Constipation has a broad definition as unsatisfactory defecation characterized by infrequent stooling, difficult stool passage or both [1]. Constipation prevalence in North America is 12% to 19%. [2] The mechanism of its development is multifactorial.

Causes of Constipation

• lifestyle and dietary choices
• medications
• medical conditions
• pregnancy

Common lifestyle causes of constipation

Low Fiber Diet

Many Americans consume diets low in dietary fiber which leads to decreased intestinal transit time ( the time foods moved through your system ) and constipation. Studies have demonstrated that higher fiber diet can increase stool frequency and a relive in constipation [1]. A recent review of studies showed that 77% of people with chronic constipation found improvement of their bowl function by increasing dietary fiber intake. [2]

However, there is no evidence that high fiber works for everyone. While some studies show that adding more fiber to your diet helps, other studies show that decreasing your fiber intake is better [3]. Depending on the type of your constipation, dietary fiber may either resolve or worsen your bowl function.

If you have decreased transit time due to gastroparesis ( food staying too long in your stomach), high fiber diet will not help. Constipation related to pelvic floor dysfunction is another condition that will not benefit from high fiber diet, but will make things worse. Talk to your doctor or dietitian about the origin of your constipation.

Inadequate Water Intake

Are you drinking coffee, soda, juice and iced tea? Some of these fluids may not be readily hydrating you or may even lead to dehydration. If you are generally dehydrated you can expect that your bowl movements will be dry and less frequent.

Inactive Lifestyle

Sedentary lifestyle leads to decreased circulation and slow intestinal motility thus is associated with lazy bowl function. In addition, sedentary lifestyle has been associated with inflammatory bowl disease and other digestive issues.

Dairy Consumption

A review of studies concluded that the removal of caw’s milk reduces chronic constipation in children. Particularly if blood analysis showed abnormalities of immune mechanisms as a result of dairy consumption. [4]

Medications leading to constipation

• Pain medicines, such as narcotics containing codeine, oxycodone (Oxycontin®) and hydromorphone (Dilaudid®).
• NSADS / Nonsteroidal anti-inflammatory drugs, like ibuprofen (Advil®, Motrin®) and naproxen (Aleve®).
• Antidepressants, such as the selective serotonin reuptake inhibitors Prozac® or Elavil®
• Antacids containing calcium or aluminum, such as Tums®.
• Iron supplements
• Allergy medications, antihistamines, Benadryl®
• Some blood pressure medicines
• including calcium channel blockers Calan SR], diltiazem Cardizem® and nifedipine Procardia®and beta-blockers (like atenolol [Tenormin®]).
• Psychiatric medications, like clozapine (Clozaril®) and olanzapine (Zyprexa®).
• Anticonvulsant/seizure medications, such as phenytoin and gabapentin.
• Antinausea medications, like ondansetron (Zofran®).

Many drugs can cause constipation. Ask your doctor or pharmacist if you have any questions or concerns.

Conditions leading to constipation

• Endocrine problems, like underactive thyroid gland or hypothyroidism, diabetes and uremia.
• Colorectal Cancer and Diverticular Disease
• Irritable bowl syndrome
• Neurological disorders such as Multiple Sclerosis, Parkinson’s Diseases and / or stokes
• Outlet dysfunction constipation. A disorder of coordination of pelvic floor muscles. The pelvic floor muscles support the organs within the pelvis and lower abdomen.
• Lazy bowel syndrome. The colon contracts poorly and retains stool.
• Pregnancy

Consequence of Constipation

Hemorrhoids

When you are constipated you are more likely to push much harder in effort to get the stool out. As a result of the increased pressure around the anus some blood vessels may become swollen and start bulging out. Hemorrhoids can be painful and itchy and cause bleeding.

Rectal Prolapse

The final portion of you large intestine is the rectum. When you’re constantly straining, the rectum can stretch and slip outside your body. Sometimes just part of it comes out, however, sometimes the whole rectum comes out. This condition is painful and may lead to bleeding as well.

