Constipation can be a pain in the ass, literally, right? Pun intended! But, it’s more than that.
Constipation is NOT normal or healthy for you, and having daily healthy bowel movements is one of the essential elements and outcomes of optimal digestion. The definition of “regular bowel movement” does not equal one bowel movement per week.
The standard definition of constipation: less than three bowel movements a week for more than three months. Sadly, an estimated 80 million Americans currently suffer from constipation, and constipation only gets worse as you age. If this speaks to you, read on. You will glean some valuable information from this blog post.
Conventional medicine is focused on treating the symptoms. Your doctor may recommend a particular laxative or stool softener, but this is simply a band aid and does not address the root cause of your constipation.
I’m going to share fourteen common culprits with you which may shed some light on your situation. As a functional nutritional therapy practitioner, I am committed to identifying and addressing the ROOT CAUSE of your symptom(s). Makes sense, right? Band aids are temporary. Identifying the ROOT CAUSE is a long-term if not permanent solution to your digestive distress.
Why is having daily bowel movements important?
The end product of your digestion is removing the waste from your GI tract - basically, the leftovers from the food that you ate. This metabolic waste contains toxins, so the longer your stool sits in your large intestine, biochemical changes occur that allow for toxic compounds that your body doesn’t want anymore to leak back into your system.
Basically, your gut is reabsorbing it’s own toxins.
Not only that, but, after a period of time, this impacts your immune system and increases inflammation which in turn impacts every organ system in your body. Obviously, the direct damage to your body includes hemorrhoids, anal fissures, anal prolapse, abdominal pain and bloating, and also just feeling like crap because you’re full of crap. In addition to this pain in your ass and abdomen, this inflammation fires up your immune system and can create brain inflammation, systemic disease, heart disease, cancer, and Parkinson’s/Parkinsonism.
What does an optimal bowel movement look like?
Funny you ask, because I happen to have the Bristol Stool Chart, a diagnostic tool developed by doctors in Bristol, UK, to help classify stools into seven categories. You can use the scale to describe and categorize feces. This is considered a practical guide in assessing how long a stool has spent in the bowels.
Not to get too graphic, but If your digestion is working properly, you should have anywhere from one to three bowel movements every single day - either #3 or #4 on the Bristol Stool Chart, or both.
You shouldn’t have to wipe much, it shouldn’t smell offensive, it should be dark brown, sink to the bottom (not float), and you shouldn’t see undigested food or mucus in your stool. Like a dog, you should look at each and every bowel movement as it’s one indication of your gut health.
If your stools aren’t optimal, let’s talk! There’s so much we can do to address suboptimal digestion.
Constipation can be a symptom of many different underlying causes, so determining the root cause(s) is my mission.
Main causes of constipation
Food sensitivities - undiagnosed food sensitivities can create inflammation and alter the function of your gut.
Gluten is definitely a big one in the U.S., and dairy is the number one cause of constipation in children.
If you are indeed sensitive to gluten, it’s important to also remove dairy, soy, and rice as well, because they are cross reactive to gluten.
Basically, this means that the protein structure of dairy and gluten are so similar, that your body has a difficult time distinguishing between the two, so it gets angry with both because it’s confused.
Of course, you can always remove these foods from your diet for a minimum of three weeks and monitor your symptoms. If they improve, great! I recommend removing these foods for at least 3 - 6 months to allow your immune system to rebuild. The MRT170 food sensitivity blood test is another great option. It includes 170 items in the panel - an excellent cross section of foods in the "Standard American Diet."
For further enlightenment on food sensitivities, see my series on food sensitivities on my website -
For information about the MRT170 test specifically, take a look at the third installment of the series -
2. Inadequate dietary fiber - a poor diet consisting of mostly processed foods and little fresh produce will also lead to constipation/compacted stool.
Dietary fiber is a key component of carbohydrate-rich foods, and is the main fuel for the beneficial flora in our large intestines. It is made up of the portions of the plants that are resistant to digestion, and comes in two types: soluble and insoluble, and getting 20 - 40 grams per day is what it takes to produce a healthy bowel movement.
Most plants contain both soluble and insoluble fiber, but in different amounts. Dietary fiber can do a lot to support gut health, which researchers are increasingly learning plays a role in supporting many different body systems.
