What to eat if you have constipation?

There are 3 types of constipation. The constipation of transit (or progression) is defined by a delay in progression of the fecal bolus in the colon. The constipation terminal or distal (rectal dyschezia) is characterized by a delay in the exonatory reflex at the level of the sigmoid and/or rectum. Finally, it can be mixed, and therefore due to a delay in progression and exemption. This pathology is due to two mechanisms: slowdown in transit and the dehydration of stools. The presence of Rome IV criteria (medicine) determines constipation when there are at least 2 of the following 6 symptoms for 12 weeks during the last 12 months:

• Frequency of defecations less than 3 per week.

• Difficulties in exonerating (defecating) fecal matter (1 in 4 defecations).

• Feeling of incomplete defecation (1 in 4 defecations).

• Hard or split stool (1 in 4 defecations).

• Sensation of anorectal blockage (1 in 4 defecations).

• Need for digital maneuvers to facilitate defecation (1 in 4 defecations).

Finally, constipation can be functional and due to hypomotility. The latter is a reduction in nervous and muscular functions allowing voluntary and automatic movements of the body. It is linked to reduced muscle tone, pregnancy, a sedentary lifestyle, but also to excessive use of laxative medications and diet. This functional constipation can also be due to a disruption of the exoneration reflex linked to stress and lifestyle. In some cases we notice the presence of hemorrhoids and anal fissures. It can also be secondary to an organic disorder, such as colonic abnormalities (colorectal stenosis) or anatomical abnormalities (adult megacolon, Hirschprung's disease).

Diet plays a key role in functional and organic constipation and is oriented towards the following areas:

• Ensure a good hydration to facilitate the passage of stools from the colon to the rectum. Indeed, we notice excessive water reabsorption in the event of prolonged stay in the colon. The stools will therefore be dry and hard.

• Favor foods rich in insoluble fiber which are laxative, such as fruits and vegetables, legumes, or even whole grains and oilseeds. These fibers have the particularity of being engorged with water to increase the volume of stools by 20 to 30 times, and therefore accelerate transit via this water intake. This is why hydration and foods rich in insoluble fiber help relieve constipation. ANSES (National Health Safety Agency) recommends a minimum of 30 g of fiber per day.

• Bring superfoods very rich in fiber, such as prunes and Psyllium powder, to optimize fiber intake. These two foods have the particularity of having demonstrated very beneficial effects on constipation. Be careful, you must make sure to increase this intake gradually, because fiber can cause bloating and gas.

• Consume foods rich in lactose, which is laxative, and which therefore accelerates transit. They also help rebalance the intestinal flora thanks to the probiotics (milk bacteria) they contain, and promote lactose absorption and digestion.

The answer is no ! You have to know that no food is not to be deleted. In fact, it is rather the excess of foods that are too fatty or meals that are too copious, slowing down gastric emptying, which could possibly cause constipation. This is why the dietary causes are mainly oriented towards the absence of fiber and the lack of hydration, rather than towards the excess of certain foods.

Prunes and Psyllium are two foods known for their richness in fiber, which makes them foods of choice in cases of constipation, which can provide rapid relief.

• THE prunes : they are composed of 5.1 g of fiber per 100 g. Beyond their richness in fiber, it seems that they contain a substance called dihydroxyphenylisatin. The latter stimulates peristalsis and therefore optimizes transit. Prunes also contain sorbitol as well as phenolic compounds which accelerate intestinal transit via their laxative role.

• There psyllium powder : it is a fiber concentrate (84g per 100g) which has been recognized by numerous studies for its beneficial roles on intestinal transit. The fibers it contains help modulate intestinal peristalsis.

Indeed, a study compared their effectiveness in cases of chronic constipation. It highlighted 40 subjects aged 18 to 75 who presented recent symptoms and who suffered from constipation 25% of the time. The endpoints were oriented towards symptoms of constipation, effort required for defecation, stool consistency and number of complete spontaneous bowel movements. The study also used satiety, taste and bloating scores. The results showed that these two foods significantly improved digestive transit. Prunes, however, showed better results on constipation symptoms and bowel movement frequency. They are therefore considered as the first-line food and as a immediate laxative. However, if prunes are not to your taste, opt for Psyllium powder which has a more neutral taste.

We recommend you :

• to bring between 5 to 10 fresh or dried prunes per day (50 g) until transit improves.

• to sprinkle Psyllium into your meals at an amount of 5 à 20 g (1 to 4 teaspoons) per day: soups, yogurts, dishes, compotes, dairy products, juices, smoothies, drinks and water.

• Be careful not to consume them in excess because they can cause diarrhea. It is best to gradually incorporate them into your diet.

Fiber is found in good quantities in fruits and vegetables. Be careful not to consume them overcooked, in mash potatoes or in compote, because it denatures the fibers and changes their characteristics and taste.

We recommend you :

• gradually increase fiber intake to approximately 5 g per day every week (on average: 2 servings of fruit and 100 g of vegetables) until symptoms improve.

• to consume 2 to 3 servings of fruit per day (i.e. 80 g per portion): kiwi, apple, banana, apricot, red fruits (strawberries, redcurrants, raspberries).

• to consume minimum 400 g of vegetables every day (four handfuls of green beans, four tomatoes, a little more than a whole broccoli...).

