How to Improve the Constipation Perplexity
A common digestive system issue that people experience from time to time is constipation in which the stool expels too infrequently. The stool becomes difficult to pass because it has become too hard, too small, or too dry. Individuals would usually report the feeling of incomplete evacuation after the bowel movement has ended. Most practitioners and published articles would characterize the objective signs of constipation to have less than three bowel movements a week. Other health authorities would note, since bowel movements vary with each individual’s typical elimination pattern, there is actually no “right” number of bowel movements a person should have in a day or a week. However, there is one consideration worth including in the equation of managing constipation from a holistic perspective. Holistically, a regular bowel movement is an essential physical process for removing toxins from the body. Studies have shown that an excess accumulation of toxins may lead to various ailments and diseases of the body. The question is: how important is having a regular bowel movement? This article will discuss how informed lifestyle changes and better eating habits can help relieve constipation and suggest progressive actions to prevent the recurrence of constipation.
Measuring Colon Transit Time
If you have a bowel movement every day, it does not necessarily mean you have a clean bill of health. There still might be other problems. Another topic that can be a blog by itself is stool health. How much stool are you eliminating? What kind of consistency is the stool? What color is the stool? Are there significant offending odors? And just as important, how fast or slow is your digestive system processing your food? These are several important questions that are worth investigating to better understand how our physiology and lifestyle habits can influence our lives.
Many research studies are being conducted about the benefits of probiotics and how a healthy colon, rich in good microbes can be beneficial to the body. However, a critical component that is worth mentioning is how much of an impact bowel transit time can have on the overall health of the digestive system. One study reported that a rich variety of good bacteria did not necessarily lead to a direct correlation of a healthy digestive system. In fact, the longer food takes to pass through the colon; the more harmful were the degradation products that were formed by the bacteria 1,2. Is your digestive system processing your food too fast or too slow? The better question to ask is what type of lifestyle choices and eating habits can you follow to optimize your health?
Understanding Colon/Bowel Transit time (BTT) is a key factor in preventing disease in the gut. In the United States, the average bowel transit time is 50-100 hours, and the average stool weight is 100gm. The adult bowel transit time should be about 17-40 hours based on several studies3,4. The BTT is measured from the time food enters the mouth to the time it takes to travel out of the anus. A transit time of 73 hours or more is indicative of a slower bowel function. Natural color markers used to indicate transit time are activated in charcoal capsules “OO” in size along with various food dyes, including beets, are used. Conventional methods conducted by doctors and scientists used markers of ingestible wireless motility capsule, manometry, and Radio opaque markers.
Signs and Symptoms
- Bowel Movement (BM) is too infrequent
- Stool is too hard, too small, too lumpy, too dry
- Difficult to pass stool
- Possible cramping; abdominal pain
- Abdominal pain before, during, or after a BM
- Possible discomfort and tenderness during palpation of the abdomen
- Distention of the abdomen
- Incomplete evacuation after having made a BM
- Decreased appetite
When does constipation usually occur?
The Autonomic Nervous System (ANS) plays a significant role in a bowel movement. Sensory nerves are connected throughout the intestinal tract sending a message to the brain about the current activity that is occurring locally in the colon. The fecal contents push against the walls of the colon; thereby sensing rectal distention and stimulation of the external sphincters. This results in the urge for bowel defecation. When contributing factors disrupt the ANS system, bowel dysfunction usually occurs 5.
Contributing Factors to Constipation
In most cases, constipation is due to various lifestyle habits. This could include inadequate exercise and consumption of poor dietary choices such as excessive junk food, fried foods, low consumption of plant base fiber-rich whole foods, insufficient water intake, and food allergies.
How Lifestyle factors and stressors can lead to constipation.
- Living a sedentary life; physical movement is essential for optimal body health. Exercise helps to increase peristalsis, which causes the intestinal muscle to contract and relax so that it creates a wavelike motion.
- Chronic Anxiety: Chronic anxiety adds to other stressors causing the nervous system to be in ‘fight and flight mode.’ Our generalized muscles may lead to constant tension thereby decreasing colon motility.
