Beyond Fiber: The Multifaceted Approach To Constipation Relief
"The origin of many diseases is in constipation. The bowels are the foundation of our health."
—Ellen G. White
Some of the most challenging cases I’ve encountered during inpatient rehab evaluations involve patients recovering from multi-trauma orthopedic injuries, often resulting from car accidents, falls, or incidents of violence. In these scenarios, patients typically undergo orthopedic surgery followed by admission to rehabilitation facilities, often while still reliant on opioid pain management. These pain relievers often lead to constipation, compounded by sharp abdominal pains, screams of pain, and the inability to do anything but sit on the toilet for long stretches.
While these tend to be severe cases, they only scratch the surface of the broader issue of constipation, which affects millions globally, and presents with symptoms such as infrequent bowel movements, hard stools, and straining during defecation. Recent research has even linked infrequent bowel movements to accelerated Alzheimer's progression. Children are particularly susceptible, often exhibiting irregular bowel habits that can be overlooked by parents, leading to painful complications like anal fissures, and is even linked to attention, anxiety, and depression.
The causes of constipation are multifaceted, encompassing dietary, health-related, and lifestyle factors. Poor dietary habits, including low fiber intake and consumption of processed foods, contribute to constipation. Health conditions such as hypothyroidism, neurological disorders, and magnesium deficiency can exacerbate constipation symptoms. Sedentary lifestyles, stress, and dehydration also play significant roles in the development of constipation, emphasizing the need for comprehensive management approaches.
There’s no silver bullet to addressing constipation but there are plenty of simple strategies.
Let’s dive in.
What Is Constipation?
Constipation is a common digestive problem that affects millions of people around the world. According to a systematic review, constipation affects about 16% of the general population (although this number was as high as 79% in one study), and 12% of children (although this was also as high as 29.6%). It is also high in the elderly population affecting 33% of those 60 years and older and 50% of nursing home residents.
Constipation is typically described with these symptoms.
Fewer bowel movements than usual. This can vary from person to person, but generally means fewer than three bowel movements a week.
Hard, dry stools.
Straining during bowel movements.
A feeling of incomplete evacuation, like you haven't emptied your bowels completely.
Stomach cramps or bloating.
While there are many concerns with constipation, a major one that was discovered in new research has found a connection between infrequent bowel movements and faster Alzheimer's progression.
"They found that having a bowel movement every 3 days or less frequently was linked to a 73% higher chance of subjective cognitive decline."
Kids & Constipation
One of the most common complaints that parents have for pediatricians is constipation.
But what exactly is constipation? It's simply when kids have trouble pooping regularly. Even if they go every day, if the poop looks like little pellets or rabbit turds or if they're going days without pooping, that's a sign.
Sometimes, parents don't even realize their kids are constipated because they think it's normal for them to go every few days. But holding in poop for too long can lead to painful issues like anal fissures. And if your kid needs to bring toys or books to the bathroom just to poop, that's a sign something's up.
Why does it matter?
Well, when poop hangs around in the gut too long, it can cause problems. Bacteria start feasting on it, making gas and toxins that mess with the body, both physically and mentally. Constipation in children has been linked to “irritability, aggression, temper tantrums, disrupted sleep patterns, straining and withholding behaviour,” according to one study. And not addressing the issue means that it becomes a habit which means a chronic condition. Research on adolescents with constipation found correlations to withdrawal, impaired attention, anxiety, and depression.
So, keeping an eye on your kid's poop habits is pretty important for their overall health.
Ideally, kids should pool once a day in a sausage-shaped stool.
What Causes Constipation?
Constipation occurs for a variety of reasons falling under three main areas: diet, health conditions, and lifestyle factors.
Diet
Fried foods: Fried foods are often high in unhealthy trans fats and low in fiber, which can slow down digestion.
Refined grains: Refined grains, such as white bread, pasta, flour, and pizza, are low in fiber and can slow down the movement of food through the digestive system.
Dairy products: For some people, dairy products can cause constipation due to the lactose.
Empty calorie foods: These high-calorie, low-fiber foods tend to be a constipation culprit. These include many of the foods that make up the Standard American Diet (SAD) including chips, pretzels, fast food, candy ice cream, cereals, muffins, fruit juice (without pulp), etc.
Caffeine: Caffeine can dehydrate you, which can worsen constipation. It can also stimulate the bowels in some people, leading to loose stools followed by constipation.
