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Preventative Medicine

How to Avoid, and Treat, Constipation

When everything is running smoothly and “going” great, we are (predictably) happy. It’s when things start to get “clogged up” that we realize just how good we had it when everything was going great. This sentiment can apply to many things in life, but is most appropriate when it comes to “going” to the washroom.

Most people go (have bowel movements) fairly regularly. But for up to 27% of adults, chronic constipation (straining or having difficulty passing stools or infrequent bowel movements for weeks at a time) is a fact of life.

For most adults, the normal frequency varies, ranging from three times daily to three times weekly (a fairly wide range). Going to the bathroom is part of everyone’s routine and usually something that we take for granted… until a problem arises.  Whether your bowel movements come too often, not often enough or your stool is hard, dry and difficult to pass, it can make you uncomfortable, hurt, bloated, irritated, or even interfere with your body's ability to absorb enough nutrients from your food. Staying regular is crucial for staying healthy. It plays a major role in how you feel (physically and emotionally) while removing waste from your body.

Clinically speaking, you are constipated if you have less than three bowel movements in a week. Constipation is a symptom, not a disease, and can be caused by many risk factors such as:

  • Poor hydration – without enough water, our digestive system comes to a painful grinding halt. Women should aim for at least nine cups a day, men should aim for twelve cups.

  • Low fibre. Fibre (both soluble and insoluble) keep our digestive system well tuned. Healthy adults need at least 25 grams daily, people with digestive issues should aim for 50 grams per day, with an emphasis on soluble fibre.

  • Laxative abuse and overuse. Far too often people find themselves using laxatives as more than just a one-time helper. Overuse of laxatives (pharmaceutical, herbal and psyllium-based) can cause a condition called laxative dependency, where your digestive system becomes lazy and learns to require laxatives to “go”. This leads to the requirement of ever increasing dosages, pain and dreading the bathroom.

  • Sedentary lifestyle (as a general goal, aim for at least 30 minutes of physical activity every day that you can split up throughout the day)

  • Being a woman. The monthly cycle women go through leads to numerous physical and emotional changes as hormone levels fluctuate. One of those potential changes is bowel activity, which can lead to bouts of constipation and diarrhea.

  • Being over 65 years old. As we age, three things happen simultaneously to conspire against our regularity. First (for most of us), we exercise less. Second, our diets tend to change with reductions in fluids and fibre. Third, our digestive system becomes less efficient.

  • Withholding. When your body signals it’s time to go, it means it. Holding it in may be more convenient (depending on circumstances) and we all do it from time to time, but holding it in frequently can lead to serious digestive problems.

  • Medications. Numerous medications will have bowel implications as side effects. These include iron, calcium, magnesium, sedatives, narcotics, antidepressants and cardiovascular medications.

  • Medical conditions. Many medical conditions have an impact on your ability to “go”. Pregnancy, diabetes, hypothyroidism, Multiple Sclerosis, Irritable bowel syndrome and many more.

Constipation in and of itself does not usually lead to serious medical conditions. But it can cause serious symptoms such as;

  • Pain

  • Bloating or feelings of fullness

  • Cramping

  • Gas or flatulence

  • Loss of appetite

  • Swollen, or distended, abdomen

  • Nausea or vomiting

  • Straining to have a bowel movement (which can trigger painful anal complications such as a hemorrhoid, tear in rectal tissue or fecal impaction).

Mild cases of constipation can usually be treated easily by changing your daily routine with a combination of changes in your diet; more fibre, more water and increasing exercise. Try eating more raw vegetables, fruits, legumes and whole grains. Don’t forget to increase your intake of clear non-caffeinated and non-sweetened fluids (ideally plain water) to alleviate the increase of insoluble fibre in your diet, which may initially cause more bloating and gas. Cut back on high-sugar, high-fat and processed foods.

Natural remedies:

  • Try a fibre supplement rich in soluble fibre, such as Fiberrific. This supplement has no taste and can be added to any soft food or liquid and provides over 4 g of soluble fibre per teaspoon.

  • To keep your gut healthy, it’s a good idea to take probiotics, but results are mixed how helpful they are for constipation specifically. On average, probiotics slowed “gut transit time”, increased the number of weekly bowel movements and helped soften stools, making them easier to pass, but more research is needed to know which specific strains are the most beneficial.

  • Bulk-forming laxatives such as psyllium, flaxseed, and barley work by swelling in the intestines, softening stool and irritating the colon. This causes the colon to “push” out the irritation (and everything with it including nutrients). Be aware, you must take these with enough water or they may cause choking, bloating and pain.

  • Stimulant laxatives work by causing the muscles in the intestines to contract. Senna and Cascara are both frequently used in over-the-counter laxatives. They both come in a variety of forms (teas, tinctures, tablets) and they both work by irritating the colon wall, causing muscles to contract.  Aloe is also a powerful laxative. However, be aware that these laxatives can cause painful cramping and are only for short-time use as they can cause electrolyte imbalances.

  • Castor oil, from the seeds of the castor plant, is a powerful laxative. Ricinoleic acid, the main fatty acid in castor oil, binds to receptors on the smooth muscle cells of your intestinal walls and stimulates contraction.

  • Adding olive oil or avocado oil (which contain healthy fats) to your daily routine can help lubricate your intestines and ease constipation while promoting overall better health. It can also help relieve gas and other digestive problems.

  • Enemas are a traditional remedy for constipation and also used to “cleanse” prior to medical examinations and procedures. Water based enemas work by stimulating the colon to contract in order to expel the liquid (along with everything else) in the colon. Mineral oil enemas work like lubricant laxatives. Enemas can be quite effective for softening and eliminating hardened stools. Enemas are not the most pleasant experience but they do often work. However, enemas do have risks. If administered improperly, they can cause inflammation and internal bleeding. Regular use can cause serious electrolyte imbalances.

Constipation and chronic constipation affect millions of Canadians. Don’t feel embarrassed. Before you reach for the over the counter laxative, think about your other “better” options. Try changing your diet and lifestyle. Adding fibre and water to your diet while getting moving will work in most cases. If this doesn’t work, talk to your healthcare practitioner to get help before it becomes a serious issue. It may be something as simple as switching medications (i.e. from a regular iron to a microencapsulated non-constipating iron), or may be a sign of an undiagnosed, easily treatable condition.

 

Joel Thuna, MH, is a master herbalist with over 30 years of experience. Dr. Claude Gallant holds a PhD in Microbiology.