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Constipation — having infrequent bowel movements or difficulty passing stool — is a common medical issue, affecting up to 20 percent of the population. Generally defined as having fewer than three bowel movements per week, the condition is considered chronic if it persists for two weeks or longer.
Despite the fact that constipation is so common, it should not be ignored. Its cause should always be sought, especially if symptoms do not improve after a few weeks. Consulting with your physician is important to ensure no serious, underlying health condition is a contributing factor.
Physical Inactivity Constipation can be due to a lack of exercise, which can prevent the stools from moving forward adequately.
Diet – A low-fiber diet is one with a low intake of beans, fruits, and vegetables. High fiber intake helps optimize healthy gut bacteria and regularity.
Processed Foods – Fried foods, cakes, cookies, pastries, pasta, and bread may cause constipation. For many, cheese is also a culprit. If you suspect a certain food or foods are causing bowel issues for you, consider keeping a food journal to identify the cause.
Dehydration – Frequently due to inadequate intake of water or excessive intake of coffee and tea, dehydration can prevent the bowels from moving. Certain medications, such as diuretic blood pressure medicines, can also deplete hydration levels.
Certain Medications – Allergy medicines (diphenhydramine, loratadine, fexofenadine, etc.) and opiate medications (hydrocodone, oxycodone, morphine, etc.) for chronic pain are known to cause constipation.
Supplements – Calcium and iron may contribute to constipation. Calcium, at a daily dose greater than 1,000 mg per day, may cause constipation if an adequate intake of magnesium isn’t taken along with it. Similarly, iron supplements, which are frequently taken for iron-deficiency anemia (should be diagnosed by a doctor), can cause constipation. However, if iron is taken with vitamin C, this can help with iron absorption and may help prevent constipation.
Irritable Bowel Syndrome (IBS) – IBS can sometimes present with diarrhea, but also common with constipation. Some people can experience both, alternating from day to day. Those with constipation-predominant IBS are frequently given prescription medications if dietary and lifestyle changes do not suffice.
Small Intestinal Bacterial Overgrowth (SIBO) – There is evidence that overgrowth of bacteria, which produce methane gas, can increase the risk for constipation due to methane gas slowing down intestinal transit time.
Hypothyroidism – Underactive thyroid affects up to 10 percent of the population. The condition tends to slow overall digestion transit time, leading to constipation.
Frequent Antibiotic Use – Disruption to gut microbiome can be caused by antibiotics. In some cases, it can cause diarrhea. However, due to the destruction of healthy bacteria, it may also lead to chronic constipation and SIBO, as discussed above.
Stress – We each react uniquely to stress. And for some, it can lead to constipation. Finding a healthy outlet to reduce internal stress is crucial for mental and physical health. It has been said that constipation results from literally holding things in —stress reduction, biofeedback, and restoring more life balance can help bowel movements become more consistent.
Chronic medical conditions, such as Parkinson’s disease, colon cancer, spinal cord injury, and sometimes even stroke, can result in chronic constipation.
Most medical guidelines recommend those 50 years of age and older be screened for colon cancer. This can be done with a colonoscopy, sigmoidoscopy, or stool test that checks for blood or cancer DNA.
Those with a family history of colon cancer may need to be screened as early as age 40 or even sooner. Consult with your physician and make sure you are current with the recommended guidelines based on your age and family risk factors.
Other medications prescribed for chronic constipation include linaclotide (Linzess, Constella), plecanatide (Trulance), and lubiprostone (Amitiza). If no underlying or reversible cause of constipation is identified, doctors frequently prescribe docusate sodium (Colace), polyethylene glycol (PEG or Miralax), lactulose (Enulose), or sorbitol.
If the cause of the constipation is an opiate medication, a common class side effect, drug companies have developed drugs (methylnaltrexone) to counteract this side effect.
Many want to avoid prescription drugs out of side effect concerns. Below are some natural approaches many have taken to help relieve symptoms of constipation and to help maintain a regular bowel schedule. Diet and lifestyle changes play a crucial role in bowel health and should always be considered first. Sometimes, however, that is not enough.
Exercise – Maintaining an active life, to the greatest extent possible, is important to help encourage regular bowel movements. Guidelines recommend most people try to get at least 150 minutes per week of moderate physical activity. This helps the bowels to remain active and regular. The simple act of going for a daily 30-minute walk can be very useful. Some have found that practicing yoga can also be helpful.
High-Fiber Diet – This is very important. Guidelines recommend getting at least 25 grams of fiber per day, which can be accomplished by consuming five to nine servings of vegetables and fruits. For example, one avocado has 13 grams of fiber while a medium-sized apple provides four grams, and a medium-sized banana has three grams. Berries are not only high in fiber but also help protect against colon cancer, according to a 2016 study in Molecules. Chia seeds are also a good option — just one teaspoon contains almost 6 grams of fiber. A cup of black beans packs 15 grams of fiber.
Plant-based foods will help ensure regularity. They also provide plenty of other health benefits, including increased absorption of such vitamins as A, K, and E, along with vitamin C and other phytonutrients which are rich in antioxidants.
A 2015 study showed that fiber was effective in those with mild-to-moderate constipation and in those with constipation due to IBS. A diet high in plant-based foods has been associated with reduced risk for colon cancer and has a favorable effect on gut bacteria. A 2012 study in World Journal of Gastroenterology showed that fiber helped increase stool frequency in adults.