- Insufficient fluid and fiber intake; bowel transit time increases which lead to an increased re-absorption of fluid in the colon. This results in dry stools which then leads to constipation. Furthermore, not having enough fiber leads to a lack of bulking of the stool which prevents stimulation of bowel walls to initiate contraction.
- Severe/sudden emotional distress is much like chronic anxiety in which the Autonomic Nervous System is replaced by the Sympathetic Nervous System; thereby decreasing intestinal motor activity (peristalsis).
- Intentionally restraining the urge to defecate affects the involuntary muscle contraction of the bowel which occurs due to the Autonomic nervous system. By neglecting the body to perform its involuntary duties, adds a consequential effect that alters the body’s processes to function normally. In this case, suppressing the urge to defecate may result in the absence of bowel movement leading to the complication of fecal elimination6.
Other contributing factors associated with medical causes are:
- Structural Abnormalities
- Neurological or Endocrine dysfunctions, ie. high levels of calcium and low levels of thyroid hormones
- Medications (antidepressants, painkillers, over the counter vitamins such as side effects of excess iron supplements)
- Muscle Disorders
- Advanced Age
- Pelvic Floor Dysfunction 7
- Medical Causes such as:
- Anal Fissures, Anorectal Abscess, Kidney failure or Diabetic Neuropathy-Diabetes, Diverticulitis, Hemorrhoids, Hepatic porphyria, Hypercalcemia, Intestinal Obstruction, Irritable bowel syndrome, Multiple sclerosis, Surgery and radiation therapy, spinal cord lesion, Tabes dorsalis, Ulcerative colitis, and Ulcerative proctitis8.
- Food Allergy:
Research studies have found that food induces constipation and has been observed in all age groups from the young to the elderly. Food sources such as tomatoes, cauliflower, peas, oranges, wheat, eggs, beans, and goat’s milk are among those foods that can cause constipation. The most common food that causes of chronic constipation in children is cow’s milk. However, dairy has also been reported to affect middle-aged and older adults. These studies have shown that eliminating the offending food agents resulted in a resolution of their symptoms9-15.
Discussion about the holistic relief and treatment of constipation
There are different methods in the approach of treating constipation. It may depend upon various factors such as duration (acute or chronic), inadequate intake of fiber and liquids, structural abnormalities, neurological or endocrine disorders, anal/rectal disorders, and consideration of other pre-existing medical conditions.
Changing your bad habits to good habits and developing a consistent routine are the best non-invasive methods of preventing constipation.
Health enthusiasts often overstate the word exercise. A preferred and alternate name is repetitive movement. The goal is to start slowly and ease into an exercise regimen. More importantly, is to find a physical activity that you enjoy doing and can remain consistent with over a period of time. The best approach is to utilize a goal-setting routine where you keep track of your physical activity. This is most useful when you are just beginning the process. Start out by creating a plan, writing it down, create a mind and then reward yourself to every accomplished goal. An example of this can be found here with the RDH’s Sugar and Physical Activity Tracker.
A Plant-based, whole foods diet can provide the fecal matter needed to have a bulking effect against the walls of intestines. Water-soluble and non-water soluble fiber can increase fecal size, increase weight, and help to retain water in the stool causing the stool to pass more comfortably through the colon 16-18.
Dehydration may cause constipation to worsen. Drinking adequate fluids is essential for optimal health in addition to preventing constipation. Water also helps fiber pass through the intestinal tract more easily.
Usually, the suggested recommendations on most nutritional supplements instructions may not be as effective in treating acute constipation but more as “nutritional” recommendations of daily value. You should not take any constipation medications before consulting with your physician. Your doctor will have a better recommendation of the therapeutic dose. You may find that you will get different responses as to how much to take and how often to take nutritional supplements.
- Magnesium: This is a mineral that can come in different types and forms. The most common are magnesium citrate or a combo of magnesium oxide and citrate, magnesium hydroxide, and magnesium sulfate such as Epsom salt. Some of these supplements may also contain vitamin C and calcium. Clinical studies have shown that nutritional doses can help to improve constipation. However, higher doses that are more than 600mg/day are usually not recommended for long-term treatment of constipation. High doses can cause a rapid bowel transit time resulting in diarrhea. Generally, you can get most of your magnesium from eating foods that are high in fiber such as whole grains, fruits, vegetables, seeds, and nuts.
