Constipation. It’s something we have all experienced at some point in our lives and for some, it is unfortunately an ongoing problem. The bloating, the fullness, the fatigue, and the never ending trips to the bathroom to gain relief, are an issue for many, especially as you age. So, what’s going on? Is there a bigger problem in your belly? Is constipation a sign of a greater issue? What can be done to help move along the problem?
Constipation can happen to anyone, male or female, young or old. In most instances, it is an isolated incident, resolves, and is never experienced again. However, for many, especially as they age, constipation becomes a chronic issue, occurring almost daily. Constipation impacts about 16 out of every 100 people on a chronic basis, increasing to 33 out of 100 people over the age of 60. Interesting how age appears to be a factor, right?
Constipation. What’s the Hold Up?
As a kid, around the age of 8 or 9, I remember dealing with constipation. There were some family issues and I was often anxious as a child, so the root cause was likely emotional. I remember my mother always having some sort of laxative on hand in the house, which was quickly offered to me to help ease the issue. That was in the mid 1970’s, and if a laxative was kept in our house, it was usually in the medicine chest along with other frequently utilized pharmaceuticals.
Constipation is not a disease by itself, but more or less, a symptom of something potentially greater. If you are constipated often, there is no need to go into the details of signs, but generally speaking they are:
- Having fewer than 3 bowel movements per week
- Hard, dry, lumpy stools
- Stools that are difficult or painful to pass
- A feeling that all stool have not passed
As mentioned, constipation itself is a symptom, not a disease. A symptom is a clinical manifestation of some other problem, so what other problems are there? Let’s look at normal physiology.
In the normal, healthy body, food is taken in via our mouth, moved to the stomach for first stage digestion, then it migrates to the small intestine. This migration of ‘food stuff’ is through snake like movements of the stomach and intestines, referred to as peristalsis. In the small intestine, the food stuff is further broken down and nutrients are absorbed over time. Then, the remaining food particles move on to our large intestine, mainly referring to our colon, where further nutrients are removed, water is absorbed, and some fermentation takes place which produces gas. The general transit time in healthy individuals from stomach to rectum is about 24 hours, give or take a few hours. This means that if you eat something today, it should be on its way out tomorrow. In fact, there is reflex, called the ‘gastro-colic’ reflex, which is stimulated when food enters the stomach. Upon realizing that new food has entered the system, a reflex stimulation is sent to the colon to stimulate movement, ideally a bowel movement, to literally make room for new food making it’s grand appearance. Anyone that has raised an infant is very well aware of this reflex with the multiple diaper changes associated with meals.
How many bowel movements is considered normal?? That’s a good question and in most research papers, generally speaking, 1-2 bowel movements per day appears to be a gold standard. Now, in one research paper that I remember from years ago, investigating the high fiber intake of some African tribal community, the researcher noted that those individuals could actually ‘poop’ on demand. Now, that may throw the 1-2 bowel movement per day standard out the window. In truth, if I look at our family pet, being a Greyhound on a home-cooked diet, she will have about 2-3 bowel movements per day, so why should you or I be any different?
The reality is that constipation impacts many people on a daily basis and some of those people may only have one bowel movement per week, some even less frequent than that based on some data! I cannot imagine and can only sympathize, but with a certain level of understanding, it is not hard to see that some true options are available.
In order to maintain bowel movement consistency, a few things must be in working order.
- First, the intestinal motility (peristalsis) must be working and with normal, smooth and consistent movements.
- Second, water must be present within the fecal material in order to ease movement through the intestines and out the rectum.
- Fourth, the digestive microbiome must be in proper balance to facilitate adequate digestion and fermentation of food stuff.
- Food must be entering the system routinely.
- Third, there should be no blockages within the digestive tract which would reduce food stuff movement.
