I know that chronic constipation is not the most glamorous topic, but it certainly is an important one. Over 25% of Americans suffer from constipation. Doctors write over a million prescriptions for constipation per year, and roughly $725 million is spent annually on laxatives. Clearly this is a significant topic, even if we don’t want to talk about it much!
So what is constipation, anyway? If you ask different providers, they very well may give you different definitions. The classic criteria for constipation (which can vary by person) will include two or more of the following: Fewer than 3 bowel movements per week, hard stool 25% of the time, feeling as if you are not “done” 25% of the time, sensation of obstruction 25% of the time, having to use manual maneuvers 25% of the time, and hard stool without the use of laxatives. Constipation is twice as likely in women as in men, and more common in people over 65.
From an integrative perspective, the vast majority of causes of constipation lie with lifestyle or with unmanaged functional digestive issues. Lifestyle factors that can contribute to constipation include: poor nutrition, including a low fiber, low vegetable diet; dehydration; over consumption of processed and/or constipating foods; sedentary lifestyle; high stress and the use of medications that can interfere with bowel motility including opiates, anti depressants, iron supplements, calcium channel blockers and aluminum-containing antacids.
Functional issues that can contribute to constipation include: undiagnosed food sensitivities; dysbiosis – an imbalance between good and not-so-good gut flora; small intestine bacteria overgrowth (SIBO); leaky gut; nutrient insufficiencies, particularly magnesium; underactive thyroid; imbalance in the enteric nervous system/second brain and hormonal imbalance can play a part.
There are also several diseases/conditions that are associated with constipation, and these include: Multiple sclerosis, diabetes, kidney disease, scleroderma, high/low thyroid function, spinal cord injury, Parkinson’s disease and colon cancer.
- Find hidden food sensitivities. The biggest culprits here are gluten-containing grains, milk products and soy.
- If you are sensitive to lactose, avoid it completely. Dairy products are inherently constipating, and this effect is compounded if you cannot digest lactose.
- Create a bathroom routine. Each morning, set aside 10-20 minutes to sit quietly on the toilet, even if you do not have a bowel movement. You are re-training your gut and your nervous system to relax at this time.
- Don’t ignore the urge to go, even if you are out in public. Yes, most of us would prefer to be in the privacy of our own home to go. This is something we want to get over. Ignoring the urge to go compounds the constipation problem.
- Rule out bacterial dysbiosis and infection with candida and parasites. All of these unfortunately can create and compound constipation. This can be ruled out by doing a complete digestive stool analysis (CDSA)
- Rule out small intestinal bacterial overgrowth (SIBO). This is done with a methane breath test. SIBO is a significant cause of chronic constipation and should be eradicated if present.
- Increase your digestive fire. Consider taking an enzyme supplement with meals. Look for one that contains amylase, lipase and protease at a minimum. Consider having a splash of apple cider vinegar before meals or as a base of a salad dressing. Eat bitter foods several times weekly.
- Address leaky gut if present. For more info on leaky gut, check out my blog post “What IS leaky gut”. Supplements like glutamine, zinc carnosine, mucin and demulcent herbs can begin to address this issue.
- Incorporate fermented foods into your weekly nutrition. Foods like yogurt and kefir (if you do not have a dairy problem), kimchi, sauerkraut and kombucha add beneficial probiotics and enzymes.
10. Consider taking a probiotic. This helps balance gut flora. Look for a product that has at least 20-25 billion CFUs and Lactobacillus and Bifidobacter strains.
11. If you have used antacid medications for a long time, it is time to consider getting off of them!
12. Slowly increase fiber intake: for those who cannot increase veggie intake, you may want to consider a supplemental fiber products. I really like acacia and psyllium based products for constipation. Start with ½ tsp in water twice daily, and increase that by ¼- ½ tsp every 5-7 days until you are at 2 TB once to twice daily.
13. Drink at least 2.5 liters of water daily. Period. Start your day with a 16-ounce glass of water. This can really help stimulate the bowel.
14. Increase watery veggies and fruits. This will add to your overall water intake.
15. Make sure that you are eating healthy fats daily. Avocado, avocado oil, olives and olive oil, coconut, coconut products and coconut oil, nuts, seeds and their butters, flax oil, fatty fish, fish oil and cod liver oil are all options. Healthy fats help lubricate the GI tract.
16. Take magnesium daily. Magnesium helps the bowel and its musculature and nervous system relax. This aids peristalsis and helps improve bowel regularity. Aim for 400mg before bed.
17. Vitamin C can be used as a laxative and to help soften stool. It has a multitude of other functions, including helping the body build collagen and soft tissue and immune health. Start with 500mg twice daily, and double this amount every 1-2 days. Once you find your Vitamin C tolerance level (the amount you can take to soften the stool) you may use this on an as-needed basis.
18. Take a hard look at your medications. Research the side effects of them. Listed above are commonly prescribed constipating medications. If you are taking any of these medications, discuss alternative medications with your doctor.
19. Take a hard look at stress management techniques. Stress is a major, often undiscussed cause of constipation. Deep breathing, tai chi, contemplative walks, reframing situations, changing perspective and thought patterns, getting rid of toxic relationships can all be used to help manage stress.
20. Sleep. Sleep is a major reset button for our physiology and for our hormonal system.
21. In addition to bumping up fiber, add in psyllium seeds and husks. Aim for 1 tsp twice daily. Psyllium adds bulk to the stool and helps with transit. If you are currently using enemas and laxatives, psyllium is a great thing to swap to.
22. Herbal laxative use is OK, just not every single day. I often recommend Smooth Move tea at dinner or before bed, along with all of these other tips, to help get things going. Use no more than three times weekly unless directed.
23. Get your thyroid checked: thyroid dysfunction can greatly impact bowel function.
24. Consider the use of serotonin building blocks and receptor-sensitizing agents. This will begin to help tone the enteric nervous system. These include B vitamins, magnesium, 5-HTP, SAMe, l-theanine and St. John’s Wort.
25. Regular exercise helps bowel motility. A mixture of weight training, sprints, burst type activity, walking and plyometrics can help improve constipation by helping to reset the nervous system, massaging the intestines and firing up metabolism.
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