- Vitamin C: Vitamin C acts as an osmotic agent that stimulates the intestines to absorb more water from the body. Consuming excessive amounts of vitamin C can potentially have adverse effects such as diarrhea, a burning sensation in the stomach, and other abdominal discomforts. Some studies indicated that vitamin C provided a resolution to constipation that occurred from the side effects of medication use19.
- Apple Pectin: Apple pectin is a carbohydrate that is highly rich in water-soluble fiber and can be found in jams, fruit juices, jellies, and in laxative agents. They are known to help with constipation, can decrease cholesterol levels, and may help people manage diabetes more effectively.
- Flax Seed Oil/Flax Meal: There are a minimal number of clinical studies of flaxseeds products for the treatment of constipation. However, many have reported its effectiveness due to the fiber content in the flaxseed meal 20. Similar to other high fiber content products, drinking a sufficient amount of water is essential when taking flaxseed meal. Water is drawn into the colon helping the fiber pass more easily into the digestive tract causing the stool to pass with less effort.
- Probiotics: Some studies in the early 1920’s indicate that taking probiotics improved constipation, but additional research is needed to determine the specific bacterial strains, duration, and appropriate dosages that will be most effective. Although studies of probiotics may not show, it has a direct correlation to treat constipation; it definitely has other benefits in the digestive system that help to achieve optimal health.
Laxatives are usually non-prescriptive medications that are used to help stimulate a bowel movement. Four types of laxatives have specific effects, and with repeated use, some can be harmful.
- Bulk-forming agents: The name describes how the mechanism works; fiber and water increase the contents of the stool which causes a bulking effect on the walls of the colon. Drinking an adequate amount water is necessary to give the bulking effect. Examples of these agents are psyllium and methylcellulose.
- Stimulant Laxatives: The mechanism in this product works by stimulating the receptors of the intestinal wall, thereby triggering peristalsis. Damage to the bowel walls can occur with excessive use and can easily lead to addiction. Examples of these laxatives are Dulcolax, castor oil, Dialose plus, and certain herbs like cascara sagrada, Per Diem, and Senokot.
- Osmotic Agents: These agents attract water into the colon causing a bowel movement to occur. Some examples are milk of magnesia, Epsom salt, and magnesium. This product can also initiate dependency, and occasional use is most often recommended.
- Stool Softeners: This mechanism works by softening the stool allowing the stool to pass through the colon easily. They are intended for the treatment of constipation and for those who are straining during a bowel movement. It is for short-term use only as stated by the manufacturer’s recommendation as well as other clinical evidence that has been reported.
- Aloe Vera: Aloe vera juice has been known to soften the stool. It has been used by many indigenous cultures as a remedy for numerous health ailments. Aloe has antimicrobial properties, digestive aid, and cleansing properties that will benefit the intestinal tract, but not pleasant in taste. Many brands have tried to make it possible to retain the health properties of aloe vera juice and still be palatable.
- Ginger: The ginger root is commonly used as remedies for most digestive issues including stomach aches, nausea, warming properties, anti-inflammatory issues, and cold and flu relief. It eases the passing of food through the intestines.
- Redefining Health’s Bowel Mover: This is a frequently used product in our herbal product solution store. It contains an all natural herbal combination design to encourage regular and optimal bowel function. In addition, while supporting the digestive system to help remove toxins through the process of elimination.
Other Factors Associated with Medical conditions
- Hypochlorhydria: Hydrochloric acid in the stomach is produced during the ingestion of food. Hypochlorhydria is a condition characterized by low levels of hydrochloric acid in the stomach which is necessary for the break- down of food. One study reported that constipation may be a symptom of hypochlorhydria. If hypochlorhydria were the underlying cause of constipation, then the supplementation of hydrochloric acid may relieve the problem 21.
