Constipation affects up to 20% of the population. While it’s a brief nuisance for some, for others it’s a lifelong struggle. Constipation can be a symptom of a chronic digestive disorder or a sign of something more serious. It’s important to know what causes constipation and when to seek help. Today’s article will dive into the complexities of constipation. We’ll discuss some often overlooked signs of constipation and what causes us to get backed up. Finally, I’ll detail some natural treatments for constipation relief
What is constipation?
This may seem obvious. Constipation is not going to the bathroom enough. Period.
Not so quick.
There’s more to it then how often you you go number 2.
Bowel movement form and frequency are two important factors.
Stool form can be described as how hard or loose your stools are, whether they break up on impact or are completely watery. In my practice I rely heavily on the Bristol Stool Chart. It’s essentially a poop chart. Something my patients have all but memorized. Nevertheless, the BSC is an important indicator of bowel health. Get to know it. Print it out. Hang it in your bathroom if you want.
Stool frequency is simply how often one has a bowel movement. While the ideal frequency can vary from person to person, it’s generally 1 to 3 times per day.
Many patients are surprised to learn that they’re constipated despite having multiple bowel movements per day. In fact, many patients will have poop backed up and not even know it. Perhaps they went to get an abdominal ultrasound or other imaging of their abdomen and they’re surprised to learn they’re full of shit! All kidding aside, it’s true.
Three other factors I always ask about is straining, urge and complete evacuations. One should have the urge to have a bowel movement. It is not normal to lack the urge to go. Straining or pushing with force is also not normal. Finally, your bowel movement should feel complete.
A good bowel movement is one that requires no straining, is smooth and easy to pass and leaves you feeling completely evacuated
What is a healthy bowel movement?
Let me paint this picture for you:
A good bowel movement is one that requires no straining, is smooth and easy to pass and leaves you feeling completely evacuated.
Many of the patients I see do have bowel movements daily, sometimes even multiple times per day. But they may feel incomplete, dry, hard or even painful to pass. They may strain excessively which can lead to the formation of hemorrhoids or even fissures.
They are still constipated despite being “regular”
What Causes Constipation?
They are many causes. Certainly too many to list.
Afterall, bowel movements are complex coordinated affairs. Gut nerves, hormones, bacteria, and muscles and many other systems interact to allow us to poop. Here are the most common reasons I see people struggle with constipation:
Imbalanced gut bacteria
In our society of overused antibiotics, nutrient-depleted foods and increasingly sterile living environments, our gut microbes need more support than ever. Intestinal producers of methane gas, known as methanogens are associated with constipation. Patients with an overgrowth of methanogens will often suffer from constipation.
Impaired motility
Impaired movement in the colon can understandably affect your ability to poop. A number of reasons can contribute to impaired motility. These include infections, high fat diets, stress, nutrient deficiencies, certain medical conditions and even travel or change in routine. Poor communication between the gut and brain often results in impaired motility and increasingly sensitive nerves. This is the case for constipation caused by irritable bowel syndrome.
Food intolerances
Cow’s milk protein intolerances and non-celiac gluten sensitivity are two issues that I see fairly common. There is also research on the impact of food sensitivities on the occurrence and healing of anal fissures, often accompanying constipation.
Medical Conditions
A number of medical conditions can affect your ability to poop regularly. Here is a very small list of them:
- Hypothyroidism
- Diabetes
- Celiac disease
- Crohn’s disease
- Parkinson’s Disease
- Multiple Sclerosis
- Irritable Bowel Syndrome
- Colorectal cancer
Pelvic floor dysfunction
Some things need to contract, others need to relax. Like a symphony, not all instruments can play at once. The same is true for bowel movements. Often constipation results from an ineffective coordination of pelvic floor muscle pressure and anorectal relaxation. This common disorder is called dyssynergic defecation. Childbirth, cesarean sections, hysterectomy, endometriosis and aging can all impact the tone and function of the pelvic floor. News flash: men have pelvic floor muscles too! And are also susceptible to issues with their pelvic floor.
