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"What if you think you're doing everything you're supposed to do for constipation, but nothing is working?!"

Well, first of all, take a deep breath, relax, and realize that you're not all alone here - and you're definitely not helpless, even if it sometimes feels that way. Constipation tends to be one of the more frustrating IBS symptoms, and it does take longer to resolve through lifestyle changes than diarrhea. But - there are many, many ways to help alleviate constipation successfully, it just takes a little patience and persistence.

Last week we tackled the first two Constipation Frustrations (Soluble Fiber Supplements Are Overnight Wonder Drugs, Right?, and Insoluble Fiber Foods Are IBS Triggers, So I Won't Eat Any!). This week we address the last three:

3. I don't eat anything at all when I'm constipated, because I don't want to make things worse.

As counter-intuitive as it may seem, you actually need to keep eating in order to help resolve constipation. The very act of eating, in and of itself, triggers your gastrocolic reflex, which in turn signals your colon to start contracting. The rhythmic waves of contractions - called peristalsis - are necessary to produce regular bowel movements. If you simply stop eating, your bowel will lose its signals to contract, and constipation will worsen.

What's most helpful is to eat small amounts frequently, making sure that you safely incorporate insoluble fiber foods. Try to keep to a regular schedule of light meals and snacks, so your body becomes accustomed to (and expects) food at predictable times. This will help get your gut in tune with a regular schedule of elimination as well.

As an aside, making sure that you're also on a consistent bedtime/wakeup routine will also help constipation. Your gut normally "wakes up" with you, and peristalsis increases shortly after you get out of bed and start moving around in the morning. Keeping to a set schedule of sleep (and getting enough of it!), plus following the same wakeup time every morning, will help your gut stay in a properly functioning pattern. With IBS, you're waging a daily battle against bowel dysmotility, so your goal is try and make every factor that influences bowel function - diet, stress, sleep, excercise - a gentle but persistent nudge towards regularity, in every sense of the word.

4. I drink eight glasses of water a day - that's plenty, right?

For most people without IBS, yep - this much water can be plenty. For people with IBS, it may take twice as much water - every single day - to help rein in constipation. It's not just your bowel, actually, but your entire GI tract, that needs water to function properly. Soluble fiber, the foundation of the IBS diet and a terrific tool for managing all IBS symptoms, needs plenty of water in order to regulate bowel function. Soluble fiber also normalizes water levels in the gut, which in and of itself helps constipation. But, there has to be enough water in the gut in the first place for soluble fiber to work its magic. Together, fiber and water maintain gastrointestinal muscle tone, dilute toxic wastes in the GI tract, bind irritants, bring oxygen to the tissues, and help maintain the correct balance of intestinal flora.

With constipation, the slower your gut motility is, the longer it takes for the transit of matter through your colon. The longer this takes, the more time there is for the colon to absorb too much moisture out of the matter, and this makes constipation even worse. Drinking plenty of water (especially in conjunction with a soluble fiber supplement) will help alleviate this.

It's pretty difficult to drink too much water, so make it your goal to drink 16 full glasses of water each day, and if you can make it a little bit more, even better. It's easiest to just space out your water throughout the day, especially between meals. Keep a water bottle or glass at hand at all times when you're at home or work, carry a water bottle with you if you're out and about or at school, and keep water bottles in your car for when you're on the go.

If you're suddenly increasing your water intake, then yes, you will be running to the bathroom an awful lot. But hang in there, because it won't take more than a week or so for your bladder to adjust. The really interesting thing is that you'll likely find if you don't keep up with your new water increase once you've adjusted, you will suddenly find yourself very irritable and thirsty. Most people function better overall when they're drinking quite a bit more water than they may think they need.

5. I know exercise is important for constipation, so I get at least 20 minutes of walking in each day.

Exercise is more than important for constipation-prone IBS folks - it is absolutely critical. Exercise in general regulates bowel function and increase the efficiency of your entire digestive process, and it also reduces muscle tension. Exercise works your muscles (including internal muscles, like your colon), releasing the energy stored from involuntary contractions under stress, and allowing relaxation. With IBS, a relaxed colon is a happy colon.

The catch here is that moderate activity - which would help regulate constipation in a normal person - might not be nearly enough for constipation from IBS. You may well need a solid hour - or two - of exercise on a daily basis. You might also need a strenuous aerobic exercise, and not just walking or gentle workouts. This is particularly true if you are sedentary throughout the rest of the day (desk jobs are not good for the gut!).

Why would an intense workout be better for constipation than a series of shorter, lighter activities? The production of adrenaline that fast-paced, vigorous exercise produces actually results in something close to the "fight-or-flight" reaction of your body. Part of this reaction is an increase in peristaltic movement and a bowel movement. Light exercise won't necessarily produce the same results.

I know it can be difficult, if not impossible, to find this much time on a day-in, day-out basis for exercise. But if you can make the attempt, please try. Obviously, any exercise is better than none at all, so don't give up shorter, lighter workouts if that's all you can fit in. However, if you are able to try at least a couple full-fledged, all-out, hard-core workouts each week, even if it's just for a trial run, you may see such benefits to your bowel that you become determined to find a way to make this a habit. Just make sure to drink plenty of water afterwards!

~ Heather

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