Constipation is when bowel movements become infrequent. Although it is ideal to have at least one bowel movement per day, a person is generally not considered constipated unless they have less than three bowel movements per week. More specifically, constipation is when there is a significant change in bowel patterns, for example, if two bowel movements a day is the norm for an individual, then having three bowel movements per week would be infrequent for them.
In addition to infrequent bowel movements, signs of constipation also include strained or difficult bowel movements, hard or dry stools, and incomplete bowel movements. Constipation may also be accompanied by abdominal pain, intestinal gas and bloating.
It is common to have short-term constipation; almost everyone gets constipated from time to time. However, if constipation lasts more than two weeks, seek medical advice. Long-term or severe constipation may cause fecal impaction, hemorrhoids, anal fissures, rectal bleeding, or diverticulitis. Seek medical opinion if there is severe pain with bowel movements, blood in the stool, vomiting, or weight loss.
This article covers:
- Causes of Constipation
- Preventing Constipation
- Relieving Constipation
Causes of Constipation
- dehydration or inadequate intake of fluids
- lack of dietary fibre
- significant changes in diet
Lifestyle and Behaviour:
- disruption of daily routine (e.g. travel)
- insufficient activity or exercise
- prolonged bed rest due to illness or injury
- ignoring the natural urge eliminate
- over-use of laxatives or stool softeners
- changes in hormones (pregnancy, PMS, menopause)
- multiple sclerosis
- spinal cord injury
- colon cancer
- kidney failure
Medications or Supplements:
- dietary supplements or antacids that contain calcium carbonate
- iron (ferrous sulphate) pills
- pain medications (opioids)
- certain anti-depressants (Effexor, Paxil, Celexa, Serzone)
- calcium channel blockers
Get Enough Dietary Fibre
Eating enough dietary fibre is a good way to stay regular. Fibre adds bulk to the stool which helps promote peristalsis (the natural wave-like contractions of the intestine which moves stools along). Foods rich in fibre include fruits and vegetables, whole grains, legumes, nuts, and seeds.
Avoid refined or processed foods as they contain very little dietary fibre. If your diet is currently low in fibre, increase your intake of fibre-rich foods gradually. Adding too much fibre too soon may cause gas and bloating.
Related: Fibre: Why You Need It
Eat Fermented Foods
Fermented foods contain the healthy bacteria which is essential for proper bowel function. Eating foods fermented foods helps restore the balance of the microflora in the intestine.
Drink Adequate Fluids
If we don’t have enough water in our body, the water from our food waste will get absorbed. This influences the consistency of the fecal matter; stools become hard, dry, and difficult to pass. Drinking more fluids does not cure constipation, but it is a huge factor in preventing it.
Drink at least 2 litres of water per day. Limit fluids which contribute to dehydration such as alcohol and beverages that contain caffeine. Be sure to increase your fluid intake in hot weather and when you are exercising because a lot of fluids are lost through sweat.
Get Regular Exercise
Regular exercise means exercising at least 3-4 times per week for 20-30, minutes. It doesn’t matter what type of exercise you do, as long as you get your body moving. Walking, running, cycling, swimming, and yoga are all great options. Body movement stimulates the muscles and nerves of the digestive system, which helps promote regular elimination.
Listen to Your Natural Urges for Elimination
Although it’s easy to suppress the natural urge for elimination, don’t ignore your bodies signals. This includes intentional suppression or indirect suppression due to habits, stress, or lack of attention. When you feel the urge to eliminate, take a moment and do it. Consistently suppressing your bodies natural urge for elimination causes the hardening of stools and a build-up of fecal matter. The excess fecal matter causes pressure to build up and distend the rectal wall causing the rectal muscles to lose their tone, decreasing the rectal reflex, which is what informs us that we need to defecate. When we no longer get the urge to defecate, we need to push and strain to pass stool.
Squat When You Poop
Sitting in a squatted position during elimination is better for bowel health than sitting on the toilet. Squatting relaxes the puborectalis muscle and puts the angle of the rectum at a more conducive angle for elimination, permitting a smoother and quicker bowel movement. Squatting also compresses the colon and releases the natural kink between the sigmoid colon and the rectum. This kink is there to maintain continence, but when we squat, the kink is released, so the passage of stool becomes easier. Squatting also supports the function of the ileocecal valve, a sphincter which is located between the small and large intestine. When this value is not working properly, feces back up in the small intestine, causing constipation.
How to Cure Constipation
There are different approaches to relieving constipation. The safest and only long-term solution to eliminate constipation is through healthy diet and lifestyle habits. There are also many natural remedies which are safe and will produce quick effects. Enemas work well as a temporary solution, especially in times of stubborn constipation, or as a means of cleansing the colon of old fecal matter before getting on an improved dietary regime. Laxatives are acceptable for short-term use, but may cause dependency over time. In addition to dependency, the overuse of laxatives or enemas may cause dehydration, diarrhea, or cramping.