That is the basic science behind the physiology of bowel movements. If you impact any one of those factors, then constipation is likely to rear it’s ugly head. A few tidbits to keep in mind here. Your fecal material is literally waste, almost like toxic debris to an extent. Anything present in the food that you ate which is not of any value to your body is pushed to the grand exit for elimination. This includes various chemicals, dyes, preservatives, additives, and other potentially toxic debris found in the food you eat. Ideally, your body wants this stuff out as soon as possible, hence frequent bowel movements. If you are constipated, this means that toxic stuff hangs around internally longer than intended, and the longer it hangs around, the more contact time it has with the lining of your colon and other tissues. This then implies a connection between colonic disorders, including cancer, with constipation. Many of those chemicals are carcinogens, cancer causing agents, and the more contact time, the more cellular damage that can develop. The same can be said regarding your urine and how often you pee throughout the day.
Constipation; Your Diet and Emotions
As mentioned above, there is normal physiology which must be present and functioning for you to have a bowel movement. Any interference in any of those factors can result in constipation. One of the biggest factors that is emphasized is your chosen diet, specifically referring to its fiber content. While this is true, it is only one facet or piece of the puzzle, and why many that take fiber supplements may not gain adequate relief.
In truth, fiber is very important to digestive health and bowel motility, including bowel movements. Fiber acts to bind water, which helps to ease the fecal material out of your body. Fiber also literally feeds and helps to balance the population of bacteria present in your digestive tract, acting as a primary prebiotic. General recommendations on fiber intake are from 15-30 grams per day, ideally aiming for the higher number. In reality, that 30 gram per day number is easily exceeded with those taking on a whole-food, plant based diet, with some cultures consuming over 100 grams of fiber per day! Remember the research participants that could literally poop on demand?
Now, while fiber is very, very important, a few points need to be said. First, consuming fiber via a plant-based diet, from natural fruits and vegetables, is far different than taking a fiber laxative supplement from your grocery store or pharmacy. Why? Well, plainly speaking, the fiber is different, more natural from food than from a mix-in supplement. Second, when you consume fiber from plant based sources, you are also gaining other prebiotic materials, not to mention plant based co-factors which exert natural antioxidant and anti-inflammatory properties. It is a lot healthier in the long-term to get that fiber from natural foods and why it is not surprising to see the clinical benefits from those types of diets. Makes you wonder if you are getting those 5-7 servings of fruits and vegetables per day, right?
One last thing regarding fiber. In order for that fiber to work, meaning to bind water and soften up the fecal material, one thing needs to be present and that is adequate hydration of your body. When you consume natural fruits and veggies, you gain additional hydration through water which is present in those foods, which is around 90% of weight. A fiber laxative in a glass of water is likely not going to cut it and in fact, most people do not consume the proper amount of water per day to keep their bodies hydrated, which is around 64 ounces of water per day, on the low end. If you are not consuming enough water per day, and this does not include coffee, soft drinks, or alcohol, then this could be a primary issue in your battle with constipation. Many drinks, such as coffee and some alcohol, not to mention some long-term medications, actually dry out your body even further through natural diuretic properties, compounding the issue of constipation in many.
The concept of hydration, or really low-level dehydration, is actually one of the main reasons why constipation is more common in people as they age. In Chinese Medicine, this is termed a YIN deficiency and is not just common, but one of the main causes behind the aging process, organ health, and even cognitive function. This is also seen in the loss of body weight, increased frailty and thinning of the skin and sunken eyes in the elderly. All associated with reduced hydration. Not uncommon to then have chronic constipation.
Now, moving further, one other main issue associated with constipation is your emotions, as noted in my personal history as a child. Anxiety, depression, anger, fear, worry and many other emotions that you may encounter on a daily basis impact your digestive motility, which then impacts your bowel movement frequency. For some, these emotions result in increased bowel movement frequency, while in others, it is reduced. Hence, the strong connection between the psyche, emotions, and digestive health conditions including irritable bowel syndrome (constipation and diarrhea), irritable bowel disease, ulcerative colitis, and Crohn’s disease.
