Contrary to popular wisdom, frequency of bowel movements is not a criterion for diagnosing constipation because of the wide range of variability among individuals…Bowel movements should be fairly regular and pass with no straining or pain.
~ Disease, Prevention & Treatment, 5th Ed., Life Extension
Constipation. It’s not a fun or pretty topic to discuss, but just about everyone needs to address it at one time or another, and about 14% of adults suffer from chronic constipation. Female and males of all ages (especially seniors over age 70) may experience its unpleasant, and potentially painful, symptoms. Regardless of gender, age, or cause, constipation is a gastrointestinal disorder that should never be ignored, and safe, effective natural remedies can, in many instances, provide relief without side effects.
Symptoms, Causes & Risks
Peristalsis (waves of muscular contractions coordinated by signals from the nervous system and neurohormones) moves fecal material through the large intestine (colon). Dysfunction in the enteric nervous system (network of nerves that control the gut) can cause dysfunction in the CNS (the brain and spinal cord), and vice versa. Researchers have determined that dysfunction in this so-called gut-brain axis not only causes insufficient peristalsis that in turn causes constipation, but also contributes to irritable bowel syndrome (IBS).
Constipation is strained or painful bowel movements of hard/dry/lumpy stools created when waste moves too slowly through the digestive tract. Chronic constipation generally lasts six months, with specific symptoms lasting at least three months (e.g., straining with 25% of bowel movements), and may be a sign of IBS. Other symptoms and complications of constipation, especially if chronic, can include: (1) abdominal bloating/discomfort; (2) delirium/anorexia/general functional decline in the elderly; (3) hemorrhoids; (4) anal fissures (small tears in the anus lining); (5) rectal prolapse (a collapse and telescoping of the rectum through the anal canal); (6) sensation of incomplete evacuation, fecal impaction, or bowel toxicity; (7) bowel/bladder incontinence; and (8) acquired megacolon (extremely enlarged colon that may require surgery).
Common causes of constipation include: (1) poor diet [i.e., inadequate intake of bulk-forming fiber and water (though some studies indicate fluids intake is not a risk factor); consumption of foods that cause sensitivities/allergies (see below)]; (2) inactivity and weak abdominal/intestinal muscles; (3) medications for pain [especially opioids (narcotics)], blood pressure, depression, digestion (antacids containing aluminum or calcium, dependence-causing excessive use of laxatives), allergies, and cancer; (4) emotional conditions (stress, anxiety, depression); (5) parasites and intestinal bacteria [yeast/candida, small intestinal bacterial overgrowth(SIBO)] ; (6) hormonal fluctuations (PMS, menopause, low-T, hypothyroidism, hyperparathyroidism); (7) certain iron and calcium supplements; (8) neurological diseases (Parkinson’s, multiple sclerosis, spinal cord injury); and (9) poor sleep.
Disadvantages of Conventional Treatment
Practitioners diagnose constipation based on a patient’s specific bowel habits, symptoms, and medical history. They generally first recommend regular exercise with adequate fluid (eight-8oz glasses of water/day) and fiber intake (20-35 grams/day). Both soluble (oats, apples, beans, peas, bread/cereal) and insoluble (fruit skins, brown rice) fiber contribute to increasing the size of stools, which makes it easier for the colon to move and pass them. Gel-forming soluble fiber renders stools softer and firmer, while insoluble fiber promotes colon contraction and scrapes the walls of the intestines to clean them. Though humans cannot digest fiber, the five pounds of friendly bacteria in the intestines thrive on it and use it to produce short-chain fatty acids that intestinal cells use for energy. Known as prebiotics, the fibers that feed healthy gut bacteria are fermented in the colon (and thus are not always well-tolerated) and include inulin, FOS, acacia gum, and psyllium.
Conventional doctors may also prescribe oral laxatives, suppositories, and/or enemas. Abuse of any of these laxatives, widespread in the United States, can cause these health issues: (1) dehydration or water retention (edema); (2) mineral (electrolyte) imbalances (with dehydration, can cause cardiovascular problems); (3) changes in pH balance; (4) inability to produce adequate digestive enzymes; (5) poor absorption of vitamin D and calcium (can weaken bones); (6) excessive weight loss or gain; (7) damage to, and dysfunction of, the intestines; and (8) cancer and death.
