Health – Keeping it regular

Since the dawn of history, humans have been preoccupied with their bowels. Remedies for constipation are recorded by the ancient Egyptians and Greeks, and apparently, one of the scourges of early Antarctic exploration was constipation, due to dehydration and lack of dietary fibre. “Bound bowels” were treated with a laxative called cascara, a remedy derived from tree bark and not much of an improvement on what the ancient Greeks were using.  

At times, constipation was considered to be the cause of just about every human malady. Sir William Arbuthnot Lane, an eminent British surgeon in the early 20th century, believed the bowel was a kind of sewer which could release toxics into the body if not flushed out every day. 

So committed was he to the concept, that he performed total colectomies on many of his patients, and was only stopped when struck off by the medical authorities. However, freed from the restraints of his profession, he went on to champion many interventions which would find favour today, including return to farmland, ample sunlight exposure, exercise and a greater intake of whole foods. So not such a crank, after all. 

There is an arbitrary definition that constipation is passing fewer than three bowel motions a week. I find this doesn’t correlate very well with real life. In terms of discomfort and complications, a better emphasis is on the consistency of the motions, that is, how hard or soft. We even have a way of scoring this, the Bristol stool scale, a beautifully graphic representation of the whole range of faecal accomplishment. Get a copy and stick it on the back of the toilet door, if you are interested in this sort of thing.

Constipation is a contributor to diverticular disease, anal fissures, piles, prolapse and sometimes complete obstruction. And there is an important correlation between disturbances in the normal gut bacteria and various types of bowel disturbance. 

Aim for a regular, well-formed bowel motion which can be passed without straining. 

The lifestyle factors to achieve this are pretty straightforward: adequate fibre, fluid and exercise. But there are times when nature needs a hand and the remedies fall into four major groups.

Bulk-forming laxatives, mostly refined fibre such has psyllium husk. They work by drawing fluid into the bowel, making the motions softer and larger, which makes peristalsis more effective. They have the advantage of reducing cholesterol in some people as well. 

Stimulant laxatives make the muscles work harder and can be used from both ends if necessary Osmotic laxatives, like lactulose and Molaxole, fill the bowel with extra fluid  Stool softeners.

Lastly, sitting on the toilet in more of a squatting position can reduce time and effort to empty the bowel. Achieve this with a footstool, a slightly bent over posture and a straight back.