Constipation refers to infrequent bowel movements or difficulty passing stools that lasts for several weeks or longer. Conventional medicine teaches that a frequency of passing less than three bowel movements a week is constipation. While this may be a working medical definition, it certainly is not considered optimal within integrative and naturopathic medicine.
There are various causes of constipation that range from medical issues causing physical blockages of the digestive tract, abnormal nerve function of the GI tract, muscular problems of the pelvic muscles involved in passage of stool, eating disorders, and hormonal issues such as hypothyroidism or diabetes. Some of the complications of chronic constipation include hemorrhoids, anal fissures (small tears in the anus), inability to expel stool (fecal impaction), and rectal prolapse.
According to a study published in the World Journal of Clinical Cases, when stool elimination is delayed in the gut it adversely affects the gut microbiome and results in increased mucus production as the body compensates with trying to eliminate stool. The main causes of chronic constipation include a lack of fiber in the diet, lack of water, not enough exercise, neurotransmitter and hormone imbalance, and the use of certain medications (i.e., opioids).
The journal Frontiers in Medicine reports several studies demonstrating a connection between gut dysbiosis and constipation. Frontiers in Cellular and Infection Microbiology states that stool consistency is associated with the diversity of gut microbiota and composition. In addition, the journal Advances in Nutrition states that adults with constipation have significantly lower amounts of the flora bifidobacteria and lactobacilli and increased Bacteroidetes in stool samples compared to control subjects.
The cornerstone of treatment for chronic constipation is the increased consumption of water and fiber. Most people with constipation will improve by focusing on these two dietary requirements.Increasing water intake between 50 to 80 ounces daily is helpful for some people with constipation. However, not everyone with chronic constipation will respond to increasing amount of water. Increased water, higher fiber diet or supplements, and exercise should be the first line approach to chronic constipation.
According to the Academy of Nutrition and Dietetics only 5% of the US adult population achieve the adequate intake of fiber. For women this amount is 25 grams and for men it is 38 grams. When looking at labels 2.5 grams per serving is considered a “good source” while 5 grams per serving is an “excellent source.” The key to fiber is plant foods that contain indigestive carbohydrates and lignins (found in many whole plant foods-whole grains, nuts and seeds, legumes, etc). Good sources include whole grains (caution for those with gluten allergy or sensitivity), vegetables, fruits, legumes, and nuts. Keep in mind that the processing of foods reduces fiber content.
Most grains people consume such as breads and pastas are refined. There is also insoluble fiber in beans, oat bran, fruits and vegetables that does not significantly increase fecal bulk but has other benefits such as blood sugar regulation and satiety.
Increased fiber helps bowel movements by increasing stool bulk, stool frequency, and reduced transit time through the intestines. In addition, fiber retains water (especially soluble fiber) and when fermented in the digestive tract the resulting bacteria increase stool mass. Moreover, fiber helps in weight control and provides a full feeling to reduce appetite. Increased fiber in the diet also reduces the risk of certain diseases such as cardiovascular diseases, type 2 diabetes, and certain cancers.
Following are examples of food categories and their fiber intake (data source from U.s Department of Agriculture Food Data Central, Dietary Guidelines for Americans, and Academy of Nutrition and Dietetics:
Fruit
Vegetables
Grains
Nuts and Seeds
Supplement with psyllium seed fiber if you are having trouble getting enough fiber in your diet. Take one teaspoon (5 grams of fiber) with 10 ounces of water two to three times daily. Gradually work your dose up. Psyllium is also available in capsule form.
Supplement Triphala (composed of the fruits of Terminalia chebula (black myrobalan), Terminalia bellerica (bastard myrobalan) and Phyllantus emblica). The journal Chinese Medicine reports that Triphala can be used long-term to improve bowel movements. Unlike laxatives it does not have stimulating effect on the bowels but rather a regulatory effect. A typical dose is 500 to 1000 mg daily of the capsule or tablet form.
Supplement a probiotic with human studied strains such as our Ultra-Mega Flora.
Dr. Mark Stengler NMD, MS, is a bestselling author in private practice in Encinitas, California, at the Stengler Center for Integrative Medicine. His newsletter, Dr. Stengler’s Health Breakthroughs, is available at www.markstengler.com and his product line at www.drstengler.com
