Constipation is one of the most common—not to mention annoying—health problems we can face. And it’s one that you probably don’t talk about much with your friends.
Yet, if you’re feeling plugged up and irregular, you’re not alone. In the United States, constipation accounts for seven million physician visits per year.1 Chronic constipation affects almost one in six adults.2 Annually, it costs an average of $3,000 per patient to do all the tests necessary to diagnose chronic constipation and another $4,500 per person to provide treatment.1
The costs to your quality of life are equally steep. A review of the medical literature published in 2010 showed that reduced quality of life from constipation was comparable to that caused by serious chronic conditions such as osteoarthritis and diabetes.3
There are, however, ways to improve regularity and enhance your quality of life. In this article, I’m going to discuss the causes of constipation and let you know exactly what the long-lasting and effective strategies are—and they don’t include laxatives.
Am I Really Constipated?
Ask this question to an alternative doctor and a conventional one and you might get very different answers. Conventional physicians define constipation as less than three bowel movements per week. They believe that bowel habits range widely among people from three per day to three per week.
Many alternative doctors, including myself, take a different stance. From our perspective, less than two to three bowel movements per day indicates constipation. This is because the bowel helps the body eliminate toxins. After all, bile is eliminated through the feces, and the liver excretes bile as it’s undertaking its detoxification role. For the body to heal and wellness to prevail, toxic waste absorption must be minimized.
The large intestine absorbs about 90 percent of the water content it receives from the small intestine. If this slurry of food material and moisture remains in the colon too long, excess moisture is absorbed and toxins and waste burden are reabsorbed disproportionately, irritating the colonic lining. This is why, when individuals fail to have two to three bowel movements per day, they feel ill and tired. Furthermore, their stools are harder and drier because the body has reabsorbed the toxic wastewater.
However, one thing both conventional and alternative practitioners agree on is that hard stools, straining excessively during bowel movements, a sense of rectal blockage and having a feeling of incomplete evacuation after having a bowel movement are all signs you’re constipated.
Causes of Constipation
There are many reasons why you may become constipated. For example, traveling or any change in daily schedule that interferes with your usual bathroom habits.
Certain medications also can trigger constipation such as antidepressants (excluding the SSRIs), calcium channel blockers, pain medications (especially narcotics like codeine, morphine and oxycodone), diuretics, antihistamines, antispasmodics, anticonvulsants, anti-Parkinson drugs and aluminum antacids.4-5
Additionally, many health conditions are associated with chronic constipation including stroke, multiple sclerosis, Parkinson’s disease, spinal cord injuries, diabetes, hypothyroidism, excessive calcium in the blood, lupus and scleroderma.5
Another possible cause of constipation is pelvic floor dysfunction. This refers to a wide range of issues that occur when muscles of the pelvic floor are weak, tight or there is a problem with the sacroiliac joint (a joint in the pelvis), lower back, tailbone or hip joints.
Even bedwetting in children can be a sign of undiagnosed constipation. In a study published online in 2011 in Urology, researchers found that 30 children and adolescents who sought treatment for bedwetting all had large amounts of stool in their rectums, even though the majority had normal bowel habits. After using laxatives, 25 of the children (83 percent) stopped bedwetting within three months.6
Emotional stress also can cause things to become plugged up. In a study of male college students published in 2010, researchers discovered that life stress was significantly higher in the constipated college students compared to the control group.7
In another study of children and adolescents, constipation occurred significantly more often in children exposed to stressful life events.8 Plus, stress affects the microbial colonization on the mucosal surface of the gut, which can lower your level of good bacteria.9
Finally, lack of exercise—which can help stimulate intestinal activity—and low fluid intake may also be the culprit behind your constipation.10
Good Night’s Sleep Promotes Regularity
A great deal of evidence indicates that melatonin, the hormone produced primarily at night when you’re asleep in a dark room, can stimulate intestinal activity. Staying up late to get things done reduces the melatonin your body produces. And even if you do go to bed earlier, looking at a computer screen before bedtime can expose the body to short-wavelength light (460 nm), otherwise known as blue light, which has been shown to reduce melatonin levels.11
Your gut contains at least 400 times more melatonin than your pineal gland, where melatonin is actually produced.12 So if you’re exposed to light throughout the night, it makes sense that it may have gastrointestinal consequences.
Complications of Constipation
Chronic constipation can have serious consequences. When you strain to have a bowel movement, it can cause hard stool to stretch the sphincter muscle, resulting in hemorrhoids or anal fissures (tears in the skin around the anus) and the accompanying rectal bleeding and pain. Straining can also cause rectal prolapse. This is when a small amount of the intestinal lining extrudes from the anal opening.10
Constipation may also be to blame for fecal impaction, especially in children and older adults. When this happens, the hard stool packs the intestine and rectum so tightly that the normal pushing action of the colon is not enough to expel the stool.10
Getting Things Moving Again
Laxatives are often the first choice to resolve constipation, but there are plenty of other lifestyle and dietary solutions that will ensure you not only resolve any existing constipation, but also that you prevent constipation from developing in the future—presuming your constipation isn’t caused by a drug, After all, constipation is a sign that your colon isn’t functioning properly, and laxatives only serve as a temporary patch rather than fixing the problem that’s causing the constipation to begin with.
Additionally, laxatives are not ideal because of their potentially adverse side effects, such as causing tolerance so that the intestine isn’t as capable at releasing the stool on its own, melanosis coli (a disorder of pigmentation of the wall of the colon caused by prolonged use of laxatives) or cathartic colon (structural damage to the colon associated with stimulant laxatives).13-14
First, you obviously want to eat more fiber, fruits and vegetables and make sure you’re drinking enough water. A green drink can help if you’re having a hard time consuming more than three servings of vegetables per day.