Alcohol: Alcohol can also dehydrate you and irritate your digestive system, both of which can worsen constipation.
High-fiber foods (ironically): While generally recommended for constipation relief, too much fiber too quickly, especially for someone not used to it, can bulk up stool too much and lead to constipation. This can happen with bran flakes or psyllium husk if not introduced gradually.
Artificial sweeteners: Some sugar substitutes, like sorbitol and mannitol, can pull water into the intestines and cause constipation.
Fruits Lower in Fiber:
Ripe Bananas: While a good potassium source, they're lower in fiber compared to other fruits.
Melons: Watermelon, cantaloupe, and honeydew are all relatively low in fiber.
Applesauce: The processing removes most of the fiber from apples.
Peeled Fruits: Peaches and pears lose some fiber when peeled.
Health Conditions
Electrolyte imbalances: Electrolytes are important for so many aspects of healthy bodily function. From a constipation standpoint, low potassium or calcium levels can disrupt muscle contractions in the digestive system.
Antibiotic use: Antibiotic use can disrupt the gut microbiome, causing constipation in two ways: by reducing stool-softening bacteria and slowing down the muscles that move food through the digestive system. This can lead to harder stools and difficulty passing them.
Hypothyroidism (underactive thyroid): When the thyroid gland doesn't produce enough hormones, it slows down many bodily functions, including digestion.
Irritable Bowel Syndrome (IBS): This chronic condition can cause constipation or diarrhea, along with abdominal pain, cramping, and bloating.
Endocrine disorders: Conditions like hypothyroidism (underactive thyroid) and diabetes can slow down digestion.
Neurological conditions: Parkinson's disease, multiple sclerosis, and spinal cord injuries can affect nerves that control bowel movements, causing constipation.
Colon cancer: While less common, constipation can be a symptom of colon cancer, especially when accompanied by blood in stool or unexplained weight loss. It's important to see a doctor to rule out other causes.
Pelvic floor disorders: Weakened pelvic floor muscles, often after childbirth or surgery, can make it difficult to have a bowel movement.
Diverticulitis: This occurs when small pouches in the colon become inflamed or infected. Constipation can be a trigger for diverticulitis, and conversely, diverticulitis can also cause constipation.
Celiac disease: This autoimmune disorder damages the small intestine when gluten is consumed. Constipation can be a symptom of celiac disease, along with bloating, diarrhea, and fatigue.
Medication side effects: Certain medications, such as pain relievers (opioids), antidepressants, and diuretics, can cause constipation as a side effect.
Hiatal hernia: This occurs when part of the stomach pushes through the diaphragm into the chest cavity. It can sometimes cause constipation due to changes in how food moves through the digestive system.
Diabetes: Uncontrolled diabetes can damage nerves that control digestion, leading to constipation.
Lifestyle Factors
Low fiber intake: Fiber adds bulk to stool and helps it move smoothly through the digestive system. A diet lacking in fiber-rich foods can lead to constipation.
Dehydration: Not drinking enough fluids can make stool hard and difficult to pass.
Lack of physical activity: Regular exercise helps stimulate muscle contractions in the digestive system, promoting bowel movements.
Ignoring the urge to go: Holding in the urge to have a bowel movement can disrupt your body's natural rhythm and lead to constipation over time.
Stress: Chronic stress can affect gut motility, the movement of food through your digestive system.
Magnesium deficiency: Magnesium helps muscles relax, including those in the digestive tract. Low magnesium can cause constipation by making it harder for stool to pass.
Poor sleep: Disrupted sleep patterns can affect hormones that regulate gut motility.
Microbiome imbalance: A healthy gut microbiome is full of bacteria that aid digestion. When this balance is disrupted, constipation can occur due to issues with nutrient absorption and waste movement.
How To Eliminate Constipation
Dietary Strategies
Get enough fiber: Get an adequate amount of both soluble and insoluble fiber.
Soluble fiber: Absorbs water and forms a gel-like substance that helps soften stool and makes it pass more easily through your digestive system. Examples of soluble fiber include oats, apples, oranges, and psyllium husk.
Insoluble fiber: Adds bulk to your stool and helps it move more quickly through your intestines. It acts like a scrub brush, helping move stool and prevent constipation. Examples of insoluble fiber include vegetables and nuts.
Recommended Daily Fiber Intake: Track your intake for a week using a nutrition tracker on your phone to see how you do.
