While it may not be polite conversation, being “regular” is something that just isn’t regular for many of us, especially women and those over 65. More than 4 million Americans have frequent constipation, and they account for 2.5 million doctors’ visits annually. But a new study suggests that simply getting more fluids may help get things moving along.
The study, published in The American Journal of Gastroenterology, uses data gathered from the 2005 – 2008 cycles of the National Health and Nutrition Examination Surveys.
Though many people consider constipation to refer to infrequent bowel movements (fewer than three per week), researchers considered stool consistency and defined constipation as “hard or lumpy stools” in order to more accurately measure the “transit times” of stool through the intestine.
“In general, women experienced more constipation than men, with 10% of women reporting constipation versus 4% of men.”
Responses from 10,914 adults were analyzed, and researchers assessed for co-variables including age, race, education level, poverty-income ratio, body mass index (BMI), self-reported general health status, chronic illnesses, and physical activity. Of the respondents, 9,373 adults had complete stool consistency and dietary data.
In general, women experienced more constipation than men, with 10% of women reporting constipation versus 4% of men. In addition, among women, being obese, having a lower education level, and being African American were significantly associated with constipation.
Interestingly, fiber intake and the frequency of vigorous exercise were not as well linked to constipation.
Instead, those who had the lowest daily fluid intake from food and drinks – 8% of men and 13% of women – reported being constipated. By contrast, of the participants who consumed the most liquid in their diets, only 3% of men and 8% of women reported being constipated.
While the study emphasizes the effects of adequate hydration on bowel movement, fiber intake, physical activity, and other lifestyle factors should not be excluded, warns lead author Dr. Alayne Markland of the Department of Veterans Affairs Medical Center in Birmingham, Alabama.
“We used stool consistency, so we took a validated scale and defined constipation as those with the hardest stool,” she states, and that may have made liquids in the diet, which influence stool consistency but not necessarily frequency or amount, seem more important.
Markland says, “I still think that diet, fiber, exercise and increased fluid should remain the recommendations.”
The Bottom Line
Given that digestive problems – from constipation to lactose intolerance – affect up to 70 million Americans, it should come as no surprise that Nexium (which is used to treat conditions involving excessive stomach acid) was the largest selling drug in the U.S. in 2012. If digestive health is a window of our nation’s health then clearly we have a problem.
While this study points to a lack of fluid intake as a major potential cause of constipation, good digestive health is based on a number of factors, the most important of which include a healthy diet, exercise, and good bowel habits. All of us would be well served to engage in all of these activities to improve digestive health.
If Americans shifted their diet from processed, packaged foods to an eating plan that emphasizes plant foods, lean protein and unsaturated fats, many of these digestive complaints would go away. Based on our nation’s latest health score, I don’t see that changing anytime soon.
Aside from diet, another cause of constipation can be from the narcotic and anesthetic agents during surgery. When combined with lack of food and water prior to surgery, the GI tract can respond with hard stools. To prevent constipation after surgery, be sure to drink plenty of fluids in the days prior. Also, to keep things moving, add a few prunes to your diet.
Healthy intestinal flora also contributes to good health, and not just in the gut. Probiotics, small organisms that help maintain the natural balance of organisms (microflora) in the intestines, work by improving transit time. Regular use can also make stool more consistent.
See our Digestive Health Guidelines to see what you can do to improve your digestive health. You’ll find that good digestive health is just a few steps, chews, and sips away!
David H. Rahm, M.D. is the founder and medical director of The Wellness Center, a medical clinic located in Long Beach, CA. Dr. Rahm is also president and medical director of VitaMedica. Dr. Rahm is one of a select group of conventional medical doctors who have education and expertise in functional medicine and nutritional science. Over the past 20 years, Dr. Rahm has published articles in the plastic surgery literature and educated physicians about the importance of good peri-operative nutrition.