• to bring vegetables at each meal, including a raw vegetable to retain maximum fiber and minerals: spinach, cabbage (broccoli, cauliflower, white cabbage, red cabbage), parsnips, salsify and Jerusalem artichoke.

• of favor vegetables refined starchy foods that do not contain fiber (rice, pasta, semolina).

Whole grains are naturally high in fiber because they have not undergone cleaning and bleaching processes like refined grains. Legumes like lentils are also rich in fiber and accelerate intestinal transit.

We recommend you :

• of prefer whole grains with refined cereals: whole grain rice, whole grain pasta, oats, rye, whole wheat semolina, wheat and oat bran.

• to favor whole grains rich in fiber for the breakfast.

• to consume whole grains in the form of cereal bar as a snack.

• to introduce legumes 1 to 2 times a week to replace starchy foods: green beans, coconut beans, white beans, red beans, lentils, chickpeas.

Water is essential in the management of constipation because it allows us to rehydrate hard, overly dry stools.

We recommend you :

• to drink between 1.5 and 2 L of water per day minimum.

• to favor waters rich in bicarbonates, rich in minerals such as magnesium to facilitate digestion.

• to use your consumption of tea or coffee to optimize your daily hydration, provided that they are not consumed in excess (5 cups maximum of coffee per day, and 2 to 3 cups maximum of green tea per day).

• to consume milk, it contributes to hydration (composed of 90% water), and is also rich in lactose which is laxative (bowl of milk: 250 to 300 mL).

Oilseeds and whole grains are rich in fiber, as are wheat and corn brans.

We recommend you :

• to add to your prepared salads of the chia seeds, linseed, poppy, or fennel.

• of sprinkle your salads or your raw vegetables with wheat or corn bran.

• a handful of oilseeds as a snack (around 15 g): almonds, macadamia nuts, walnut kernels, pistachios.

Despite popular belief, lactose promotes intestinal transit. Indeed, lactose is a laxative carbohydrate allowing the acceleration of transit. Dairy products are particularly rich in it, particularly whole milks and fresh cheeses (cottage cheese, petit suisse, sheep's cheese). They are also rich in calcium, which plays an important role at the muscular and nervous level (muscle contraction, transmission of nervous messages). In addition, certain dairy products such as yogurts are rich in probiotics which have shown their beneficial effects on constipation.

We recommend you :

• to bring dairy products throughout the day, in the number of 2 to 3 per day : whole milk, fermented milk (kefir), natural yogurts, cottage cheese.

• to introduce approximately 30 g maximum of fresh cheese every day to boost lactose intake.

• a bowl or cup of whole milk per day.

• to consume at least one natural yogurt per day for its richness in milk bacteria (probiotics). It is estimated that one jar contains over a billion bacteria.

In the typical case of constipation, there are no real foods to avoid or limit. The objective is rather to have a sufficient daily fiber consumption of at least 30 g per day. It is wise to vary the sources of fiber, and to alternate between soluble and insoluble fiber, but also to avoid excesses. Thus, we can say that we must favor more foods rich in fiber on a daily basis than foods which do not contain them.

We recommend you :

• to consume less starchy foods only vegetables every day, to boost fiber intake, with a minimum of 400 g of vegetables per day.

• not to consume excess soluble fiber, present in many fruits and vegetables (apricot, pineapple, spinach, beetroot, etc.) and which limit the acceleration of intestinal transit.

• of limit alcohol which is a diuretic drink, it inhibits vasopressin and blocks water reabsorption in the kidneys. This accelerates the elimination of urine which is abundant and clear and promotes dehydration.

• not to consume food too many calories, red meats, cold meats, industrial products, and other fatty foods, in excess because they can slow gastric emptying.

Breakfast :

• Muesli or whole grains
• Bowl or cup of milk
• An Apple

Lunch :

• Tomato salad seasoned with rapeseed oil
• Chicken thigh
• Red beans
• Cauliflower
• Wholemeal bread and cottage cheese

Snack :

• A few prunes
• A handful ofalmonds
• Psyllium powder with water or fresh fruit juice

Dinner :

• Cod fillet
• Complete rice
• Broccoli
• Natural yogurt

• Practicing physical activity is optimal because it encourages the acceleration of intestinal transit by causing the contraction of the intestinal muscles, what is called peristalsis. This boosts the absorption of nutrients from the intestine. Sport also helps combat mental stress, which is a risk factor for constipation.

• Reduce your daily stress since it tends to increase the risk of constipation. Turn to relaxation and cardiac coherence exercises, as well as essential oils to relieve everyday stress.

• Castor vegetable oil : its ingestion through the skin facilitates digestion and intestinal transit via its richness in ricinoleic acid. This acid will irritate the intestinal mucosa in order to encourage the stomach to produce greater quantities of lipases, which are digestive enzymes. Be careful not to consume it in high doses. For adults and with the doctor's approval, it can be consumed orally via a small tablespoon, not to be repeated.

• Constipation is often linked to magnesium deficiency. In this case, it may be wise to provide food sources of magnesium such as mineral water (Hépar® in particular), whole grains, legumes, but also dark green vegetables and dark chocolate.

• Recreate the defecation reflex by going to the stool every day at the same time, taking your time and without forcing.

• Essential oils can be effective against constipation because they allow gases to be evacuated, promote peristalsis, or even ensure the proper breakdown of food.