Not eating enough. Period. Not just fiber. But actually not eating enough food. This is often the case in some of my elderly patients. Especially if their appetite has decreased. If the bowels receive little bulk then they will do little work. Sometimes it really is that simple. The solution is to eat more regular, bulky meals with adequate fluids throughout the day.
Isn’t constipation just a lack of fiber and dehydration?
The short answer is no.
Do these play a role in constipation for some? 100%
But, there are many who still remain constipated. It’s complicated.
Let’s stop and take a second to discuss why fluids ands fibers are helpful though.
Fibers are naturally bulking and often contain nutrition for our bacteria, while fluids help keep our stool hydrated and easier to pass. Bulking is critical because it causes the bowel walls to stretch. This is important for activating mechanical receptors in the large bowel. When these are activated, the muscles located in the wall of the bowels will contract to push those feces along.
On the other hand, fluids are absorbed from your colon. So if poop is sitting there for too long, it will lose its water content to reabsorption. Leaving you with the dreaded rabbit turds (Type 1 on the BSC). Thus, adequate hydration is important for ensuring stools remain soft.
But as I said, for many this won’t be enough.
Further, a lot of people misunderstand the role of fiber. In an attempt to feel better many will dramatically increase fiber content only to find themselves feeling much worse.
When should you be concerned about constipation?
When Constipation Is More Concerning
If you are over the age of 50 and have had a sudden onset of constipation this is more concerning. If you have noticed blood in your stools this is also concerning. Don’t assume it’s just a hemorrhoid!
Constipation can be the first signs of colorectal cancer so it’s important you don’t shrug this off. Consider talking to your doctor about colorectal cancer screening.
Alright, with that let’s dive into some natural treatments for constipation.
Natural Treatments For Constipation
How I approach constipation with my patients will depend on their unique underlying causes for their issues. That being said, here are some things to consider when pursuing natural treatments options for constipation
Proper Elimination Positions:
Elevating the feet 4-8 inches. This is more akin to a true squat position. This helps to promote proper pelvic and anorectal coordination. This is essential for a proper elimination.
Laxatives:
Bulk laxatives – those which increase mechanical stretch in bowels to promote contraction
- Psyllium husk
- Partially hydrolyzed guar gum
Osmotic laxatives – those which promote flow of fluids into bowels
- Magnesium oxide or citrate
- Glycerin suppositories
- Sorbitol (sugar alcohol)
Stimulant Laxatives – irritate the gut lining to stimulate movement
- Senna
- Rhubarb
Foods:
- Kiwi (including the skin)
- Prunes, dates, figs (high sorbitol)
- Bran (oat, wheat)
Digestive bitters:
Digestive bitters may be helpful for patients whose food intake is reduced due to poor appetite. Further, bitters stimulate digestion, promote healthy appetite and motility.
Digestive bitters include:
- Gentian root
- Dandelion
- Chicory root
- Artichoke
- Wormwood
Prokinetics:
Prokinetics are medications or natural treatments that promote motility and improve constipation.
Natural prokinetics:
- 5-HTP
- Ginger
- L-Carnitine
- Vitamin B6
Medication prokinetics:
- Prucalopride
- Linaclotide
Probiotics:
Certain probiotic strains can be useful natural treatments for constipation. The following strains have the strongest evidence:
- Lactobacillus reuteri DSM 17938 – reduction of methane, improves constipation
- Bifidobacterium lactis HN019 – improves gut transit time
Not all probiotics are created equal. Read my guide to probiotics
Pelvic floor physiotherapy:
Many of my patients who have pelvic floor dysfunction find working with a trained pelvic floor physiotherapist can be extremely helpful with their constipation.
Conclusion
Constipation is a nuisance. For some the severe discomfort can be life-altering. Just know that you’re not alone in your struggle. There are many ways to address constipation naturally and a prescription for laxatives shouldn’t be the only offered solution. If you feel like you need more support, my advice is to seek out a trained professional like a Naturopathic Doctor. They will take the time and tailor a plan that includes safe and personalized natural treatments for constipation