Posted by Dr. Ronnie Mathew, 

Senior Consultant Surgeon, Colorectal Care Specialists (CRCS)

Fibre, probiotics, and exercise play an essential role in maintaining optimal gut health and preventing constipation. In this article, we’ll give you a breakdown on how this trio works together to improve gut health and overall digestive efficiency. 

Fibre: Your Gut’s Best Friend

What is Fibre?

Fibre (roughage) is the part of plant food that is not digested. It stays in your gut and is passed in the stools (faeces). Fibre adds bulk to the stools. This helps your bowels to work well and helps to prevent some bowel and anal conditions.

Why is fibre important in gut function?

Stools (faeces) are usually soft and easy to pass if you eat enough fibre and drink enough fluid. A diet with plenty of fibre may:

• Help to improve constipation and ease bowel movements.
• Help to manage conditions such as haemorrhoids (piles) and diverticular disease (wear and tear of your bowel), and anal fissure (a painful condition due to a cut in the anus/back passage).
• Help you lose or control weight. It is filling, but it has no calories and is not digested.
• Reduce the risk of developing colorectal cancer. 

Optimising  your fibre intake has also been shown to improve the population of helpful germs (bacteria) in your gut, known as the microbiome. An unhealthy microbiome has been linked with many conditions, in addition to serious conditions such as bowel cancer. It has been linked with the immune system, diabetes, mental health, inflammation, and obesity. We still don't know much about our microbiome's role in our health. However, we know that a high-fibre diet is important in ensuring our microbiome keeps us healthy.

How much fibre should we eat per day?

The general recommendation is that adults eat 30 grams (g) of fibre daily. However, your medical history and tolerance for fibre should be considered.

Types of fibre:

Fibre can generally be typified into two types — insoluble fibre and soluble fibre. 

• Soluble fibre: Found in foods like oats, beans, apples, and carrots, it dissolves in water and helps form a gel-like substance that softens stool.
• Insoluble fibre: Found in foods like whole grains, nuts, and vegetables, it doesn't dissolve in water and adds bulk to stool, speeding its passage through the intestines.

They work in different ways in the body. A combination of both types of fibre should form part of a healthy, balanced diet to keep your gut healthy. Many foods containing fibre will naturally contain both types. 

How does fibre help with reducing constipation?

Fiber plays a crucial role in alleviating constipation by promoting healthy bowel movements. Here's how it helps:

1. Adds bulk to stool: Fiber increases stool volume, making it easier to pass. It binds to water in the intestines, helping to soften and bulk up the stool, which reduces straining.
2. Speeds up digestion: Fiber speeds up the movement of food through the digestive system, preventing it from sitting too long in the intestines, which can contribute to constipation.
3. Increases stool water content: Some types of fibre (especially soluble fibre) absorb water, helping soften stool and making it easier to pass. This is especially important for preventing hard, dry stools, which often cause constipation.
4. Stimulates bowel movements: Insoluble fibre, found in whole grains, vegetables, and nuts, helps stimulate the muscles of the intestines, encouraging regular contractions (peristalsis) that move stool along the digestive tract.
5. Supports gut health. Fibre feeds beneficial gut bacteria, which can improve overall digestive health and help maintain regular bowel movements.

Note: Drinking plenty of water is essential when increasing fibre intake. Fibre absorbs water and hence it is important to be well hydrated when taking fibre. In fact, there is a risk that without adequate hydration, any additional fibre intake may cause hardening of stools and constipation. Lack of hydration may also  cause discomfort or bloating. 

Gradually incorporating a balanced amount of fibre into your diet can help prevent or relieve constipation over time.

Probiotics: Good Bacteria, Great Digestion

What are Probiotics, and what do they do?

Probiotics are good bacteria that can help keep your gut healthy. A healthy gut supports your immune system, protects against illness, and helps your body function normally.

The gut refers to your entire digestive system, from mouth to anus, also known as your digestive tract. In your gut, you have thousands of different types of bacteria and other microorganisms. Scientists call this your gut microbiome. Probiotics are the bacteria that support important bodily functions and your overall health.

Your gut microbiome plays a key role in your immune system and many daily operations of the human body, and so the evidence suggests that addressing an imbalance of bad and good bacteria may help protect against several diseases and health problems.

What are the benefits of taking probiotics?

There is little evidence that taking probiotics through food or dietary supplements can benefit healthy people. Research even suggests that many people's gut microbiomes don't change when they consume probiotics and that most actually pass right out of the body. Yet, probiotics may be worth trying if you have a problem linked to your digestive health.

There's evidence that taking probiotics may help:

• Relieve the symptoms of irritable bowel syndrome (IBS)
• Reduce occurrences of diarrhoea, constipation, bloating, and excess flatulence (gas in your intestines)
• Improve lactose intolerance symptoms
• Manage blood sugar levels in people with type2 diabetes
• Help those who take a prolonged course of bacteria-destroying medications - such as antibiotics.

Does probiotics help with constipation?

Yes, probiotics can help with constipation, especially if it's related to an imbalance in the gut microbiome. Probiotics are live beneficial bacteria that can support gut health and promote regular bowel movements when consumed in adequate amounts. Here's how they can help:

1. Improves Gut Microbiome Balance

• Gut bacteria balance: Probiotics help restore and maintain a healthy balance of beneficial bacteria in the gut, which can improve digestion and bowel regularity.
• Fermentation and short-chain fatty acids (SCFAs): Some probiotics help ferment dietary fiber, producing short-chain fatty acids (like butyrate), which nourish colon cells and promote healthy bowel movements.

2. Increases Bowel Motility

• Enhanced peristalsis: Certain strains of probiotics, such as Bifidobacterium and Lactobacillus, can stimulate bowel movements by improving intestinal motility (the movement of food through the intestines). 