Children:
Ages 1 to 3 years: 14 grams
Ages 4 to 8 years: 25 grams
Boys 9 to 13 years: 31 grams
Girls 9 to 13 years: 26 grams
Boys 14 to 18 years: 38 grams
Girls 14 to 18 years: 26 grams
Adults:
Women 50 years and younger: 25 to 28 grams
Men 50 years and younger: 31 to 34 grams
Women 51 and older: 22 grams
Men 51 and older: 28 grams
These are the minimums. Many functional medicine practitioners recommend getting at least 50 grams of fiber a day for adults.
But don’t get too much fiber too quickly: If you had too much fiber at once you can actually increase constipation. The rule of thumb is 15 grams of fiber a day and gradually increase by 5 grams until you get to the recommended amount for your age and gender.
Hydrate: Drink plenty of fluids, especially water, throughout the day. Drink to thirst and make sure you get enough electrolytes.
Do an elimination diet: Stop eating or drinking the potential culript(s) from the list above for 2-4 weeks.
Limit processed foods: Reduce intake of refined carbohydrates, sugary drinks, and unhealthy fats.
Constipation candy: I found a homemade “constipation” candy” on Mommypotamus.com that consists of coconut oil, lemon juice, Himalayan salt, and syrup/sucanat/cocnout sugar.
Consider Specific Foods: Here are some great foods to improve gut motility.
The Four P's: Nature's laxatives! Stock up on peaches, pears, plums, and prunes.
Leafy Greens: Packed with fiber and essential nutrients, leafy greens are a constipation fighter's friend.
Chia Seeds: Interestingly, flaxseeds work to treat both constipation and diarrhea as this study wrote, “The consumption of 10 g of flaxseed twice a day for 12 weeks significantly improved constipation symptoms, particularly stool consistency.” You can also put them in a cup of water or milk for a half hour in which they’ll turn into a great gel-like mixture which you can eat with a spoon. We also give our kids these Mama Chia pouches.
Flaxseeds: Research [reference the constipation and flaxseed study here] shows flaxseed can combat both constipation and diarrhea. Enjoy them whole, ground, or soaked in liquid for a gel form.
Probiotics: Promote gut health and regularity. Sources include kefir, kombucha, kimchi, sauerkraut, and probiotic-rick yogurt.
Ginger: Don't underestimate this spice! Add it to smoothies for a gentle digestive boost.
Fruits with Skin: Don't peel fruits like pears and kiwis. The skin is a great source of fiber.
Beans and Legumes: A fantastic source of fiber and protein. Consider lentils, black beans, chickpeas, and kidney beans.
Lifestyle Strategies
For everyone:
Exercise regularly
Don’t Ignore bowel urges
Practice breathwork: Breathwork strategies are great for a variety of reasons. See these articles to learn more: Breathwork 101: What It Is & 5 Breathwork Techniques to Improve Your Health and 3 Breathwork Exercises for Stress & Anxiety.
Sit better on the toilet. We humans evolved to squat when we poop. These now-common elevated toilets are pushing us in the opposite direction. Consider a squatty potty for a better hip angle on the toilet.
Incorporate yoga. Yoga is especially great for those who tend to stay in one position (e.g. sitting) for most of the day. If you can only do one pose though, do child’s pose. Child's pose helps to relax the muscles in the abdomen and pelvic floor, making it easier to pass stool. Plus, it's a gentle stretch that can help alleviate any discomfort associated with constipation. Aim to hold child's pose for at least 1-2 minutes several times a day. Here are 7 more yoga poses to do to help constipation.
Do an abdominal massage: The colon is an interesting shape within the stomach. Follow these directions to massage it in a specific pattern to help facilitate the literal movement of the bowels.
Especially for kids (but adults too):
Sit up higher: For kids who are using a potty seat, have them place their feet on books. For those who are old and safe enough, have them put their heels on the toilet seat in a squatting position.
Practice visualization: Have your kids close their eyes and practice having a normal, smooth, seamless poop as they sit on the toilet. Practice this visualization strategy in the morning and at night.
Avoid distractions: Don’t let kids bring video games, books, or phones into the bathroom. When they do this, they avoid being mindful of the somatosensory feeling.
Screens and attention: Kids with poor attention or frequent use of screens also miss signals that their body is trying to send them for toileting. This can create a cycle of being too late, having accidents or holding it in, fear of going in the future, etc
Child’s pose: When my son was really gassy and backed up, we went into child’s pose for a minute and he felt so much better.