Do not use laxatives or enemas if you are experiencing abdominal pain, rectal bleeding, or fecal impaction. Those with inflammatory bowel disorder such as Chron’s or Colitis should also avoid using laxatives or enemas.
Foods to Relieve Constipation
Prunes or prune juice are a classic remedy for constipation. They are effective in almost every case. Prunes work so well not only because they are high in fibre, but they also contain sorbitol, a sugar alcohol with laxative effects. This is why prune juice, which does not have the fibre of the prunes, still works. A typical serving of prunes to relieve constipation would be seven whole prunes or a half cup of prune juice twice a day.
Rhubarb has laxative effects due to the presence on anthraquinones, a compound which has stimulating effects on the colon. Anthraquinones tend to irritate the colon slightly, but rhubarb also contains tannins which are anti-inflammatory and balance the harsh effects of the anthraquinones. You can eat rhubarb stalk; it is good stewed and sweetened or cooked with apple. Alternatively, you can use a half teaspoon of the dried root to make tea.
Do not overuse rhubarb; it is quite strong in its action. Use only the stalk of rhubarb as the leaves are poisonous.
Beets are another great cure for constipation. They are high in fiber and are also a great cleansing food as they help pull toxins out of the liver and move matter through the colon. Beets are also good for general colon health as they contain a compound called betacyanin, which helps fight colon cancer. Eating freshly cooked beets is best, but if you can’t seem to work them into your diet, a great alternative is using beet granules which dissolve easily in juice or water.
After eating beets, you may notice your stool or urine has a red tinge. Don’t panic; it is just the natural pigments in the beets which do not get absorbed by the body.
When constipation is due to hormonal fluctuations, try chewing on some carrots. There is a certain fibre in carrots which helps to detoxify excess estrogen in the colon. Women who experience constipation during PMS or menopause may find relief from constipation by eating a few raw carrots per day.
All whole grains are good sources of dietary fibre, but oats contain a high amount of both soluble and insoluble fibre, making them especially useful for relieving constipation. Because of their high content of soluble and insoluble fibre, oats bulk up and soften the stool and also help lubricate the colon which helps ease the passage of stool.
Coffee contains caffeine which is known to stimulate bowel movements. Coffee can also have the effect of softening stools in some individuals. However, coffee is dehydrating and may worsen symptoms of constipation if your intake of other fluids is not adequate. Coffee may be useful to relieve occasional bouts of constipation, but it is not a long-term solution or effective in every case.
Supplements for Relieving Constipation
Fibre is extremely helpful in maintaining regularity. It helps bulk up the stool and promote peristalsis. It also absorbs toxins and helps waste slide through the intestinal tract. Consider taking a fibre supplement to ensure adequate fibre when you are unable to have a consistent whole foods diet. Read more about the different types of fibre and how to take them.
When taken regularly, probiotics re-establish the intestinal flora. A healthy population of good bacteria is essential for regular bowel function; if the intestinal flora is lacking then digestive issues such as constipation are almost unavoidable. For this reason, probiotics are strongly recommended in cases of chronic or recurrent constipation.
Be sure to take a good quality probiotic with enough variation of bacterial strains. My favourite is Dr. Ohira’s.
For the quick relief of constipation take 1000mg of Vitamin C every hour until you feel the urge to have a bowel movement. Vitamin C is an osmotic agent, which means that it draws water into the colon. This excess fluid softens and loosens fecal matter and also temporarily stretches the colon walls which stimulates contractions to produce a bowel movement.
Taking a regular but lower dose of Vitamin C will also help prevent constipation. To find what dose you need per day, increase your intake of Vitamin C by 500mg every day until you get loose stools. Then, decrease the dose by 500mg per day; this is your bowel tolerance, the amount you can take while still having formed stools.
Most people are deficient in magnesium. If you suffer from chronic constipation, a lack of magnesium may be a contributing factor. Magnesium relaxes the muscles of the intestine which helps to promote bowel movements. Certain forms of magnesium, such as magnesium citrate, are also osmotic agents.
An alternative to taking magnesium orally is to apply it topically. Applying magnesium on the skin is safer because your body will only absorb what it needs. When taking magnesium orally, there is a possibility of taking in too much, which will loosen the stools too much, causing diarrhea. You can massage magnesium oil onto your abdomen or soak in a bath with Epsom salts (magnesium sulphate) or Magnesium Flakes (magnesium chloride).