When choosing high-fiber foods, there’s one word of caution. Many products on the market are advertised as being “multi-grained” and good sources of fiber. But are they really? The only way to tell for sure is to scrutinize the ingredient list. If the product is a good source of whole grains, the first word you’ll see on the ingredient list is “whole.”
Flaxseed is a good choice for soluble and insoluble fiber. It’s been used as a traditional medicine for centuries to treat constipation. Modern research supports the use of ground flaxseed in your diet to ease constipation. Flaxseed exhibited the similar laxative actions in healthy and constipated subjects.15-17
You can find it in several forms—whole seed, ground seed and partially defatted flaxseed meal (PDFM). For the highest content of dietary fiber, choose the PDFM form.13
If you’re prone to constipation, one of the foods you’ll want to avoid is white bread, because white flour is low in fiber. Nuts, cheese, chocolate, white rice and bananas also tend to be constipating.5
A good fiber supplement containing ingredients such as psyllium husk powder, apple pectin, prune fiber powder, citrus pectin, rice bran, and/or beet fiber also can help get things back on track again.
Making sure you’re eating plenty of magnesium rich foods such as black beans, halibut, pumpkin seeds, cooked spinach, okra and peanuts also is helpful, as magnesium is known for its ability to stimulate bowel movements. Additionally, you can consume magnesium supplements. Aim for 500 to 600 mg per day taken in divided doses.
Vitamin C is another bowel-stimulating nutrient. Incorporate it into your diet by eating more high-fiber fruits or consume up to 1,000 mg of a vitamin C supplement per day, ideally in divided doses.
Taking a 15- to 30-minute walk per day can help stimulate intestinal activity. Or try any exercise you enjoy, such as swimming or running. Just be certain to drink plenty of fluids, as dehydration also is associated with constipation.
Massage does double duty. It helps reduce stress, which is associated with constipation, and it can relieve the constipation directly. In one study published in February 2011, researchers compared the effect of two types of massage in 38 female college students suffering from constipation. Both types of massages relieved stress and constipation, leading the study authors to conclude, “Resorting to either types of massage will contribute to the reduction of use of stool softeners, suppositories or enemas.”18
Traditional Chinese Therapy
There’s also research to support that acupuncture combined with moxibustion, a traditional Chinese therapy that uses the mugwort herb, can relieve constipation. Researchers conducted a review of the medical literature, published in January 2012, in which they analyzed a total of 15 papers involving 1,052 patients. Their findings indicated that acupuncture and moxibustion do a better job at curing constipation than ordinary medication.19 While the researchers called for more high-quality studies to support their conclusion, the findings look promising.
If the cause of your constipation is pelvic floor dysfunction, then you’ll want to look into learning biofeedback. Biofeedback retrains the muscles in the pelvic floor that control release of bowel movements.
Many studies, including recent randomized, controlled trials, have shown that biofeedback can relieve constipation in people with pelvic floor dysfunction.20-22
In one study, published in June 2012, patients with dyssynergic defaecation—a complication of pelvic floor dysfunction that causes constipation—underwent a four-session, structured biofeedback program under the supervision of trained nurses. The subjects experienced reduced constipation and improved quality of life. After one year, 160 (71 percent) patients reported that improvements were maintained.23
Probiotics offer your colon powerful protection against stress‐mediated alterations of gut functions. They keep your intestinal barrier strong through the reduction of altered gut permeability. This means they can stop what’s known as leaky gut syndrome, where gaps in the intestinal wall allow miniscule bits of food particles to escape into your circulation.24
Probiotics also help in achieving intestinal regularity. In one study, Lactobacillus plantarum improved abdominal pain and normalized stool frequency in constipated patients with irritable bowel syndrome (IBS). The effect appeared to be strain specific, as Lactobacillus rhamnosus GG had more of a beneficial effect in IBS patients who predominantly had diarrhea.24
The strain of probiotic known as Bifidobacterium longum is equally effective. In one trial published in September 2011, researchers studied 59 constipated children ages 5 to 15 years old. They gave the children goat’s milk yogurt supplemented with Bifidobacterium longum for five weeks, then only the yogurt without the Bifidobacterium longum for another five weeks.
Both groups receiving the B.-longum-supplemented yogurt and the plain yogurt demonstrated improved defecation frequency compared to baseline—which makes sense given that yogurt already contains probiotics. However, the group treated with B. longum experienced the most significant improvement while they were taking the probiotic-supplemented yogurt. When they switched over to the yogurt that didn’t contain B. longum, their stool frequency decreased.
The children also experienced a more significant improvement in abdominal pain and defecation pain when eating the B. longum yogurt.25
Sleep and Melatonin
If you’re troubled by constipation, going to bed by 11 p.m. every night to ensure your body produces optimal amounts of melatonin can help you restore your regularity.
Another option is to supplement with melatonin, 3 mg before bedtime, which may enhance gut motility.
If you tend to work late at night on your computer, you can also download an app for your computer that changes the color of light it emits. Normally, computer screens emit blue light. In the day, this is fine because it matches daylight. But at night this blue light interrupts your melatonin production.
Downloading a free desktop application known as f.lux™ adjusts a computer screen’s color throughout the day from blue in the daytime to a warm shade of red-orange at night. In the morning, it returns to blue again.
You Can Be Regular Again
Constipation is a real problem for many people. While laxatives can help on the short-term, for longer-lasting solutions, try the advice in this article to help get things moving again.
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