Have cause and effect discussions: Whether it’s hydration, body position, or their interception and body awareness related to going to the bathroom, discuss these with your children. Draw the direct connection to their success and failures with voiding. If my son has a belly ache and gives us a hard time about going to the bathroom we will often have him describe the feelings beforehand and then immediately afterward to bridge the divide.
Natural Supplements for Relief
While these supplements have been proven effective for many, focus on the foundational stuff first.
Magnesium: Magnesium is a superhero of minerals that is involved in hundreds of reactions in the body with many benefits that go beyond constipation relief. Unfortunately, about 75% of people are deficient in magnesium, which can exacerbate digestive issues. Thankfully, there are various ways to incorporate magnesium into your diet to enhance digestion and promote softer stools. When using magnesium, start with a lower dose and titrate to tolerance which you can usually tell by the shape and consistency of the stool.
Magnesium recommendations:
Magnesium citrate: There are different types of magnesium but when it comes to stool relief, magnesium citrate tends to be the hero.
Solaray Magnesium Citrate (capsule)
Magnesium glycinate: This is not as quick but it’s still effective. I use it because it’s considered to be the most absorbable form.
Solaray Magnesium Glycinate (capsule)
Thorne’s Magnesium Bisglycinate (powder)
Epsom salt: You can also use Epsom salt in a relaxing bath to help relieve constipation. Just dissolve a cup of Epsom salt in warm bathwater and soak for about 15-20 minutes. This method can also help soothe sore muscles and promote relaxation. Remember to stay hydrated and consult with a healthcare provider before trying any new remedy.
Magnesium spray: Magnesium is very absorbable transdermally, or through the skin. Spray some on your bellow (or any aching muscles to help with recovery) and rub it in before bed. Choose one free of parabens, fragrance, and harsh chemicals.
Magnesium for kids:
I try to avoid the gummy options for the obvious teeth concerns. Instead, a great magnesium powder is Natural Vitality Magnesium (powder) which you can just mix into water.
Probiotics: Support gut health and may regulate bowel movements.
Psyllium Husk: A natural fiber supplement that promotes bulk and eases stool passage.
Coconut Water: this is a go-to for me since coconut makes me go but also provides electrolytes and hydration. I drink Vita Coco Coconut Water.
When to See a Doctor
If constipation is severe or persistent
If you experience rectal bleeding
If you have sudden changes in bowel habits
If constipation is accompanied by unexplained weight loss or abdominal pain.
Maximizing Impact: The Top 10 Constipation Solutions
Eat whole foods, including fruits and vegetables
Limit processed foods
Get enough fiber
Drink enough water
Address underlying health conditions
Establish good toileting practices
Incorporate yoga and general exercise
Keep screens out of the bathroom
Consider supplements
Manage stress
Disclaimer
As a reminder, I’m not a doctor. The information provided here is for educational purposes only and should not replace professional medical advice. It's important to consult with a qualified healthcare professional if you experience any concerning symptoms or conditions.
FAQ
Should I use Miaralax for constipation?
The most common laxative on the market is probably Miralax. This is a problem for three main reasons:
It’s only supposed to be used for a maximum of 7 days with adults.
It’s not approved for use with children.
There is no long-term literature on the safety of Miralax.
Concerns have been raised regarding its potential neuropsychiatric effects, with reports of tremors, tics, and obsessive-compulsive disorder in children after taking Miaralax. In 2011, the FDA listed Miralax as having the possible side effects of “Neuropsychiatric events” and asked researchers to further look at its safety. The concern is that its active ingredient, PEG 3350, lacks sufficient research on systemic absorption in children.
What are some good probiotic foods I can incorporate into my diet?
Excellent question! Fermented foods like kimchi, sauerkraut, kefir, kombucha, and yogurt are all rich in probiotics that can improve gut health and potentially aid with constipation.
I've tried increasing fiber and it made my constipation worse! What should I do?
While fiber is essential for regularity, sometimes increasing it too quickly can lead to bloating and worsen constipation. Start by gradually increasing fiber intake by 5 grams a day to allow your gut to adjust. Additionally, ensure you're drinking plenty of water alongside the extra fiber, as it helps bulk up stool and facilitates easier passage.
Is coffee okay if I'm struggling with constipation?
Coffee can be a double-edged sword for constipation. While it can stimulate the bowels for some people, it can also be dehydrating, potentially worsening constipation for others. If you find coffee helps, limit your intake and ensure you're staying well-hydrated throughout the day. Decaffeinated coffee may also be a good option.