Probiotics Foods – Probiotics are healthy bacteria. They can be very helpful in restoring the balance of the gut microbiome, especially when it has been altered by antibiotics or chronic use of acid-reducing medications.
Restoring the population of healthy bacteria, such as lactobacillus, bifidobacteria, and other important beneficial microorganisms is important to overall health and for easing constipation. A 2017 study in Advances in Nutrition showed that these crucial bacteria tend to be lower in those with chronic constipation.
Consuming cultured foods and drinks, such as sauerkraut, miso soup, tempeh, yogurt, and kombucha tea, may also be beneficial in restoring this natural balance. A 2016 study from Iran showed that pregnant women with constipation had improvement when they were given yogurt on a daily basis. Probiotic supplements are also frequently taken and will be discussed below.
Magnesium – Magnesium is a ubiquitous mineral that is involved in over 350 biochemical reactions throughout the body. Magnesium deficiency is also one of the most common nutrient deficiencies and may manifest in the form of headaches, heart palpitations, muscle cramps, and even constipation.
As a result, magnesium supplementation can be beneficial in those with constipation. However, if loose stool develops, the dosage should be reduced. Those with advanced kidney disease need to consult with their doctor. A 2017 study in Magnesium Research evaluated patients who had undergone open-heart surgery and not only did magnesium help prevent constipation but also helped prevent irregular heart palpitations, specifically atrial fibrillation.
A 2014 study in Clinical Gastroenterology and Hepatology focused on women with constipation in France. Researchers found that when magnesium-rich mineral water was consumed daily, symptoms of constipation improved significantly.
Vitamin C – Commonly found in citrus fruits and peppers, vitamin C intake is important to help prevent a condition called scurvy. It can also help with constipation.
Psyllium Husk – Psyllium Husk can be very helpful for those with chronic constipation. It may also help with blood-sugar control in those with diabetes. A 2018 study in Complementary Therapies in Medicine showed that individuals with type 2 diabetes who experienced constipation not only lost weight when they consumed psyllium but also saw improvements in glucose control. In addition, a 2016 study in Appetite showed that psyllium helped with satiety, allowing one to feel fuller and have less hunger between meals.
Prebiotics – Prebiotics are the nutrients and/or foods that healthy gut bacteria consume. By supplementing with prebiotics, such as inulin, one can help ensure that beneficial gut bacteria are adequately fed to help restore harmonic balance to the intestinal tract.
Foods which are considered prebiotics include apples, asparagus, banana, barley, chicory root, dandelion greens, flax seed. and garlic. Learn more about Prebiotics.
A 2019 study demonstrated the usefulness of optimizing prebiotic intake in the treatment of constipation. Likewise, a 2017 study published in the American Journal of Medical Sciences demonstrated that prebiotic alone, and in combination with probiotics, could help improve stool frequency and reduce straining and bloating symptoms.
Probiotics – Over the years, many of my patients have noticed a reversal of constipation when a probiotic was supplemented. A 2017 study in the Archives of Gerontology and Geriatrics compared a probiotic supplement to a placebo pill and found that probiotics improved constipation by 10 to 40 percent.
Another 2017 study in Asian children with constipation demonstrated that probiotics helped increase stool frequency. Further, a 2018 study showed that probiotics could also be beneficial in those with Parkinson’s disease who have constipation.
Cascara Sagrada (Buckthorn) – Buckthorn is an herb that has been used for hundreds of years to help with chronic constipation. The name translates to “sacred bark” and has played an important role in indigenous medical treatments. Scientists have discovered anthraquinone as being the active ingredient which provides its gut benefit.
Triphala – While Triphala is frequently used by some for constipation with success, I was unable to find any studies specifically on constipation. I did, however, find a study which shows the herb had a positive effect on the gut microbiome, which may explain why it has reportedly been helpful in the treatment of constipation.
Aloe – The aloe cactus has been used for multiple purposes throughout Asia and Mexico for centuries. Many report its usefulness in easing chronic constipation. There are studies going back to 1974 (and as recent as 2008) showing its benefit. It can be taken as a juice or supplement.
Senna – Used for millennia, senna’s usefulness was demonstrated in a 2017 study of children with constipation. Another study in 2018 not only showed senna to be effective but also very safe. Can be consumed as a tea or supplement.
Rhubarb – The Chinese have used the Rhubarb vegetable for almost 3,000 years for medicinal purposes, specifically, as a laxative. Modern science supports its ancient use. A 2018 study showed that rhubarb could be helpful in those who experience constipation during hospitalization. Can be consumed as a food or in supplement form.
According to ancient Ayurvedic remedies, a glass of warm milk and ghee can be helpful. I recommend one consider adding the ghee to coffee or tea — a combination that has been referred to as bulletproof coffee or bulletproof tea.
Licorice root powder added to warm water may also be beneficial.
Prunes and prune juice are a common constipation therapy that many find useful. A 2011 study found prunes to be more effective than psyllium for the relief of the condition.
Also, regularly consuming a warm cup of herbal teas, including black tea, chamomile, green tea, ginger, peppermint, or senna could get things moving again.
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By Dr. Eric Madrid, M.D.
