Skipping meals can lead to flatulence

Carrier bowel - what to do?

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Dipl. Oec. troph. Christiane Schäfer

constipation is one of the most common everyday complaints. Women are affected at least twice as often as men. By changing your diet and lifestyle, the symptoms can be significantly reduced in many cases.

Delayed emptying of the bowel is called sluggishness or constipation, medical professionals speak of constipation. Slight constipation is a common symptom that is difficult to objectify and can have different causes. Since they encompass different clinical pictures, the difficulties in diagnosis are manifold. Although in many cases there is no underlying causal disease, the first thing to do is to clarify the cause. For example, diabetes, an underactive thyroid or a tumor in the intestine as well as neurological-psychological diseases such as Parkinson's or depression can be responsible. Often there are also side effects of taking medication. In about every fourth patient, a disturbance of the complex movements of the bowel with reflex emptying is the cause. The frequently mentioned lack of exercise as a contributory cause of constipation, on the other hand, cannot be proven by study data. However, inactivity should be avoided.

What is normal?"

The transport of food in the intestine takes place through rhythmic peristalsis, which among other things depends on the filling pressure of the intestine. A transit time of 24-36 hours is ideal. Both emptying up to three times a day and at least three times a week are considered normal. The type of daily diet determines the amount of stool, which is around 100 to 500 grams per day on average with Western diets (see Tab. 1). A lack of fillers and bulking agents - especially from grain, vegetables and fruit - leads to a decrease in the amount of stool, but also to a change in the bacterial intestinal flora, to changed pressure conditions in the small and large intestines and thus to a longer transport time. Based on their subjective perception, patients perceive constipation very differently than doctors do. Affected people understand constipation as different things: for example too hard, too seldom, too little or too painful. For example, they often complain of difficult and painful bowel movements with the elimination of small and hard lumps, often associated with a feeling of incomplete emptying.

Causes of Constipation

Organic causes:
Intestinal tumor, diabetes mellitus, neurological diseases (e.g. Parkinson's, multiple sclerosis), dementia, hypothyroidism, psychological disorders (depression, anorexia nervosa), pregnancy, surgery, changes in the pelvic floor

Opiates, antidepressants, antihypertensive drugs (calcium blockers, diuretics), iron, anti-epileptics, anti-Parkinson drugs, neuroleptics

In the medical sense, on the other hand, constipation is only spoken of when the following criteria are met, which gastroenterologists agreed on in the 2013 S2K guideline. According to this, at least two of the following symptoms must have been present continuously or recurrently in at least a quarter of the bowel movements during three of the previous six months:

  • violent pressing
  • hard stools
  • Feeling of incomplete emptying
  • Sensation of anal blockage
  • manual maneuvers for defecation, e.g. B. with the aid of the finger
  • two or fewer evacuations per week

If a patient complains of persistent constipation symptoms, the first thing to look for is an underlying disease that is causally responsible. Otherwise, all of the recommendations for better defecation cannot be applied.

Before any dietary recommendations are made, the daily diet should always be checked, preferably by evaluating a seven-day diet, symptoms and stool log. In all studies, nutrition is indicated as the first measure. But the problem lies in the details and requires basic nutritional knowledge: In addition to the intake of sufficient fluids, the most important thing is the amount and composition of the "correct" dietary fiber. In addition, these patients benefit from foods that affect the intestinal flora, such as sour milk products and probiotics. A regular meal structure is also clearly beneficial. Three main meals with possibly one or two snacks in between cause significantly fewer discomforts than skipping meals or serving too large.

Drinking is not everything, but without drinking ...

Patients suffering from constipation drink no less than healthy people. In many studies, there was no difference in fluid intake. Only drinking less than 0.5 liters has a stool hardening effect. Overall, however, studies on the value of fluid intake are inconsistent with regard to stool consistency and frequency. The same recommendation applies to constipated patients as to healthy people: between 1.5 and two liters of fluid spread over the day. Nevertheless, the balance sheet of drinking behavior and the recommendation of sensible beverages lay the foundation for nutritional therapy for constipation. In addition, it should be noted that about every fifth patient must be permanently used medication (laxatives), the effect of which requires regulated fluid intake.

Bowel movement and pelvic floor training

Bowel movement or toilet training is about getting the best time to go to the toilet. Usually an individual rhythm can be found, which is dependent on many environmental and nutritional factors, but which still shows a certain regularity. Toilet training requires voluntary and consistent cooperation on the part of the person concerned, as it requires time and a feeling for one's own body and the actual emptying. It makes sense to work with a physiotherapist. Emptying can be supported by simultaneously addressing certain muscle groups via pelvic floor training. In addition, measures such as “not pressing” and certain breathing techniques can be trained during bowel movements.

Not all fiber is created equal

In constipation, whatever the cause, the heterogeneous group of dietary fibers plays a special role. The filling and swelling effects are completely different depending on the water solubility. So it is no wonder that so many studies on the subject of constipation assess the amount of fiber differently. Because all too seldom a distinction is made between soluble and insoluble fiber, although they have different therapeutic benefits.

Insoluble dietary fibers such as cellulose, lignins or hemicellulose are mainly found in whole grain products or wheat bran. They increase the mass of the stool without improving its gliding ability. As long as the patient is already drinking enough fluids and the large intestine has been emptied without stubborn faecal stones in the rectum, these fibers can effectively support bowel emptying. Otherwise, the gift would lead to increased discomfort and in no way bring relief. On the contrary, especially in patients with flatulence, after intestinal operations or in diseases such as intestinal inflammation and tumors, in which intestinal constrictions (stenoses) are to be expected, the administration of insoluble dietary fiber above normal levels should only be done carefully.

Soluble fiber such as pectin, ß-glucan and seed mucilage are mainly found in vegetables and various types of fruit, as well as in seed coats such as flea or flax seeds. They serve more as bulking agents than as fillers, they can pass tight intestinal loops more easily and, above all, make the stool moist and slippery. At the same time, as a prebiotic, they support the intestinal flora, as they partially serve as food for the intestinal bacteria. Constipated patients usually get this support well. Depending on the microbiome, there may be increased flatulence at the beginning of the conversion, but this can be effectively prevented by the simultaneous consumption of sour milk products.

In any case, quark, yoghurt and fermented sour milk products should not be missing in any daily plan for a patient with constipation. Scientific research suggests that sour milk products and special probiotics promote regular bowel movements. The extent to which the isolated administration of a probiotic makes sense or whether the regular consumption of sour milk products is not sufficient must be decided on a case-by-case basis. In any case, the stool consistency and stool frequency of the patients benefit from regular consumption of these products due to the change in the biomass in the colon.

Practical nutritional knowledge is required

The goal of nutritional therapy in patients with the main symptom of constipation should be to enable those affected to prevent constipation. They should also be able to take effective action themselves. By keeping and evaluating a stool log, those affected can better assess the extent to which the food they eat affects their bowel movements and what countermeasures can be taken. The task of nutritional therapy is to provide tips that are suitable for everyday use and that enable those affected to improve their quality of life on their own responsibility.

A detailed list of literature can be requested free of charge by sending an email to [email protected] using the keyword constipation.

Source: Schäfer, C .: UGB-FORUM Special Nutrition Therapy 2013, pp. 13-15
Photo source: dv76 /