The Call of Nature
Constipation is not something most people want to talk about. It’s often considered embarrassing and unpleasant. But let’s face it: pooping is normal, and everyone does it. When things go wrong, it can significantly affect quality of life. Somewhere between fifteen to thirty percent of North Americans are affected, depending on the criteria used, and chronic constipation occurs globally in about one in five persons. While constipation can significantly decrease quality of life, there is much that can be done, and the condition is usually impermanent.
What is it?
If you have it, you generally will know. There are official criteria, but if stools are regularly difficult to pass, incomplete, or infrequent, it’s constipation. What is normal varies depending on whom you speak with. Some define it as having three or more bowel movements per week. In integrative circles, one to three soft, easy to pass bowel movements per day is considered normal. A transit time of twelve to twenty-four hours is ideal. Longer than twenty-four hours allows water from the large intestine to get reabsorbed, leading to harder stools, straining, and possibly hemorrhoids. Waste products and toxins in the stool also stay in the body longer.
There are many potential causes of constipation. While constipation is often food and lifestyle-related, it is a good idea to work with a healthcare provider to rule out any possible underlying conditions. These include diabetic neuropathy, multiple sclerosis, Parkinson’s Disease, stroke, spinal cord injuries, intestinal obstruction, tumors, and diverticulosis, to name a few. It is important also to find out if you have Irritable Bowel Syndrome (IBS), gut dysbiosis, SIBO (Small Intestine Bacterial Overgrowth), or even food sensitivities. Gut dysbiosis is an imbalance in the bacteria of the intestinal tract. SIBO occurs when an overgrowth of bacteria inhabit the small intestine, where they do not belong. They produce gases, which can lead to bloating and severe constipation.
Many medications can also lead to constipation. These include opiate narcotic pain medicines, certain antidepressants, some blood pressure medications, anticonvulsants, calcium and iron supplements, some antacids, and NSAIDs, to name a few. In addition, overuse of laxatives can create dependency if used inappropriately. Check the labels of your medications to find out if they are an issue.
Many constipation sufferers are sent home by their providers with instructions to stay well hydrated, eat more fiber, and get plenty of exercise. If you are coming from a Standard American Diet (SAD) filled with processed foods and lacking in hydration, this advice will usually be helpful. However, if you already eat a healthy diet based on whole, unprocessed foods, these recommendations can fall flat. You may already be doing all of the above, with frustratingly few results. Fortunately, there are other avenues to explore.
Feed your microbiome
The microbiome, or the bacteria that inhabit the digestive tract, play a role in transit time. Some people have an imbalance in their gut bacteria, with few if any beneficial bacteria inhabiting their guts. Encouraging healthy bacteria by feeding them properly can help. Fiber, especially soluble fiber, is good food for the bacteria and can help ease constipation. A large portion of stool is actually made of bacteria, which can ease passage through the intestines. Foods higher in soluble fiber include beans (black and lima beans are particularly good), whole oats, Brussels sprouts, turnips, sweet potatoes, yucca, plantain, oranges, passion fruits, avocado, bananas, ground flax seed, chia seeds, and psyllium husk. This is by no means a complete list, and most fruits and vegetables contain a mixture of soluble and insoluble fiber. Eating more vegetables and fruits in general is a good idea.
Fiber, however, can be a double-edged sword. Certain types of carbohydrates called FODMAPs (topic for a future article) can be irritating to some with IBS and are best minimized until healing has taken place. And there will be exceptions and times when increasing fiber is not appropriate. It can easily get complicated.
Check your carbohydrate intake. Have you recently switched to a lower-carb, Paleo-type diet and experienced uncomfortable constipation? If so, you may be restricting carbohydrates too much. Eating whole-food carbohydrates generally brings more water into the intestines, making stools easier to pass.
Supplements that are helpful for constipation are numerous. Digestive enzymes, probiotics, prebiotics, mucilaginous herbs such as marshmallow root and slippery elm, and magnesium are some of many choices available. They can all be helpful depending on one’s individual deficiencies and needs. Though not a supplement a warm cup of water (with or without lemon) or a warm cup of tea upon waking can be helpful as well.
Mind and Body
Physical exercise can increase regularity by gently massaging the intestines. It is also important to listen to your body. When you get signals to move your bowels, do not put it off. If you defer your body’s needs repeatedly, your body may eventually fail to respond normally to these signals. Stress management can also play a role. Reducing stress as much as possible and using mind-body therapies such as meditation, yoga, qi-gong, and deep breathing exercises can all be useful.
Constipation can be incredibly frustrating to manage considering all of the potential causes and management options available. The good news is that many therapies can be extremely helpful, and there is no need to be embarrassed. If trials at home do not ease your symptoms, consider speaking with a knowledgeable healthcare provider. Treatment options go well beyond the scope of this article, and each person is an individual with unique needs and considerations.
The information provided in this article is intended for general use only and is not to be used in place of medical advice from a licensed health professional.