Herbs to Relive Constipation
Slippery Elm (Ulmus fulva)
Slippery elm is a mucilaginous herb which is soothing to the digestive tract. The mucilage content of slippery elm helps move the contents of the bowel along the tract, making it an excellent remedy for constipation. Slippery elm is not the fastest cure for constipation, but it’s ability to nourish and heal the intestinal lining makes it one of the best herbs for overall colon health. It calms irritation and inflammation, making it especially useful in inflammatory bowel conditions such as IBS, colitis, and diverticulitis.
Slippery elm is available in capsules but is more efficient to use the powdered form. Be sure to get 100% pure slippery elm powder.
Slippery elm becomes glutinous when mixed with water, so it is good to take as a gruel (a porridge-like mixture). Make the gruel by mixing 2-6 teaspoons of slippery elm powder in two cups of warm water. The slippery elm is pleasant in taste, but bland; you may want to add spices such as cinnamon, nutmeg, and ginger or fruits such as berries, apples, or pears. A natural sweetener such as maple syrup, molasses, or honey can also be added. Alternatively, you can make a tea. Use two teaspoons per cup of water. You can combine with other herbs to improve the taste and get other benefits.
Marshmallow Root (Althaea officinalis)
Marshmallow root is another great mucilaginous herb. It has a similar effect as slippery elm in that it will help soothe and coat the intestinal lining allowing for the easier passage of stool.
Use two teaspoons per cup of water to make a tea. Since it’s a root, allow it to infuse in cold water overnight or make a decoction by simmering it for 10 minutes. This will get you the most benefit out of the herb. Drink the tea three times a day, or as needed. Alternatively, take marshmallow root capsules.
Yellow Dock (Rumex crispus)
Yellow dock contains anthraquinones which cause the bowel to contract and expel stool. Like rhubarb, yellow dock contains tannins as well which help to counteract the harsh effect of the anthraquinones, making it a more gentle laxative. Yellow dock also improves the health of the gastrointestinal tract in the long run. It helps to increase the production of bile and stimulates the organs of detoxification.
Dandelion Root (Taraxacum officinale)
When taken 10-20 minutes before meals, dandelion root can help alleviate constipation. It is a great digestive aid as it stimulates the liver to produce bile. Roasted dandelion root tea tastes great and is easy to make. Don’t expect immediate or miraculous results from dandelion root; it is one of the more gentle acting laxative herbs, but it will help improve digestive function over the long term.
Herbal bitter formulas are readily available and contain a broad range of herbs that will act to stimulate digestive secretions including hydrochloric acid, pancreatic enzymes, and bile. Bitters improve overall digestive function and will help relieve constipation. Yarrow, gentian, angelica, horehound, elecampane, and dandelion are some examples of herbs found in Bitters formulas. “Swedish Bitters” are a common pre-made herbal bitters formula sold by various manufacturers.
Triphala is an Ayurvedic remedy consisting of three herbs: amalaki (Emblica Officinalis), Bibhitaki (Terminalia Bellirica), and Haritaki (Terminalia Chebula). Triphala is a digestive tonic and a powerful detoxifier. It is a very safe remedy to use for constipation because it does not cause dependency like laxatives. It acts by improving the peristaltic function of the gastrointestinal tract and also stimulates the secretion of bile and digestive enzymes.
Stir one teaspoon of Triphala powder into a glass of water, let it sit overnight, then drink the water in the morning. Do not stir it before drinking as you only need to ingest the water, not the powder at the bottom. Alternatively, take Triphala tablets which are much easier to take, since the powder has a quite a strong taste.
Aloe Vera (Aloe Barbadensis)
Aloe vera juice reduces bowel transit time which can help relieve constipation. Aloe vera also softens the consistency of the stool because it increases its capacity to hold water. Aloe is also an excellent tonic for the gastrointestinal system. Not only does it decrease the build up of fecal matter, but it also improves colonization of the good bacteria in the colon. Aloe vera also has anti-inflammatory effects and is beneficial in cases of Chron’s disease, hemorrhoids, and other gastrointestinal disorders.
Aloe vera is not a fast-acting laxative; it may take a couple of days of taking it to notice effects. Start off with a dose of 2oz per day and gradually work up to 8oz. Use pure aloe vera juice which is meant for internal use.
Cascara Sagrada (Rhamnus purshiana)
Cascara sagrada is a strong laxative. It contains anthraquinone which irritates the colon, causing contractions. Cascara sagrada acts relatively quickly, producing a bowel movement within 6-8 hours.
Cascara sagrada is for short-term use only (up to one week). It may cause abdominal cramping, and when overused leads to bowel dependency. Do not use Cascara sagrada is you have an inflammatory bowel disorder, appendicitis, intestinal blockages, or chronic stomach pain. It is recommended to take cascara sagrada in capsule form for a more controlled dose.
