes of constipation, like a low fibre diet, lack of magnesium, and poor gut flora.
These include bulk-forming laxatives or fibre like Metamucil; stool softeners like Osmolax; stimulant medications like Dulcolax that stimulate gut peristalsis; suppositories (either plain glycerin or dulcolax); and microlax enemas. So use these medications as an emergency intervention but then step back and address the true causes of the problem.

2. Drink plenty of water. If your child does not like plain water, add lemon, berries or a few slices of cucumber or orange to give it some taste, or make the water fizzy. How much water does your child need to drink? That depends on the temperature outside, and how much they exercise and sweat. According to healthykids NSW they need at least 5 glasses (1 litre) for 5 to 8 year olds; 7 glasses (1.5 litres) for 9 to 12 year olds and 8 to 10 glasses (2 litres) for 13+ years. In hot summer weather they may need even more.

3. Fibre bulks up the bowel motion and makes it move faster through the intestines. Fibre is the part of plants we humans cannot digest – however it is needed to bulk up our stools and to feed our healthy gut bacteria. Only 7% of Australians and New Zealanders consume the 5+ servings of vegetables that are recommended – that is 5 hands full of veggies – smaller kids have smaller hands, so the servings are smaller for them, but everyone should be eating at least 5 times (in volume) what fits in their scooped palm. How do you get children to eat vegetables? You have to start early in the day, it is impossible to eat all 5 servings at dinner – no one’s stomach is big enough for that! Pack carrots, cucumber sticks and chopped up capsicum for morning tea - maybe along with a hummus dip; add lettuce and other sliced veggies to a sandwich; serve a platter of veggie sticks for afternoon tea. If children are very picky you can hide vegetables in pasta sauce, meat balls, and even in muffins. One of the best predictor of long-term health is how many vegetables you eat – that is not only because vegetables are packed with vitamins, minerals and fibre, but also because they feed our microbiome – the bacteria that live in our gut. Another helpful recommendation is to cut down on how much meat you eat. Meat does not contain any fibre, so it slows down the transit time of the poo. Replace some meat and seafood meals with plant based protein like legumes: chickpeas, lentils, and beans. Definitely do not have meat or fish more than once daily, and ideally have several meat free days a week. This will improve your child’s gut flora, reduce constipation, and as a positive side effect reduce their carbon footprint and save the planet.

4. Removing dairy. One of the proteins in milk, casein, can bind to endorphin receptors in our body and have a similar effect as endorphin. Think of endorphin as our self-made morphine: it has the same effects: reduces pain, is addictive and causes constipation. That is why some people get addicted to things like running – it gives them a little high. Milk can do the same – that is why cheese can be so addictive. Here is a short video worth watching about the connection between dairy and constipation in children.

5. We all carry trillions of bacteria in our gut that are helping us digest food and give nutrients to our gut muscle. Various influences like being born by caesarean, not being breastfed, taking antibiotics, eating processed foods, all affect our gut flora negatively. But don’t despair – you can improve the gut flora even if things did not start out optimally, simply by eating lots of different kinds of fibres. The more variety the better because each fibre feeds different kinds of bacteria and what your gut really needs is lots of variety. The more diverse the gut flora is, the healthier it is. Eating probiotic foods like yoghurt or sauerkraut and taking probiotics as a supplement all soften the bowel motions, reduce transit time and increase peristalsis.

6. Just like any other muscle in your body, the gut needs magnesium to contract and relax - and move its contents along. Magnesium is easy to get from your diet if you eat your 5+ servings of vegetables, at least one serving of legumes and one of nuts and seeds per day. Alas, 60% of Australians and New Zealanders are not getting enough magnesium from their diet. Symptoms of low magnesium include muscle cramps and sore legs, sleep problems, anxiety and – you guessed it – constipation. Magnesium can work just as well as a laxative – it softens the bowel motions and improves the muscle contractions in the gut. If you take more magnesium than you need it stays in the gut and makes the poo soft – just what you want when you suffer from constipation. You can use magnesium citrate powder or capsules – start with a small dose and increase until you have this desired effect.

7. A clockwise tummy massage can physically help to move the faeces along faster.

8. Create a squatting position when on the toilet by elevating the feet with a stool. Anatomically this makes it easier for the body to have a bowel motion.

9. Last but not least lifestyle factors affect constipation. Exercise is helpful at moving the bowels. Jumping on a trampoline and twisting exercises are especially good. And it is important to relax. If you are stressed and in “fight or flight” mode, all your blood goes to your muscles and brain and you hold onto your bowel motions. In order to pass a bowel motion you have to switch to “rest and digest” mode. A warm bath or a massage often help young children to relax; you can also use a mindfulness app like Smiling Mind; calming music; or read a soothing story. This will allow your child to move from a stressed, high adrenaline jumble into a relaxed, chilled, parasympathetic state – and everything will flow easier.

So going into the holiday season, push the veggies and the water; reduce meat and processed foods in the diet; get active and relax. This should help your whole family to have healthy tummies.


Dr Leila Masson

Sydney based paediatrician specialised in nutritional and environmental medicine. Author of the handy 'Children's Health A to Z' guide for parents. Dr Masson lectures internationally on children's health.

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