3. Improves Stool Consistency

• Soften stools: Probiotics can help increase the water content of stool, making it softer and easier to pass. This is particularly beneficial for people with dry, hard stools associated with constipation.

4. Supports Digestive Health

• Enhances digestion: By maintaining a healthy balance of gut bacteria, probiotics can improve overall digestive health, reducing bloating, gas, and discomfort that often accompanies constipation.
• Improved stool transit time in the intestines: Probiotics can also help regulate the time it takes for food to move through the digestive system, reducing the feeling of "backed up" intestines and promoting more regular bowel movements.

5. Reduces Inflammation

• Gut inflammation: Chronic constipation is sometimes linked to mild inflammation in the gut. Probiotics may help reduce this inflammation, allowing the intestines to function more efficiently and alleviate constipation.

Which Probiotics are effective for constipation?

While different probiotic strains have varying effects, the following have shown promise in studies related to constipation:

• Bifidobacterium lactis
• Lactobacillus acidophilus
• Bifidobacterium infantis
• Lactobacillus reuteri

Considerations:

• Not all probiotics are the same: The effectiveness of probiotics for constipation can vary depending on the strain, and different strains may have different effects on digestion.
• Consult a doctor: If you have chronic or severe constipation, consult a healthcare provider before starting probiotics, especially if you have any underlying conditions (such as IBS, Crohn's, or a weakened immune system).

In summary, probiotics can be an effective additional natural remedy for constipation by improving gut health, supporting bowel motility, and enhancing digestion. However, they are most effective when combined with other healthy lifestyle habits, such as a balanced diet with adequate fibre and regular exercise.

Exercise for a Well-functioning Gut

Exercise can significantly help with constipation by promoting regular bowel movements and improving overall digestive health. Here’s how:

1. Stimulates Intestinal Motility

• Increased movement: Physical activity stimulates the muscles of the digestive tract, particularly the colon, encouraging peristalsis (the wave-like contractions that move stool through the intestines). This leads to more efficient movement of stool through the gut.
• Faster transit time: Regular exercise helps food move more quickly through the stomach and intestines, reducing the time waste material spends in the digestive system, which prevents constipation.

2. Reduces Stress

• Stress relief: Stress and anxiety can slow down digestion and contribute to constipation. Exercise, particularly aerobic activities like walking, jogging, or yoga, can lower stress levels, allowing the body to relax and improve gut function.
• Hormonal balance: Exercise can help regulate hormones like cortisol, which, when elevated due to stress, can negatively affect digestion.

3. Improves Muscle Function

• Strengthens abdominal muscles: Strong abdominal muscles help support the intestines and promote effective bowel movements. Exercises that engage the core muscles, like Pilates or yoga, can enhance your body’s ability to push stool out.
• Improves pelvic floor health: Exercises such as pelvic floor exercises (Kegels) can strengthen the muscles involved in bowel movements, which is particularly useful for people who have difficulty "bearing down" or coordinating their muscles to pass stool.

4. Increases Blood Flow

• Better circulation: Regular physical activity improves blood flow throughout the body, including to the digestive organs. This increased blood circulation helps the intestines function more effectively, which may help relieve constipation.

5. Promotes Regularity

• Consistent routine: Engaging in regular physical activity, even a brisk walk every day, can create a routine that helps you establish more regular bowel movements. The body's internal rhythms, including the digestive system, tend to work better with a predictable daily routine.

6. Improves Gut Flora

• Better microbiome health: Exercise has been shown to positively impact the gut microbiome, which plays a role in digestive health and bowel regularity. A healthy microbiome supports smoother digestion and can reduce symptoms of constipation.

What types of exercises are good for constipation relief?

• Aerobic exercise, such as Walking, jogging, swimming, cycling, or dancing, can help stimulate the digestive tract and reduce constipation.
• Strength training: Lifting weights or performing bodyweight exercises strengthens muscles, including those involved in bowel movements.
• Yoga: Certain yoga poses, such as twists and forward bends, are known to help massage the abdominal organs and promote digestion.
• Pilates: Pilates focuses on core strength and posture, both of which support better bowel movements.

Tips:

• Aim for at least 30 minutes of moderate exercise most days of the week to help improve constipation.
• Stay hydrated. Exercise can lead to fluid loss through sweat, which could exacerbate constipation if you don’t drink enough water.

Incorporating regular physical activity into your daily routine is an effective, natural way to help prevent and relieve constipation over time.

Important: Exercise can reduce the risk of cancer: Regular physical activity can help reduce the chance of developing cancer. It roughly halves the chance of developing oesophageal (food pipe/gullet) or colorectal (large intestine) cancer.

Do I need to see a doctor before I start any physical activity?

Not usually. However, a sports doctor or physiotherapist might be a good source of advice for someone intending to start a very vigorous physical activity programme. Someone worried that increasing physical activity might worsen a joint or back problem might consult with a physiotherapist. Generally, it is good to see a doctor for those people who are not used to physical activity or are planning to significantly increase their physical activity.

People with the following conditions should speak to a general practitioner or a specialist doctor urgently:

• People with chest pains, particularly if chest pain is brought on by exercise.
• People who have had falls due to becoming dizzy or blacking out.
• People who become very breathless on mild exertion. This might be due to a lack of conditioning and improvement by exercise, but there are other conditions that can cause this.

If you have any questions regarding constipation or what to do about it, then do get in touch with us today to have them answered. https://www.thecrcs.com

Important Disclaimer: The information provided here is not specific and is meant for general information only. It does not constitute guidance for managing or treating any condition and does not replace information from your healthcare professional. Please consult your healthcare professional for more information and guidance.