What’s pretty neat, at least to me, is to see how tightly emotions are tied in with organ function, including your digestive tract. We all know how emotions such as anger can raise blood pressure and your heart rate, but it can also impact your digestive motility, slowing things down to a crawl. When you slow down motility, it give the body more time to absorb water from the food stuff, which then makes your bowel movements harder and firmer, often painful to pass at times. This is the impact of your emotions on your brain function and neurotransmitter release. It is also a reflection of the ‘fight or flight’ response. If your body is all stressed out (fight response), then your bowel motility is literally shut down as blood is redirected to other areas of more importance. What’s even more interesting is that your emotions also impact your digestive microbiome, which is noted in research on anxiety and depression. In order to facilitate proper digestive movement and health, your body needs to be relaxed! Not easy to achieve in today’s world, right? But…it is of vital importance to your health!
Options for Constipation Management
Hopefully you can see that chronic constipation is not always an easy fix. Sure, for some, it can be quickly improved just by changing your diet and increasing water consumption. However, for others, the problem is much deeper and often emotionally rooted.
Fiber, moisture and the concept of ‘YIN’ are deeply intertwined. All impact your digestive health and truly, impact the aging process. All three are conquered together by eating certain foods, vegetables and fruits, which are naturally high in moisture and fiber, which also tonify your body for the concept of ‘yin’. Yin refers to many facets of health, generally speaking it is of a cooling, moisturizing type of property, typical of many fruits and vegetables. Many green vegetables and some fruits are yin-tonics, but so are some root vegetables, including the sweet potato and wild yam for instance. If you are not a fan of consuming multiple servings of vegetables per day, then making a green shake may be an option, as long as you are also consuming adequate water in volumes during the day. One option is the Cur-OST HU Multi-Enhance, which offers not just a variety of high dose vegetables, but includes a good serving of natural fiber to boost and support digestive health.
Regarding fiber and natural laxative properties, two other formulas come to mind and something that I consume personally on a daily basis. The Cur-OST HU Stomach & Soothe is a blend of two very moisturizing and high fiber herbs, being marshmallow root and aloe. Both are used traditionally to aid in restoring hydration to the body and serve as natural laxatives, while supporting digestive health and the microbiome. Additionally, in the world of Ayurvedic medicine, the herbal blend Triphala (Cur-OST HU Tri-GUT) is a high revered digestive tonic that serves as a natural laxative and has inherent cofactors to benefit overall digestive health and inflammation. That is an herbal formula that I do not go without on a daily basis due to it’s overall health properties.
Additionally, you must keep in mind the emotional factor that is intertwined with digestive concerns, including constipation. If you do not get the emotions in check, then the problems tend to persist. Things that work for me personally include daily exercise routines, yoga, Qi Gong, and meditation. They are a part of my daily routine, seven days per week, and can pack real power to your health and well-being when practiced often. Adaptogenic herbs are also very helpful, aiding the body to regain balance and vitality, against the strains of daily stress. Herbs that come to mind include Ashwaghanda, Bacopa, Eleutherococcus, Ganoderma, Lemon Balm, and Cordyceps. One last quick note, when talking about emotions and constipation is magnesium. This is one mineral that is often very deficient in a high percentage of people. Magnesium can impact your digestive motility, but a low level can also make you more susceptible to emotional events, stress, and anxiety. Always a good idea to increase your magnesium intake in those cases, and a form that I prefer is Magnesium L-Threonate, due to it’s high level of absorption and ability to impact brain function.
In the end, constipation is not a disease, but a symptom of a potentially bigger problem. In most cases, a change in diet, water intake, along with keeping your emotions in check can make a huge difference for your digestive health and frequency. However, keep in mind that some forms of constipation can be a sign of even bigger problems, including a bowel blockage or even some forms of cancer. If your constipation persists, or you experience bleeding with bowel movements, pain, or weight loss, please consult your physician.
Author: Tom Schell, D.V.M., CVCH, CHN