How to Heal Constipation

Constipation refers to a change in bowel habits – stools may be too hard or too small, difficult to pass or infrequent (less than 3 times/week), and people may notice a frequent need to strain and a sense bowels are not completely empty. The prevalence of constipation in the U.S. varies between 2 – 27%, and is more common in women, people with less physical activity, and those over 60 (with 26% of men and 34% of women reporting constipation). I will first discuss constipation in adults and then in children.

Adults
Many factors can contribute to constipation, although in most people no single cause can be found. The most common contributing cause is poor dietary fiber and water and magnesium intake and lack of physical activity. Other causes can be systemic disorders (such as hypothyroidism and diabetes), neurologic or obstructive intestinal disease, irritable bowel syndrome, or commonly as a side effect of medicines (especially pain medicines). You can usually treat constipation at home, but come to see me if the problem is new and lasts longer than 2-3 weeks, is severe, or is associated with concerning things such as blood on the toilet paper, weight loss, fevers, or weakness.

Treatment includes changing some behaviors, eating foods high in fiber (lots of healthy vegetables, fruits, and beans), taking magnesium, drinking plenty of water, and natural supplements or laxatives/enemas if needed.

Behavior changes – The bowels are most active following meals. This is the time when stools pass more readily, so pay close attention and go to the bathroom when you get the signal (and a small amount like a cup of coffee can be helpful).

Ignoring your body’s signals to have a bowel movement can make the signals weaker over time.

Increase fiber (at least 25-30 grams/day) and water (at least ½ of your body weight in ounces/day) – Eating at least 5-10 servings of healthy fruits and vegetables/day and legumes/beans is very helpful for constipation and required for the best health. Often grains, especially wheat, are not the best because gluten intolerance is an alarmingly increasing problem and grains can interfere with your body’s magnesium absorption.

Magnesium as a nutrient not a laxative (anyone with kidney disease should not take magnesium supplements without consulting your kidney specialist) – Adequate magnesium levels in the body cause water to be drawn into the colon, where it softens the stool for easy passage, and magnesium acts as a natural stimulant on bowel muscles (magnesium is beneficial to the body in many other ways for energy production, proper insulin use, heart rhythm and blood pressure, and overall feeling of calm). Magnesium is in high concentration in green plants, and are best eaten properly cooked (not overcooked!) or raw. Also, if we were eating our meats from animals grazing on open pastures of grasses and herbage, these meats would have substantial amounts of magnesium.

For adults to determine your effective magnesium dose, start with 150-200mg after dinner, and can increase it by 150-200mg every 2-3 days until your stools are regular (most people find their effective dose between 400-1200mg/day). If you start having loose stools, then gradually decrease your dose. Remember that during stress your body uses up more magnesium, so you may require more during those times. Also, you may need more magnesium when eating dairy foods from cow milk (contains the sticky protein casein).

Magnesium aspirate (the one we carry at our office) or citrate in capsular forms are the most absorbable forms of magnesium, and very good when in combination with vitamin B6 in a well absorbed multivitamin in capsular form (like our Orthomolecular Alpha Base) or B complex vitamin. The best most well absorbed vitamins are almost always in capsular forms, and you need also to check the contents (see “How to Pick Out Vitamins and Supplements” on the 2nd page of my “For Your Health” article accessed under “Resources” on our home page). Be very wary of drugstore or discount store vitamins and supplements which are often very poorly absorbed and poor quality, and get your vitamins and supplements from a trusted informed place like our office or quality health food store (and still check the contents or bring in at your next visit with me to check).

Aloe Lite (supplement at our office) – take one daily (and can take up to two) containing 150mg/capsule aloe vera (anti-inflammatory for the digestive tract helping constipation and even diarrhea/irritable bowel), slippery elm (soothes digestive tract mucosa), and stone root (can help shrink and decrease inflammation of hemorrhoids)

Laxatives – You usually will not need any of these by following the above, but if you do, here are the categories.

Bulk forming Laxatives – Psyllium (Metamucil, Perdiem), Methycellulose (Citrucel), Calcium Polycarbophil (FibeCon, Fiber-Lax), Wheat Dextrin (Benefiber) – Increase these slowly to prevent gas and bloating, and always take with at least 16 ounces of water.

Hyperosmolar Laxatives – Polyethylene Glycol(MiriLax, GlycoLax), Lactulose prescription generic medicine and Sorbitol (these produce more gas and bloating than polyethylene glycol).
Saline Laxatives – these act similar to the hyperosmolar laxatives and include Milk of Magnesia and Evac-Q-Mag.

Stimulant Laxatives – include senna (Ex-Lax, Senokot, Flether’s Castoria) and bisacodyl (Correctol, Dulcolax) – overuse can cause side effects such as low potassium

Stool softeners – less side effects but less effective than laxatives – docusate (Colace)

Enemas – sodium phoasphate/biphosphate (Fleet) can be used and work quickly but are not recommended for people with kidney or heart problems, and hydrogen peroxide enemas should be avoided due to extreme colon lining irritation

Others – mineral oil (prolonged use can decrease absorption of nutrients or hurt the lungs if vomited), a prescription medicine Amitiza, or other natural products

Children
Complaints of constipation from children should not be ignored. If the opportunity for early intervention is missed, complications can quickly occur such as worsening constipation, stool withholding and fecal soiling, anal fissures, and even fecal impaction. The times when constipation are most likely to occur include: introduction of solid foods or cow’s milk/dairy, toilet training, and school entry.

Transition to solid diet – Ensure adequate fiber in fruits and vegetables (about 20grams/day in toddlers and young children) and adequate water (about 1 ounce per pound body weight in toddlers and children). Limit cow’s milk to less than 24 ounces/day.

Toilet training – Ensure the potty seat provides appropriate foot support and leverage for elimination, and that your child’s diet has adequate fiber and water and not too much cow’s milk/dairy. Once stool withholding behavior has begun, it can only be reversed by making the stools soft and passage pain-free. If your child just does not like having a bowel movement on a potty after your best encouragement and instruction, you may need to use a glycerin small child suppository to encourage them. (I had to do this with one of my children, and it only took one suppository to then encourage that child to regularly use the potty!)

School entry – Some children do not want to have a stool at school or do not have enough time, so they withhold their stools. Make sure to occasionally ask about their bowel movements, especially in young school age children. The best time to have a bowel movement as discussed above is usually following meals and paying attention to your body signals.

Treatment

In infants less than 1 year – Addition of indigestible osmotically active carbohydrates to the formula – increasing the dose as needed to induce a daily bowel movement. This includes sorbitol-containing juices or purees (for babies who have started solids) – apple, prune or pear. Barley cereal may e substituted for rice cereal, and soy formulas may be tried. Glycerin suppositories or rectal stimulation with a lubricated rectal thermometer can be used occasionally if there is very hard stool in the rectum (but not used frequently).

Older children – Ensure adequate fiber and water and you may need to eliminate cow’s milk/dairy. Children unwilling to consume adequate dietary fiber may need daily fiber supplement (as described under adults, but 20 grams/day for early childhood and 30 grams/day for adolescent girls and 40 for boys). An occasional does of laxative may be needed, or an enema if a child has not had a bowel movement for several days and cannot pass a stool.