The right amount of overall dietary fiber can:
Feed the good bacteria in your gut. These beneficial bacteria in your gut make up what’s called your “gut microbiome”
control body weight
control and possibly prevent hypertension
help balance cholesterol levels in blood
regulate bowel movements and prevent hemorrhoids
regulate blood sugar
regulate your body’s satiation signals, which let you know when you’re full
lower risk of colon cancer
lower risk of breast cancer
lower risk of diabetes
require more chewing, which slows down your meals and aids digestion
Soluble fiber mixes easily with water, includes plant pectins and gums, and when it dissolves, it creates a gel that may improve digestion in a number of ways.
This gel-like substance supports the integrity of your gut lining - which is necessary in preventing what’s called “leaky gut.” See culprit #1: Food sensitivities.
Examples: apples, asparagus, avocados, brussels sprouts, black beans, broccoli, collard greens, flaxseeds, grapefruit, oranges, pears, nectarines, sweet potatoes, and oats.
Insoluble fiber doesn’t dissolve in water. It includes plant cellulose and hemicellulose.
It attracts water into your stool, making it softer and easier to pass with less strain on your bowel. Insoluble fiber can help promote bowel health and regularity because it sweeps through the GI tract mostly intact.
Examples: almonds, apples, berries, beans, kidney beans, lentils, green peas, okra, brown rice, spinach, sweet potatoes, whole grains, walnuts
Here’s a great option for getting your fiber into your breakfast without eating veggies or beans:
Superseed Blend = Equal parts ground flax, hemp hearts, and chia seeds: 1 - 4 Tbsp per day. Add to yogurt, smoothies, salads, etc. Store in the freezer to retain freshness.
3. Magnesium deficiency - very common today, and can cause other symptoms such as muscle cramps, twitching legs, insomnia, anxiety, and heart palpitations. Magnesium deficiency is dramatically under-diagnosed because it doesn’t show up on a blood test!
Only one percent of the magnesium in your body is stored in your blood, and the majority of it’s stored in your bones. Ideally, you should get your magnesium from your food as opposed to supplements, but if you are truly deficient, you can’t eat enough kale to restore the proper amount for your body.
Foods high in magnesium include spinach, swiss chard, pumpkin seeds, almonds, black beans, avocados, dark chocolate, figs, yogurt and bananas.
Are you noticing that many of these foods are also high in fiber?
Optimal Mg intake per day is between 500 - 700 mg, and the form of magnesium I recommend is magnesium glycinate.
Generally, start with 1 capsule before bedtime and increase the dosage by 1 capsule each night “to bowel tolerance.” This means, until you produce a #3 or #4 Bristol Stool Chart bowel movement the next morning.
4. Inadequate healthy fats. If your diet doesn’t include much healthy fat, then your GI tract isn’t properly lubricated.
Healthy fats such as MCT (medium chain triglycerides) serve as a lubricant. It’s best to start with a small amount of MCT oil - 1 teaspoon for women, and 1 Tbsp for men to start. Too much MCT can elicit loose stool (not ideal either)
Other healthy fats include extra virgin olive oil, avocado oil, butter, nuts and nut butters, coconut and coconut oil.
5. Dehydration - When we are dehydrated- and most of us spend our days constantly dehydrated to some degree- we are affecting the performance of the majority of our body. Nearly all of our systems do not function as well without the proper water intake. The body loses water through breathing, sweating, and digestion, which is why it’s important to rehydrate by drinking fluids and eating foods that contain water. Your body uses water in all its cells, organs, and tissues to help regulate its temperature and maintain other bodily function
Drink half your bodyweight in ounces of water (if you weigh 160 lbs, drink 80 oz of water each day).
If you drink 8 oz of a diuretic (coffee, tea, soda) - add 12 ounces of water to your daily intake (1.5 times)
Carry a bottle everywhere with you as a reminder to keep drinking.
Eat raw fruits and vegetables - they are dense in water. You can get water from food, not just from beverages.
6. Lack of exercise - the human body is designed for movement. If you are sedentary, it makes sense that sitting for long periods of time and not moving your body physically will slow down your digestion. Fear not! I'm not telling you that you need to become a "gym rat" or train for a marathon. Walking 20 - 30 minutes daily is fine and dandy when it comes to helping your digestion.
7. Poorly managed stress - we all have stress in our lives, but how we manage our stress is critical for our gut health.
Cortisol is the primary endocrine stress hormone and it curbs nonessential functions that might slow fight-or-flight such digestion, etc. Cortisol communicates with the brain regions that control mood, motivation, and fear. Cortisol dysfunction can contribute to blood sugar dysregulation, weight gain, sleep disturbances, memory and concentration issues, anxiety, fatigue, inflammation and pain, and lowered immunity.