Nutritional Supplements to Prevent or Relieve Constipation
These nutritional supplements can help relieve symptoms of mild-to-moderate constipation:
Aloe Vera Juice/Gel: This extensively studied plant contains polysaccharides, electrolytes, enzymes, minerals, and vitamins that help heal the gut. Its polysaccharides have proven to support digestion by promoting a healthy stomach pH and the growth of healthy bacteria. Aloe also has potent anti-inflammatory, antibacterial, antifungal (including candida albicans), and antiviral properties (including herpes).
Fiber: If the fiber-water combination discussed above does not provide adequate relief , try with plenty of water: (1) chitosan (a component of the shell of shellfish), which binds fat from food in the stomach/intestines, thereby rendering feces soft and smooth (3 grams chitosan + 1 gram vitamin C before each meal); or (2) glucomannan (a water-soluble fiber from the konjac root that is even safe in often-constipated pregnant women), which promotes a larger, bulkier stool and generally promotes a bowel movement within 12-24 hours.
Magnesium: This often deficient mineral is a well-known natural laxative, generally in doses exceeding 600mg/day. Well-absorbed magnesium citrate or glycinate are effective options.
Enteric Coated Peppermint: Menthol, the active ingredient of peppermint, is a natural antispasmodic that relaxes intestinal walls, especially when constipation is secondary to IBS. Patients with acid reflux (GERD), hypoglycemia, or gallstones, should not use this herb.
Probiotics: Restoring healthy intestinal flora balance in the gut should generally be part of any regimen to improve bowel function. Beneficial strains include Lactobacillus acidophilus and Bifidobacterium bifidum, and appropriate doses can range from 15 billion to 200 billion bacteria or more, depending on tolerance and the cause of constipation. Rotate tolerated refrigerated products to maximize propagation of various beneficial strains.
Vitamin B5 (Pantothenic Acid): On an empty stomach, 2-3 grams can promote rapid evacuation of the bowels. This remedy should not be used at night/bedtime given the vitamin’s ability to support the adrenal glands and energy production.
Vitamin C (Ascorbic Acid): High doses of this antioxidant (1,000-4,500 mg/day) are well-known to relieve constipation when taken on an empty stomach. Some maintain that buffered vitamin C is as effective as non-buffered.
Some Dietary & Lifestyle Choices
Diet Changes: Eliminate potentially problematic foods from the diet for 30 days to determine the extent to which they cause sensitivities/allergies. One at a time, avoid these common offenders: (1) dairy (pro-inflammatory; slows motility); (2) eggs and meat [slow motility; red meat rots in the colon and its consumption increases the risk of colon cancer; and (3) gluten (in wheat/barley/rye/contaminated oats; celiac disease can cause secondary constipation). Other common food allergens include soy, nuts, fish, and corn (especially GMO). Consuming certain healthy foods with a laxative effect can also be beneficial, including certain fruits (pears, plums, apples with skins, prunes, kiwi/other berries) and dried fruits (more fiber than fresh fruit), certain vegetables (green leafy, high in magnesium; broccoli; sweet potatoes/skins), nuts (almonds, walnuts) and seeds (chia, flax, pumpkin), whole grain gluten free bread, coconut water, and non-dairy probiotic foods (absent candidiasis; not always well-tolerated).
Also Potentially Helpful: (1) yoga – navel pumps in counts of three for as many minutes as possible, as many times per day as possible; (2) retrograde colonic irrigation (RCI); (3) chiropractic adjustments (valuable for infants); (4) perineal self-acupressure (application of external pressure to the perineum, the area between the anus and genitals); and/or (5) acupuncture.
The statements in this article have not been evaluated by the Food and Drug Administration (FDA) and are not intended to take the place of a physician’s advice. Unless supported by specific cited research, the natural remedies discussed herein are not intended to diagnose, treat, cure or prevent any disease.
Submitted by Michael Dworkin, PD, CCN, a Registered Pharmacist and State Certified Clinical Nutritionist (CT Cert. No. 232), with J. Erika Dworkin, Certified Lifestyle Educator and Board Cert. Holistic Nutrition (Cand.). Owner of the Manchester Parkade Health Shoppe (860.646.8178, 378 Middle Turnpike West, Manchester, CT, www.cthealthshop.com), Pharmacist Dworkin has been guiding patients since 1956 and is available for consultation by appointment. Erika is available to speak to groups. All statements in this article are based on research or clinical experience and references are available upon request.