Happy summer! Ah, the season of sunshine, outdoor play, barbecues, travel and … constipation!
Summer is the hardest season for many of my patients with chronic constipation. I’ve noticed this trend for years, and I’ve mostly attributed it to dehydration. We live in a hot, dry summer climate, and my patients and their families like to spend a lot of time playing outside. It doesn’t take long for poop to dry out.
But I’ve been reading more about circadian rhythms lately, and I think schedule disruptions might be as much of a culprit in summer constipation as dehydration. Let me explain:
We are creatures of habit, and so is our gastrointestinal tract! This is because every system in our body, indeed, many of our actual cells, follow a circadian clock. Circadian rhythms are repeating patterns of activity in our bodies that typically work on a 24-hour cycle. Our central circadian rhythm is regulated by a structure in our brain (the suprachiasmatic nucleus, for those of you who took neuroanatomy) controlled by light. But light isn’t the only thing that governs the rhythms of our body systems: when we eat, our hormones, our body temperature and our activity level can also change our rhythms.
In a super ideal world, our food consumption, activity level, body temperature and light exposure would sync with the 24-hour cycle of the sun. But we don’t live in that ideal world, so sometimes our peripheral rhythms don’t sync with the central rhythm. That is to say: sometimes we stay up too late looking at screens and eating, sometimes we travel and change our food and sleep patterns drastically, and sometimes our sleep and digestion suffer as a result. It’s rocket science, I know. You can read more about the science here.
The most obvious effect of circadian rhythms is on sleep, and it appears that the sleep rhythm and GI rhythm work together. Many studies have shown that sleep disturbances and gastrointestinal disorders have a strong correlation in adults, and this study published in 2021 found a clinically significant link between sleep disturbances and GI disorders in kids. This may be because our GI tract needs a long stretch of time every day to rest, let new cells grow and proliferate, let the microbiome flourish, and absorb nutrients. Your GI tract needs you to get regular sleep so it can function optimally.
So, how do we try to keep our circadian rhythms in sync? I believe a good place to start would be by following the rules for sleep hygiene, with a few modifications.
Keeping healthy sleep habits is easier said than done, but here are my suggestions:
- Follow a regular sleep/wake cycle. Set a bedtime and a wake-up time and stick to it, even on weekends. (Note: Realistically, this schedule might shift to a later bedtime and later wake-up time in the summer. I think that’s OK, as long as you try to keep it consistent.)
- Eat regular meals and snacks (don’t graze all day long!), and stop eating at least an hour before bedtime. Eating food right before you sleep will kick your GI tract into digest mode just as it’s readying itself to rest and regenerate. That midnight snack sends your body a mixed message.
- Watch your light exposure. You really should turn off those screens at least an hour before you want to go to sleep.
- Make your room a sleep-friendly place: close the curtains, turn on a fan for white noise, and turn the thermostat down.
- Be active and get exercise during the day, but make the hour before bed relaxing and calming. Read, color or paint by numbers, put on some classical music … anything to signal to your body that it’s time to unwind.
And now is the point in the blog where I level with you: my youngest child has gone to bed around 10:00 every night for the last two weeks. It’s impossible to implement all of the above in the summertime and still have that relaxed summer feel. Remember, getting stressed about summer schedules might actually make your kid’s constipation worse, so don’t worry too much.
Here are my real-life suggestions for preventing too much summer constipation:
- Bedtime may vary, but try to set a rule that the kitchen (and the freezer, and the snack drawer) closes at 8 p.m.
- Start every day with a glass of water. It’s the easiest way to stay on top of dehydration.
- If you’re traveling, remind your kids that they need to try to poop even if they don’t feel like they need to. My kids turn beet red when I yell across the gas station lot “don’t forget to try to poop!”, but they need the reminder!
- If you’re traveling, pack a container of magnesium gummies. They’ll come in handy if you end up missing a daily laxative dose.
- Speaking of packing, I also try to pack a bag of trail mix with nuts and dried fruit. It’s really hard to eat right on the road, and trail mix is sometimes the only way we get fiber and protein and fruit on a travel day.
There you have it! A midsummer update from your constipation coach.
I hope the rest of your summer goes swimmingly!
Christine Stephenson, PT, DPT
P.S. If you’re a school nurse or therapist getting ready for the school year, you might be happy to know that I’ve put together five-packs of The Constipation Game Plan on the website. They’re so cheap that it won’t matter if you loan one out and it never finds its way back to you.