- Hypothyroidism: Constipation is also a common symptom associated with hypothyroidism. When individuals have their thyroid function levels corrected and their laboratory findings are positive; the administration of the appropriate medication dose has been reported by clinicians to have resolved the problem of constipation.
- Pregnancy: Although pregnancy is not the cause of constipation, it is worth considering that constipation is not uncommon during pregnancy. Research has shown that the problem can be addressed most often with changes in lifestyle habits and diet.
- Individuals who are on bed rest may benefit from frequent repositioning. Conducting active and passive exercises as indicated by the certified practitioner or physical therapist may also be helpful.
- Abdominal toning exercises have been known to be beneficial if general muscles are weak. Pelvic floor exercises are also useful and may significantly benefit a person when taught by a certified Physical/Physio Therapist or a qualified professional.
- Breathing and relaxation techniques can help to trigger the Autonomic Nervous System thereby reducing stressors, initiating involuntary muscle contracting of the digestive tract, and reducing the fight & flight response. It has been recommended that not reading a book or watching a movie on your phone or digital device while defecating is also a wise choice.
- It can be helpful to attempt to defecate at the same hour of the day and make it a habitual activity. Repetitive actions can set a normal nerve reflex that will help pass the stool easily.
- When possible, do not resist the urge to defecate. Holding in your ‘poop’ can lead to other digestive or elimination issues. Although flatulence can be embarrassing, it can certainly be uncomfortable to hold the stool in. Due to the build-up of air pressure in the intestinal tract, you should definitely not make a habit out of it.
- If you would like to learn more information about the consistency of healthy stool, we recommend that you read about the Bristol Stool Scale.
- Tora Tora Principles of Anatomy and Physiology
- Lippincott, W & W. Sixth Edition: Professional Guide to Signs & Symptoms. Wolters Kluwer, 2011;168.
- Pemberton, JH et al: The pelvic floor: its functions and disorders. Philadelphia, 2001, Saunders.
- Lippincott, W & W. Sixth Edition: Professional Guide to Signs & Symptoms. Wolters Kluwer, 2011.
- Daher S, Sole,de Morais MB. Cow’s milk and chronic constipation in children. N Engl J Med 1999;340;891.
- Arrequin L. Ortiz I. Chronic constipation as a manifestation of allergy to cow’s milk proteins. Ann Allergy Astma Immunol 1997;78:147.
- Iacono G, Cavataio F, Montalto G, et al. Intolerance of cow’s milk and chronic constipation in children. N Engl J med 1998;339: 1100-1104.
- McGrath J. Allergy to cows’ milk presenting as chronic constipation. Br Med J 1984;288.
- Iacono G, Carroccio A, Cavataio F, et al: Chronic constipation as a symptom of cow milk allergy. J Pediatr 1995;126:34-39.
- Chin KC, Tarlow MJ, Allfree AJ. Allergy to cow’s milk presenting as chronic constipation. Br Med J 1983;287:1593.
- Vanderhoo JA, Perry D, Hanner TL, Young RJ. Allergic constipation: association with infantile milk allergy. Clin Pediatr 2001;40:399-402.
- Cann PA, Read NW, Holdsworth CD. What is the benefit of coarse wheat bran in patients with irritable bowel syndrome? Gut 1984;25:168-173.
- Graham DY, Moser SE, Estes MK. The effect of bran on bowel function in constipation. AM J Gastroenteol 1982;77:599-603.
- Corinaldesi R, Stanghellini V, Bocci G, et al. Dietary fibers and intestinal transit times. Curr Ther Res 1982;31:173-180.
- Scher J, Rice H, Kim S, et al. Massive vitamin C as an adjunct in methadone maintenance and detoxification. J Orthomolec Psychiatry 1976;5:191.
- Cunnane SC, Hamadeh MJ, Liede AC, et al. Nutritional attributes of traditional flaxseed in Healthy young adults. Am J Clin Nutr 1994;61:62-68.
- Harstock CL. The treatment of digestive disturbances in asthenic patients. Med Clin North Am 1934;17:1029-1044.