Senna (Cassia senna)
Another strong laxative which contains the bowel stimulating anthraquinones is senna. Like cascara sagrada, senna should only be used when other methods to relieve constipation have not worked, and it should not be used for more than one week at a time. It may cause abdominal cramping and electrolyte imbalance. Senna should not be used by pregnant women, people with inflammatory bowel disease, or any other disorders of the gastrointestinal tract.
Ginger Root (Zingiber officinale)
Ginger is an excellent overall tonic for the digestive system. It stimulates the appetite, improves digestion, and reduces gas. Ginger contains chemicals (shogoal and gingerol) which stimulate the release of bile and other gastric secretions. It also helps to relieve constipation by improving the tone of the intestinal muscles and stimulating peristalsis.
Ginger can be taken as a tea; grate the fresh root and let steep in hot water for five minutes. Dry ginger also makes a nice tea and is readily available in prepared tea bags. Alternatively, chew on some candied ginger root.
Natural Remedies for Constipation
Apple Cider Vinegar
Apple cider vinegar contains pectin, a soluble fibre which helps to bulk up stool and aid it’s passage through the colon. Apple cider vinegar also contains malic acid which helps improve overall digestion.
Add 1-2 tablespoons of apple cider vinegar to a small glass of water and drink it on an empty stomach first thing in the morning. You can add a spoon of honey to make the mixture more palatable. Be sure to use only raw, unfiltered apple cider vinegar. You will know it is good quality if still contains the “mother,” which is strands of protein along with healthy bacteria and enzymes.
Warm lemon water helps stimulate the production of bile and improve digestive function. Lemon water also helps cleanse the body. It is not a fast acting cure for constipation, but done on a daily basis is a good way to tone your digestive system. Mix the juice of a half lemon into a glass of warm water and drink it first thing in the morning.
Blackstrap molasses is high in many vitamins and minerals, especially magnesium. Magnesium deficiency is a common cause of constipation. Mix two tablespoons of blackstrap molasses into a half glass of warm water and drink before bed. Alternatively, add blackstrap molasses into your diet; blackstrap molasses works well in porridge, baked goods, casseroles, as a glaze for meat, in coffee or tea, or as a substitute for syrup or other sweeteners. Blackstrap molasses does have a strong taste; you may find it more palatable in the beginning to mix equal parts honey and blackstrap molasses.
Castor oil is extracted from castor beans. It is an ancient remedy frequently used in Ayurveda. Castor oil is a powerful laxative that is likely to work every time.
Take 1-2 tablespoons of castor oil on an empty stomach. It should produce effects within a few hours. Castor oil has a strong taste; chasing it with lemon water or orange juice helps to get rid of the unpleasant aftertaste.
Castor oil is an irritant to the intestinal tract and should not be taken internally for extended periods. Do not drink castor oil if you have abdominal cramps, stomach ulcers, or inflammatory bowel disease.
A safer alternative to taking castor oil internally is to massage a small amount of the oil over the abdomen. Apply the oil before bed and you should have a bowel movement in the morning.
An even better option, if you have the time, is to use a castor oil pack. Not only will it relieve constipation, but when used on a regular basis, castor oil packs strengthen the liver, promote healing in the abdominal area, and improve overall digestive function. To learn more, see the instructions for using a castor oil pack.
Massaging the abdomen is a gentle and safe way to promote peristalsis and relieve constipation. Lay on your back and place your hands on your abdomen. You can use oil if you wish. Massage in a clockwise direction around your navel. Start on the lower right side of your abdomen and rub up, across, and down the left side, finishing in the left groin area. This follows the natural movement of waste matter through the colon. Continue the circular motion for five minutes. Remember to breathe and relax.
Take a Hot Bath
Sitting in a hot bath helps to relax the abdominal organs and relieve discomfort and cramps. It is also a good way to reduce stress, which is a common cause of constipation. Add two cups of Epsom salts to the bath to increase the relaxing effects and get some magnesium into your body.
Use an Enema
An enema is the insertion of a large volume of fluid into the colon to produce a flush. Enemas soften and loosen impacted fecal matter and promote contractions of the intestine which encourage a bowel movement.
A salt water enema is sufficient to relieve constipation, but there are many different types of enemas with added benefits.
Before trying an enema, please read “Everything You Ever Wanted to Know About Giving Yourself an Enema.”
- www.merkmanuals.com, Constipation
- www.news-medical.net, Drugs That Cause Constipation
- James Duke, The Green Pharmacy Herbal Handbook
- www.doctorschar.com, Yellow Dock
- Jeffrey Bland, Ph.D., Effect Of Orally Consumed Aloe Vera Juice On Gastrointestinal Function, Linus Pauling Institute of Science & Medicine Preventive Medicine