Chronic constipation is no laughing matter. It can be physically uncomfortable and emotionally upsetting. It may even lead to toxins and waste products. The body reabsorbs it when stool remains in the colon for an extended period. Fortunately, chronic constipation is relatively simple to resolve with dietary and lifestyle changes. The tricky part is identifying which particular ones might best benefit an individual.
The first step is to define constipation. Many become alarmed if they change their diet and go from having a daily bowel movement (BM) to skipping a day or two. But defining constipation is not by the frequency of BMs; it’s by the consistency of the stool and the level of pain or difficulty in passing it.
According to the American Society of Colon & Rectal Surgeons:
“The belief that one must have a bowel movement every day simply is inaccurate and can lead to unnecessary concern and even abuse of laxatives. If one’s daily bowel movement is hard, expelling requires great effort. If it does not satisfactorily empty, the individual would still be considered to have constipation despite having a normal frequency. On the other hand, if one has a movement every third day that is not hard, does not require straining, and completely evacuates, one may very well consider this a normal bowel movement. Despite the fact it is not a daily event.”
Information from the University of Michigan Health System concludes that normal bowel habits range from 3 times a day to 3 times a week.
So if a patient is concerned about not having daily bowel movements, it’s best to ask about stool consistency and pain level or straining during a BM. Because they might be worried about “constipation” when they’re not constipated. If someone does experience discomfort during a BM or has difficulty completely emptying their bowels, then assessing potential causes and solutions is in order.
A prominent place to start is hydration. If someone has inadequate fluids, the body may look to hold on to precious water from wherever it can. Including reabsorbing some from the stool, leading to stools that are hard, dry, and difficult to pass. (Feces are typically 75% water.) Proper hydration can prevent this, and many people across the age spectrum do not consume adequate water. If someone already does have sufficient water intake, though, increasing it further may be unlikely to help. According to researchers, no evidence increasing fluid intake successfully treats constipation. Unless there is evidence of dehydration. Nevertheless, fluid intake should be inquired about to rule out dehydration as a possibility. Or to recommend increased water consumption if warranted.
Suppose feces are about 75% water, which leaves 25% solid material. Of this 25%, about one-third consists of indigestible matter such as cellulose and other fibers. With this in mind, it’s easy to see how inadequate fiber intake could contribute to constipation. And why low-fiber diets are a risk factor for constipation. An “n=1” experiment of increasing dietary fiber should tell someone within a few days whether that simple intervention is enough to get things moving smoothly.
However, people should note that increased stool bulk may help stimulate colonic motility. Or improves transit time for some patients. In others, increasing dietary fiber can make things worse. If the cause of constipation is not a lack of fiber, adding more fiber would unlikely help. If dietary fiber is already adequate and colonic motility is compromised for some other reason, increased dietary fiber would result in larger, bulkier stools that are still not promptly eliminated. Ultimately leading to more constipation. Increased bloating and abdominal distension from increased fiber intake are often cited for not complying with advice to increase fiber consumption.
Some people who adopt a low-carb or ketogenic diet find that they have less frequent BMs. It is often attributed to the lack of fiber in ketogenic diets. But the truth is, there’s plenty of room for fiber on keto between vegetables, nuts, seeds, and low-sugar fruits. It’s possible the decreased frequency—which, again, does not necessarily indicate constipation—is due to the elimination of high-carb foods like grains and beans, which are gut irritants for many people and may have been causing artificially increased BM frequency.
No surprise here: getting moving can…get things moving, at least for some people. Increasing physical activity is a frontline recommendation for those with idiopathic constipation—as little as 30 minutes a day may alleviate symptoms in some people. Though, the findings are case to case basis. And there’s a lack of overwhelming evidence that daily exercise relieves constipation. (Exercise is terrific for physical and mental health; it might not be a silver bullet for constipation.)
Medications & Supplements
Last but not least, when a patient presents with constipation, healthcare practitioners should be on the lookout for supplements and pharmaceutical drugs that may cause constipation, such as iron supplements, pain relievers (including opioids), aluminum-containing antacids, blood pressure medications, antidepressants, and medicines for Parkinson’s disease.
Hypothyroidism is another avenue to investigate when hydration, fiber intake, exercise, and medications have all been ok, and someone still experiences chronic constipation. Mainly if the patient exhibits other signs and symptoms of the condition, such as weight gain (or difficulty losing weight), hair loss, depression, fatigue, slowed heart rate, low blood pressure, and low body temperature.
Consider a low-fiber diet for those with unexplained and difficult-to-treat constipation when all else fails. A World Journal of Gastroenterology study found that reducing or even altogether stopping dietary fiber intake could effectively reduce idiopathic constipation and its symptoms.
Dr. Patrick Lovegrove is board certified by the American Board of Family Physicians. He was born in Staunton, Virginia, and graduated from the University of Virginia where he majored in Biology. He received a Medical School Scholarship from the United States Air Force. A graduate of Nova Southeastern College of Osteopathic Medicine, his over 20 years of clinical experience includes Family Practice, Anti-aging, Holistic Internal Medicine, Pain Management, Aerospace, Sports, and Emergency Medicine. He believes that holistic medicine should be integrated with conventional medicine in a scientifically based model to achieve the best results for patients.