To reserve energy and increase blood flow to the brain and muscles for fighting or fleeing, the stress response reduces blood flow to the GI tract and digestive juices and enzymes become inactive - thus slowing digestion (i.e. constipation.)
8. Your prescription medications - iron supplements, blood pressure medications, narcotics, and diuretics may also cause constipation in some individuals.
Never discontinue or alter the dosage of your prescribed medications without consulting with your primary care physician.
9. Yeast (candida) or opportunistic bacterial overgrowth in the gut - Completing a stool test such as the GIMAP DNA stool test is a great tool to assess the state of your gut microbiome and digestive function.
For additional information, read this blog post:
10. SIBO - Small Intestinal Bacterial Overgrowth - if opportunistic bacteria overgrown in the small intestine, these bacteria can produce methane which will slow down your transit time which will lead to constipation.
SIBO can affect the migrating motor complex in your gut. This action is required for “peristalsis” which is the squeezing and sweeping movement of food through the GI tract from beginning to end.
11. Do you still have your gallbladder? If not, are you currently taking bile salts with each meal? If not, you absolutely must for the rest of your life. The gallbladder is an incredibly important organ as it pertains to the digestion of healthy fats. Contact me at your earliest convenience so we can discuss "organ replacement therapy" in the form of ox bile.
If we have exhausted all of the above avenues of investigation, and are still unable to resolve your constipation, here are a few more possibilities that would involve additional testing through your primary care provider.
12. Low thyroid function - your primary care physician can order a thyroid hormone blood panel. Be sure to include the following markers: TSH, TPO antibodies, T3, Free T4, Reverse T3, and Thyroglobulin antibodies. These tests should be covered by your insurance, and may require an appointment with your primary care provider.
13. Heavy metal toxicity can also impair gut function.
14. Tick infection can cause neurological damage to the pathways that enable peristalsis.
In conclusion, you should never settle for a diagnosis of IBS - C. This is not a condition you need to live with for the rest of your life, as constipation is detrimental to your overall health, but your digestive health specifically.
As you have read, there are many possible causes of constipation, and a myriad of ways to address it that don’t involve laxatives or pharmaceuticals or a daily dose of Miralax or Citrucel.
If you are feeling overwhelmed by this article and/or don't know where to start with your particular situation, don't hesitate to reach out for a free 20 minute consult. You don't have to do this by yourself, and I am happy to guide you through this process.
I am available via insurance if you are a patient at Complete Health Care, or private pay, out of pocket expense. Trust me, either way you slice it, living constipation-free for the remainder of your days, is TOTALLY worth each and every cent.
Here are a few OTC / supplements that can be used occasionally, but in functional medicine, these are considered “band aids”. Supplements, laxatives, enemas, colonics, etc. are fine for occasional use, but do not solve the underlying problem. We don’t want to create a “lazy bowel” whereby the intestines become reliant on these supplements to the point where you are unable to have a bowel movement without them.
SUPPLEMENTS/ OTC OCCASIONAL SUPPORTS for SYMPTOMATIC RELIEF
These products can be purchased from your local drug store, natural food store, online or friendly in-person supplement vendor. (me)
Aloe vera juice: 2 oz.1 - 3 times per day (Lily of the Desert brand) (OTC) Increase dosage to “bowel tolerance”
Whole Food Fiber: 1 scoop per day in water (Standard Process) Exactly as it sounds, this is a highly effective, whole food fiber that supports motility and softens the stool.
Colon Plus Capsules: 1 capsule with meals (Biotics Research) Psyllium-based fiber in capsule forms.
Magnesium Glycinate (Pure Encapsulations) to bowel tolerance (short term only). This is an effective method for increasing motility but we never want to give a single mineral in isolation long-term. Start with 1 at bedtime.
Increase dosage each night until you achieve a #3 or #4 on the Bristol Stool Chart.
Smooth Move Tea: 1 cup at bedtime (short term only) (Traditional Medicinals) (OTC) The primary ingredient in this tea is senna, which has strong laxative properties.
Start with a weak brew and build up as it can cause cramping and diarrhea if brewed too strongly.
Cleanse More: 1-3 capsules at bedtime (short term only) (Renew Life/Amazon) This is an effective formula to promote elimination and increase bowel motility while you work to address the underlying cause of the constipation.
Please note: this formula is strong, so start with 1 and increase dose only if needed.