Constipated? You don’t have to be

Toilet paper roll in forground with toilet in background

We talk a lot about what we put in our bodies. What we don’t talk about is what comes out. Unless you’re the parent of a toddler-in-toilet-training or a teenager who likes to amuse himself by reporting to his friends the shape and color of the day’s BM (that’s shorthand for bowel movement), the subject has been all but wiped clean from our daily conversations. Ken Weizer, N.D., a naturopathic physician with Providence Integrative Medicine, says the state of your stool is an important marker of your overall health. "I don’t think poop gets the respect it deserves," he says.

While some folks go between five and 10 times a day, others can have a BM as infrequently as once a month. Seventy-five percent of the population tends toward constipation, and if you’re in that class, your experience is anything but normal, Dr. Weizer says.

Why are we so backed up? Four things contribute to our irregularity, says Dr. Weizer: inactivity, dehydration, not enough fiber and – of course – stress. The good news is that there is plenty we can do to prevent each of them.

Constipation cause No. 1: inactivity

We sit a lot. Especially if you’ve got a desk job or you’re older and less active. All that sitting isn’t healthy for your gut. "The bowel – the tube that goes from your mouth to your bottom, also called your gut – it’s made up of muscles that push food and then waste from one end to the other," Dr. Weizer says. If you’re not exercising those muscles, your poop is just sitting there, clogging up your pipes. And it’s uncomfortable.

Solution: Dr. Weizer recommends investing in an inexpensive pedometer to track your daily steps. A good goal is 10,000 per day. And if you’re tethered to a desk for employment, Dr. Weizer suggests getting creative: Stand at least once an hour. Take breaks and walk a little bit. Take the stairs and park farther away from the entrance. "Most people say, ‘Well, I don’t have time.’ But if you’re physically and mentally sharper, you’ll do better work," Dr. Weizer says.

Constipation cause No. 2: dehydration

Water helps flush your system, quite literally. When you don’t drink enough of it, your stool sits idle in your colon, drying up and becoming more of a challenge to move along.

Solution: Drink more water. "Especially in the winter, in can be hard – it’s so dry inside, and we’re not used to drinking enough," Dr. Weizer says. "You should drink enough so that you’re not constipated and so that your urine is clear." While water is best, some people also benefit from bitter drinks, such as coffee (no cream or sugar), or black or green tea, which stimulate bile production that aids in breaking down and passing stool through the colon. Dr. Weizer also recommends prune juice. "Prunes have a lot of insoluble fiber, and they just seem to work great at getting your bowel moving."

Constipation cause No. 3: not enough fiber

"It’s easy to have a low-fiber diet in America because there’s so much processed food," Dr. Weizer says. "If you don’t eat enough fiber, it’s very hard for your bowel to work properly." Soluble fiber, he says, helps dissolve water and feed the good bacteria that line your gut. Insoluble fiber is what he calls "nature’s broom" – cleaning out from your body what you don’t want.

Solution: Eat at least 50 grams of fiber per day. Most people get only 10 to 15 grams of fiber daily. And he says you should get your fiber from food, not supplements. Finally, the answer is not to throw more insoluble fiber at your already-clogged gut. "You’re going to get more constipated," he says. "You’re just creating cement in there." Focus on upping your fruit and vegetable intake, and moving from refined grains to whole grains.

Constipation cause No. 4: stress

"Our emotions affect our gut," Dr. Weizer says. "If we have stress, we tend to shut down our gut." And for those who choose to use medication to help manage emotions, those medications – such as antidepressants – often can affect our regularity.

Solution: Apply the first three solutions – move more, drink more water and eat more fiber-rich foods. Study after study proves that exercise can make a huge difference on your mood, as can what you eat and drink. If that’s not enough, there are other options to calm your nerves and even out your emotional highs and lows, such as meditation, martial arts, yoga, massage and acupuncture. Providence offers health and wellness classes, health coaching and discounts on alternative care, as well as abundant mental health services. Talk to your health care provider about the things you can do to calm your body and mind. Self-care is the answer to a more serene life – and perhaps less stress in the bathroom, too.

Medications also can mess with our regularity. Antidepressants, antibiotics, chemotherapy and steroids all can slow things down. "Most of the drugs that people are on in America affect their gut," Dr. Weizer says. Probiotic foods (or supplements) taken daily can help counter the effects of medication on the gut. "Having good bacteria come into your gut – for example, through yogurt, kefir, natural pickles that have probiotics – can help therapeutically when people are constipated," Dr. Weizer says.

Intervention vs. prevention

Prevention is ideal, but stubborn cases of constipation may require a little more attention to get things moving. Most people let constipation linger, Dr. Weizer says, and when they can’t take it anymore, they treat it with harsh laxatives or an enema. Rather than going from one extreme to the other (laxatives can result in cramping and even diarrhea), Dr. Weizer suggests to his patients a more gradual approach:

  1. Food. Dr. Weizer recommends prunes or prune juice as a first line of treatment for being backed up. He also suggests making ground flax seed part of your daily diet; you can sprinkle it on cereal, yogurt, kefir, oatmeal and salads. You also can put the ground flax in water, let it sit for a day and then drink the resulting syrupy concoction.
  2. Epsom salts. "If the constipation is incredibly resistant to change, then we get a little more serious," Dr. Weizer says, noting that soaking in an Epsom salt bath (five cups of salt) for at least 10 minutes can help. When you soak in an Epsom salt bath, magnesium is absorbed into your muscles, which relaxes the gut. That extra magnesium also draws water into your gut to help soften your bowel movement.
  3. Oral magnesium. This is next in the treatment line to help stimulate the bowel. Consult with your doctor about appropriate dosages and forms of magnesium to take.
  4. Over-the-counter laxatives. "If the constipation is intractable, we consider over-the-counter laxatives," Dr. Weizer says. "But none of those should be used long-term." Over-the-counter laxatives include Miralax, Senokot, milk of magnesia and the like. While they may work in the short-term, if used for too long, laxatives can interrupt the body’s natural rhythm. "The tone of the muscle decreases, and you become dependent on the drug," Dr. Weizer says. Some laxatives may even discolor the lining of your gut and cause inflammation and irritation.

The scoop on your poop

In the end, it’s your comfort and your health that matter. Dr. Weizer is willing to bet that most of us would like to have at least one "wonderful, happy, glorious bowel movement" every day. If you don’t, he encourages you to take the matter up with your health care provider – especially if you’ve experienced constipation for a long time. "It can change the bacteria that line your gut, and you can become prone to more unhealthy bacteria and fungus," he says. "You tend not to get rid of things you want to get rid of, like toxins, chemicals and hormones."

Dr. Weizer gets the conversation with his patients moving in the right direction with equal parts humor and seriousness about the benefits of becoming regular and producing healthy poops. "I think people know intuitively that it’s important. Once you open up the conversation, it’s kind of fun – most people love it."

The shape of things

Not sure what a healthy poop should look like? Check out the Bristol Stool Chart. Dr. Weizer says you should aim for a type 3 or type 4 bowel movement.