What is constipation?

Constipation is fewer than three bowel movements per week. Having hard to pass, dry and small bowel movements.  Constipation can be quite painful with bloating and pressure and aggravate hemorrhoids.

Constipation can cause a few burdensome conditions such as dysbiosis with candida overgrowth leading to leaky gut, bloating, weight gain, liver burden, sluggish, bloated and even acne to name a few.

What causes constipation?

Our genetics can cause constipation as well as it is more common females.  Certain medications and medication conditions can cause constipation.  Our lifestyle contributes to constipation such as a diet high in refined carbohydrate and sugar, ketogenic diets and a lack of fiber.

Medical conditions that cause constipation:

• hypothyroid
• adrenal insufficiency
• endometriosis
• found in irritable bowel syndrome, chronic fatigue syndrome, depression and fibromyalgia
• female
• stress--sympathetic overload with reduced parasympathetic
• no cause, just happens

Common advice: (This may not always work)

Common advice to alleviate constipation are to exercise more, drink more water, increase fiber.  In many cases, this does not work.  Especially increasing fiber can actually cause more bloating and constipation in many people.

Treatments to alleviate Constipation

First you want to look for underlying disease or conditions as mentioned above and treat those conditions.  You can also take many over the counter and prescribed medications as well as supplements and herbs.  These treatments are grouped into: STIMULANTS, OSMOTICS, SURFACTANTS, BULK FORMING.

• Stimulants: Stimulants decrease the absorption of water and electrolytes from the bowel, causes irritation and stimulation the colon lining.  Common medication is bisacodyl (dulcolax).  Natural herbal stimulants are Aloe and Senna. Even coffee acts as a stimulant to help constipation. Although it must be said, stimulants for constipation are addictive.
• Osmotics: Osmotics increase water in the stool.  Medications are usually lactulose, it does contain lactose and polyethylene glycol (PEG) – (Miralax).  Magnesium citrate is a great osmotic but in heart failure patients and renal insufficiency patients may have a concern.  Magnesium can cause gas so using a combination of magnesium and calcium as a 1:1 ratio helps to eliminate gas.  Vitamin C is a osmotic but monitor dosage as too much can cause diarrhea.  
• Surfactants: Surfactants are are stool softeners that increase the mixture of fat into the stool.  A commonly prescribed surfactant is ducosate.  A natural remedy is to use is  coconut oil or increase oils in diet.  Unfortunately, surfactants do not usually work alone and may need to combine it with a stimulant or osmotic.  
• Bulk Forming: Bulk forming increases mass of the stool.  Some examples of bulk forming are non-soluble fiber, psyllium and cellulose.  This is not always recommended because of the risk of obstruction.  Bulk forming can cause bloating, gas, pain and more constipation, especially if you are not drinking a lot of water.

For medication induced constipation such as opioid pain medications, most will need to use a combination of stimulating and osmotic.

Natural Treatments for Constipation:

• Stopping coffee in the long run will help constipation and digestive distress.  While a lot of people rely on coffee to help with their morning bowel movement it can actually backfire on you causing more constipation and exacerbating SIBO (small intestinal bacterial overgrowth) and leaky gut.
• Stop Senna / Cascara as these are habit forming and over time, you will need to take more and more to have an adequate bowel movement.  
• Avoid Fiber (Psyllium) as this can just cause more bloating and can enlarge the colon that is makes the constipation worse.  
• Do increase food fiber (fruits and veggies), apples and pear have a lot of good fiber.
• Magnesium citrate for individuals that can use it is great as it is not habit forming and can help with bloating as well as the constipation.  
• Vitamin C (buffered vitamin C powder – mineral ascorbate) also is non-habit forming and is also good for your immune system at the same time.
• Aloe vera juice / capsules can help with constipation, the aloe root seems to work better than the leaf.  

Constipation can actually be a reflection of our liver status.  So do yourself a favor and support your liver by working on phase I and phase II detoxification, which are the two phases of liver detoxification.

An “overburdened liver” has and increased Phase I and decreased Phase II, which can contribute to constipation and constipation can contribute to an overburdened liver.  Phase I of liver detoxification breaks down toxins and Phase II makes them water-soluble so your body can eliminate.  

Without proper elimination, there is a backup of toxins that our liver has to detoxify which in turn overwhelms Phase II so that toxins are not eliminated out of our bodies. What does this mean? This accelerates leaky gut, SIBO and also aggravates our immune system resulting in allergies, fatigue, acne, mood issues, joint pain, weight gain to name a few.   

Adrenals status can also be very important in digestion and constipation. Our adrenals are important for our stress management, but if we are always in a constant state of stress that brings digestion to a standstill.  Working on our adrenals not only helps digestion and constipation but our overall well being, which is an entirely another topic.