Impaction

When stool stays too long into your body it becomes very dry and hard, this mass can get stuck and cause intestinal blockage. The normal movement of the intestines can no longer push the stool out of your body because of its hardness and increased size. This condition can cause pain, nausea and vomiting. Most cases require a visit to the the emergency room. Children and older adults are the the greatest risk for fecal impaction.

Anal Fissures

Constant straining to pass stool can lead to tear in the tissue around your rectum and anus. These tears are called fissures. The tears can be very small or they can become large and cause itching, pain, and bleeding. This condition is hard to heal, you may need medication or surgical resection to fix the problem.

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Dietary Modification to Improve Constipation

Meal Size

Are you eating small frequent meals rather than two or three consolidated meals? A great way to stimulate the colon to get moving is by natural signaling called gastrocolic reflux (GCR). GCR is a messaging system which tells the colon to empty as more food is coming down the pipeline. This causes the colon to start clearing out space for the new food consumed. When you are eating small meals, however, this signaling system does not get triggered and you end up constipated. Eating two or three more sizable meals per day instead of grazing will likely get your colon moving more regularly.

Increase fluid intake

Aim for 64 to 80 oz per day ( 8 to 10 cup ) of total fluid per day. Drink additional 32 oz of fluids if you are taking medicinal fibers such as Metamucil, Benefiber, Trulance or other.

Increase Dietary Fiber Intake

The average dietary fiber intake in the US is 15 mg per day. The daily recommended dose is 25 gm for women and 38 gm for men. However, this recommendations are made to be realistic and achievable. Some populations take in as much as 70 gm of fiber per day and are in excellent gastrointestinal health.

Dietary fiber has healthful benefits in number of ways. Fiber helps with lowering blood cholesterol, thus decreasing you risk for cardiovascular disease. It also controls spikes in blood glucose levels. Fiber may also speed up the transit of stool through the digestive system, which can help keep you regular.

Here are some tips that will help you increase your dietary fiber. Ensure that your whole grains ( bread, pasta, tortillas etc ) have at least 1 gram of fiber for every 5 grams of carbohydrates. In other words, a 1:5 ratio fiber to carbohydrate is recommended. Divide the gm of carbohydrates to gm fiber, the number you get should be 5 or less.

When reading a food label, choose foods that contain more fiber. As a rule of thumb, choose cereals with 4 or more grams of fiber per serving, breads and crackers with 3 or more grams per serving, and pasta with 4 or more grams per serving.

Dietary Prebiotic and Probiotics

Incorporate food related probiotics or probiotic supplements to improve bowel regularity. In a review of six studies, the authors concluded that the use of probiotics significantly increased the stool frequency in children suffering from chronic constipation [5]. In addition, the use prebiotic may also alleviate constipation in children. The type of probiotic and prebiotic is important in order to achieve result.

Nutritional Supplements that Help Constipation

Many consumers nowadays look for natural, holistic approach and treatment. They aim to avoid medications on all cost, but are open to supplement a nutrient that they need anyway. Magnesium is an essential nutrient and electrolyte with benefits for hearth health, bone health, headache prevention, depression and restless leg syndrome treatment. It is also shown to treat anxiety and depression. Lean more HERE.

When you supplement with 350 mg, magnesium helps draw water into your intestinal lumen. For many years constipated patients whose kidneys are working well, use magnesium to help alleviate their impacted bowls and meet their magnesium needs.

Take 350 mg Magnesium Citrate in the evening, at bedtime to have a bowl movement in the morning. The additional benefits from taking magnesium at night include, calming effect, decreased anxiety and improved sleep.

When looking for a magnesium supplement however, be aware of its quality. FDA does not regulate supplements. Unfortunately, most supplements are not providing the promised amount listed on the label and are contaminated with heavy metals such as lead [6]. Among the recommended supplements was the Designs for Health magnesium citrate which passed the test for purity and had the amount of magnesium listed on the label.

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