If you experience constipation, you know how miserable it can feel. And it’s a lot more common than you might expect: according to the GI Society of Canada, chronic constipation affects as many as 30% of us in Canada. That’s a lot of unhappy bellies.
How do you know if you’re constipated? Why does constipation occur? And what can you do to treat it naturally? Let’s take a peek at how I approach constipation in my nutrition practice.
Are you constipated?
Okay, so no one really likes to talk about poop. But we need to talk about it more often because our digestive health is central to a healthy body.
So let’s just get this out of the way: poop, poop, poop. There. Now we’re ready.
Constipation is one of those words you might expect to have a vague meaning when in fact, it’s definition is pretty specific. The Rome Foundation, which creates the diagnostic guidelines for functional gut issues, has defined functional constipation as 2 or more of the following symptoms occurring over the last six months:
Straining to evacuate: >25% of time
Hard, lumpy stools: >25% of time
Feeling of incomplete evacuation: >25% of time
Feeling of blockage: >25% of time
Less than 3 stools per week
See what I mean? Specific.
Which is why you can be constipated even if you eliminate your bowels daily. I also feel that moving your bowels less than daily is less than ideal…even if you aren’t technically constipated. Feces is waste – and you want that stuff moving through you as regularly as possible. Slow movement is usually going to mean more gas, more bloating, more lethargy.
Something else we need to consider: you might get constipated once in a while. Perhaps a stressful week with too many take out dinners. Or when you travel (the bowels love to seize up when you go away!). Constipation happens in a normal healthy life, but if constipation is your normal, and has been for a while, it’s time to fix it.
When you’re constipated, there is plenty you can do to treat it naturally without relying on over the counter remedies that do nothing to fix the root cause.
Speaking of root causes, what are they?
Inadequate hydration: if you’re dehydrated, you probably expect that you might pee less. However, the body also has a failsafe that retrieves fluid from the feces, making them drier, lumpier and harder to pass.
Low Fibre: So boring. I know. But we still aren’t doing well enough! Women need at least 25 grams of fibre daily and men need 38 grams. Less fibre means less hydrated, slower moving waste.
Activity Levels: Your gut is essentially a muscle. If you move, it moves…gravity is your friend. If you are inactive, your bowels will be sluggish. Full stop.
Medications: Several medications and supplements can constipate you; these include antidepressants, calcium channel blockers for blood pressure, calcium, iron pills and opiates. If you suspect medications and not lifestyle, talk to your doctor.
Diseases: Your gut movement is governed by the enteric nervous system, which can be dysregulated in many conditions such as multiple sclerosis, diabetes and diverticulitis. However, serious and hard to treat long term constipation should always be investigated by a physician because of the potential for tumors or intestinal strictures causing the issues.
Learned behaviour: It’s possible that your nervous system has dysregulated to the point that it no longer smoothly navigates defecation. This has happened to clients who have withheld defecation due to embarrassment during travel, work or school commitments.
Getting Your Move Back
If you are constipated, and it’s not accompanied by any other notable symptoms like pain, blood in the stool or serious fatigue or joint issues, you are likely safe to tackle it on your own for a month or so.
In practice, I always start with the simplest approaches first. Start by drinking a ton of water. Particularly early in the day. If you can get 1-2 litres in by 1PM, it will take care of the hydration question…and make overnight urination less of a chore. Hydration becomes doubly important for my second recommendation, which is to greatly increase your fibre intake. Women need 25 grams a day. Men need 38 grams.
What does 30 grams of fibre look like in a day? It’s 2 slices of sprouted grain toast, ½ cup of blueberries, 1 tbsp chia seeds, 1 apple, 1 cup of cooked lentils, 1 cup of broccoli and 1 cup of raw spinach. It’s not crazy…but it takes work.
An easy place to start? With psyllium. It’s a special soluble fibre (gluten free) that isn’t highly fermentable – meaning it won’t cause a ton of gas which is great when you’re already constipated. I start my clients with 1 tsp of ground psyllium in a smoothie or morning oats. Over two weeks, work up to 1 tbsp. Drink a ton of water!
Move your body daily. Even if it’s a 20 minute after dinner walk, you need to increase your activity to help nature do its work. If you are chained to a desk, get up once per hour even if it is just to do a few toe raises and a stretch. Decompressing the abdomen assists with movement.
And, know that your body loves routine. If you want to encourage morning elimination, try getting up at the same time. Have a large glass or two of water (or warm water if you can’t stomach cold!). Then, take 10 minutes to just sit on the toilet without expectation or anxiety (because your bowels get stage fright!) over whether you’ll go. You may need to get up an extra 15 minutes earlier to hack this routine, but it’s worth it.
If those basics don’t work for you, here is what to consider next:
If you eat meat and cheese, pare back. I find this can be really helpful. In fact, a couple of years ago, I had a spate of clients who had been diagnosed with constipation-predominant irritable bowel syndrome but really they were just constipated. We upped the fibre, vegetables, water, decreased the meat and cheese. All good.
Eat prunes. Yep, your grandma’s fave food. They work, and are way more delicious than you remember. Try eating 5-6 nightly as a snack.
Take a probiotic. The type of microbes living in your gut can stop you up, such as methanogens, which belong to a class of microbes called archaea. They produce methane gas (just like the cows!) and that methane can permeate into your gut lining and slow peristalsis. Taking a good probiotic can help bring you back into better balance.
If you’re still constipated after all of these other things, motility might be to blame. Try Iberogast, an herbal pro-motility agent that is non-habit forming…but also appears to be temporarily unavailable due to reasons I can’t figure out. I’ve linked to the Australian site.
Constipation is common, but doesn’t have to be a permanent part of your life. I hope that some of these strategies will work wonders for you and help you feel your vibrant best.
An important note: go see your doctor if these strategies don’t work after 1-2 months or if you have any concerning symptoms that accompany the constipation. Get a clean bill of health. You might need a motility study, antibiotics to kill methanogens, or biofeedback to help regulate pelvic floor dysfunction.