Constipation: A Regular Occurrence

man in gray shirt stomachache

Part of my job in the office involves talking to my patients about subjects that don’t usually come up at a cocktail party. One of these conversations is about poop. It’s a topic that comes up all the time, and one of the most common issues that concerns my patients frequently is constipation.

It’s remarkable how often people tell me that they are constipated. In fact, it’s surprisingly common for people to tell me that they only poop once per week! Now, normal bowel movement patterns can vary — going once or twice per day is probably ideal, but going every other day is still usually acceptable. Any longer than 48 hours is a problem. And if it is as bad as once every 7-10 days, that’s a serious problem.

Hippocrates, hailed as the Father of Western Medicine, once said, “all disease begins in the gut.” There is certainly some truth to his observation, as we now know that good bowel regularity is crucial to good health body-wide. In other words, effective treatment for constipation is important not just for relieving gastrointestinal discomfort, but for the body as a whole.

I’ve come to learn that the word “constipation” means different things to different people. Here are a just few of the most common things that people tell me that they mean when they say that they are constipated:

– It hurts to poop.
– My poop is difficult to push out.
– I don’t feel like I got it all out.
– My intestines feel bloated and full.
– I only poop every 3-4 days.
– My poop comes out in little pellets.
– My poop is skinny or thin.

Because there is so much variation in personal experience, it’s really important to tell your doctor all of the gory details so that he or she can really understand what you are experiencing. The Mayo Clinic defines constipation as having less than three bowel movements per week. This term can also be associated with people who have difficulty and/or discomfort passing bowel movements (having to strain really hard), and with those who have dry, bulky stool. Some unlucky individuals have all of these constipation symptoms at once.

Constipation is an amazingly common problem. According to a 2015 article by Dr. Satish S.C. Rao, published by the American Gastroenterological Association, one in six Americans is affected by constipation. Dr. Rao also states that it is the third most common reason for an outpatient clinic visit. Constipation can lead to hemorrhoids, fissures, tears in the mucus membranes of the rectum (as a result of having to push too hard), and a great deal of stress. Needless to say, when constipation becomes severe, it can have a significant impact on one’s quality of life.

So, what causes constipation? There are a variety of factors involved in this condition. The most common dietary factor is not eating enough fiber. Fiber is essential for keeping bowel movements regular because it promotes a larger, softer, more hydrated stool, which can more easily pass through the intestine.

Most Americans eat only about 15 grams of fiber per day, which is way below the target. National guidelines suggest that women should consume at least 25 grams of fiber per day, and men should get at least 38 grams daily. Avoiding low fiber, highly processed junk foods and adding fiber rich food sources like beans, whole grains, vegetables, and fruits is the way to go. Of course, a whole foods diet like this also offers all sorts of benefits in addition to the fiber they contain.

There are several non-dietary factors that can lead to constipation, as well. The three most common are:

Excessive stress: This is one area where the mind-body connection is clearly apparent. Emotional stress, which is so often generated by problems with relationships, money, work, or health can compromise the function of the intestines, which can result in constipation.

Lack of physical activity: The intestine is a muscle, and like the other muscles in your body, it benefits from exercise. Sitting all day does not stimulate the muscles of the bowel, which can lead to weak musculature and constipation. A daily walk is often all it takes.

Medication: Many of my constipated patients take medications or supplements that can cause constipation as a side effect. Common culprits include antacids, iron supplements, antidepressants, pain medications, and calcium supplements. Yes, even nutritional supplements can be a culprit.

Now for the treatment plan. There are many things you can do to help alleviate constipation. First and foremost is getting more high fiber foods into your diet. These include beans, seeds, nuts, fruits (especially berries), and vegetables, especially green, leafy vegetables. Mineral-rich foods are also important (many of the ones I just listed are great sources of minerals), especially those containing magnesium. It’s also crucial to stay hydrated. Try having a warm drink in the morning to start your digestive system off on the right track. Warm tea, or warm lemon water, are great, nutritious options.

Be sure to avoid highly processed foods, such as packaged snack foods, as well as fried foods and fast foods, as these are common triggers for constipation. For some people, especially children, dairy products cause constipation. If you are constipated and you eat dairy products like milk, cheese, or yogurt regularly… try eliminating dairy for three weeks to see if it helps. You might surprise yourself on the toilet after a week or two.

There are also a number of useful supplements that may help to remedy constipation. These include:

Magnesium: Many people get relief by taking Magnesium citrate: 150-300 mg before bed.

Fiber supplements: Although food sources are preferred, fiber supplements can help as you are working on improving your diet. Ground flax seeds are great: 1-3 tablespoons per day can be added to food or smoothies. Psyllium husk is another popular way to increase fiber in the diet. I prefer unflavored, sugar free products like Konsyl over the typical flavored brands like Metamucil.

Probiotics: A healthy GI microbiome can have a positive influence on bowel regularity.

Digestive enzymes are also one of my top recommendations for helping people with chronic constipation.

I hope this was useful to you, and that it helps you get out of the bathroom and back to your life.

– Dr. Joshua Levitt