Simple Remedies for Constipation
Jane E. Brody : NY Times : February 8, 2016
Chronic constipation is an all-too-common problem rarely discussed in polite company and only reluctantly mentioned to doctors during checkups. Although it accounts for eight million doctor visits annually, only “a minority of those with constipation seek medical attention,” Dr. Arnold Wald, a leading expert on the problem, reports.
Yet this hesitance can perpetuate mistaken beliefs about its consequences, causes and treatment, and often results in failure to get effective relief. Most of the time, relatively simple treatments prove adequate. Even more complex cases, like those that involve a disorder of muscle action in the pelvis, usually respond well to currently available remedies.
Chronic constipation can accompany a long list of medical problems – mechanical ones like a stricture or tumor; neurological disorders like Parkinson’s disease or multiple sclerosis; or metabolic conditions like severe low thyroid or low blood levels of magnesium.
Constipation can also be a side effect of medications, especially opiates like Percocet and OxyContin, as well as some antidepressants, anticonvulsants and antihistamines.
As someone who has dealt with constipation, with varying degrees of success, for most of my life, I had more than an academic interest in learning more about it. Hence this column, prompted by a friend’s excruciatingly painful problem that seemed to emerge from nowhere and by a new review of studies on the topic published in JAMA by Dr. Wald, a gastroenterologist at the University of Wisconsin School of Medicine and Public Health.
Many strongly held beliefs about constipation are not based on medical evidence, Dr. Wald and his colleagues have noted.
One of the oldest yet most persistent of these unsubstantiated notions is that failure to empty one’s bowels each and every day can result in so-called autointoxication – the absorption of poisonous substances produced from partially digested food and food byproducts in the intestines. Through the years, autointoxication has been erroneously blamed for a host of ailments, including high blood pressure, arthritis, atherosclerosis, gall bladder disease, various cancers and skin disorders.
Autointoxication is often cited as a reason for the common but mistaken belief that a daily bowel movement is essential to good health. But there’s no evidence that food that sits in the intestine leads to the buildup of toxins. The medically accepted definition of constipation is “fewer than three bowel movements a week, or hard, dry and small bowel movements that are painful or difficult to pass,” often resulting in abdominal pain or bloating.
Unfortunately, as a college freshman, I met those criteria. An astute physician provided advice that has helped to minimize the problem ever since. She gave me a list of “constipating” foods to avoid – white rice and other refined grains, unripe bananas, tea, cheese and chocolate – and even more important, foods to eat regularly: beans, whole grain cereals (especially bran) and breads, vegetables, fruits (especially dried fruits) and nuts. Eating more of these and other high-fiber foods can be very effective in curbing constipation. And she recommended drinking a full glass of water before bed to help soften the stool and another after awakening to stimulate my bowel.
Following this advice I’ve never had to rely on laxatives, although those medications are associated as well with myths and misconceptions that are important to dispel. One mistaken belief Dr. Wald and others have cited is that long-term use of stimulatory laxatives like senna and bisacodyl (Senokot and Dulcolax, respectively) can impair normal function of the colon and cause dependency on the medication.
While it is true that using stimulatory laxatives for many years at more than a dozen times the suggested dosage can damage the colon’s nerves and muscles, Dr. Wald and others say that properly designed studies of these laxatives have shown no harm to the colon when they are taken in recommended amounts.
Yet many doctors still warn – inappropriately, Dr. Wald says — against taking stimulatory laxatives for more than a few days. Indeed, the website FamilyDoctor.org states, “When these laxatives are taken for a long time, the bowel can lose its muscle tone and ‘forget’ how to push the stool out on its own.” Best to forget this outdated idea as long as you stick to the recommended dose if you must take these products.
Short of potent laxatives, other milder remedies often prove helpful. One is exercise, the more vigorously done the better. Another is to establish a regular bathroom time and respond promptly to the urge to defecate. I am among many who have found that a large cup of hot coffee in the morning is often a very effective stimulus.
However, as my ability to prevent constipation has diminished with age, I’ve added two other over-the-counter aids: a daily soluble fiber supplement of psyllium dissolved in juice or water (other fiber products like methyl cellulose, calcium polycarbophil and wheat dextrin can also be effective) and a twice-daily dose of a stool softener, both of which can safely be used indefinitely.
However good dietary fiber normally is for maintaining a healthy gut, it can be harmful when the cause of constipation is muscle weakness or a nerve problem, Dr. Wald said. Such patients often do better by eating less fiber and instead taking a secretory drug like lubiprostone (Amitiza) or linaclotide (Linzess) that adds water to the colon and softens the stool.
Sometimes, too, standard remedies for chronic constipation are ineffective. None worked for my friend, a New Yorker who suddenly developed an extremely painful problem at age 73 that was finally diagnosed as a failure of her pelvic floor muscles to relax when they are supposed to and allow the stool to pass through. Instead of relaxing, the muscles around the rectum contract. “It is a learned unconscious act that can be unlearned,” Dr. Wald explained.
Despite the usual remedies of diet, exercise and a costly prescription-only stool softener, the problem has recurred every eight days or so, she said. She is now being treated with deep breathing exercises 10 times a day and abdominal massage above the colon twice a day, and has begun biofeedback to “retrain” the muscles that are responsible for normal colorectal action. Dr. Wald said that biofeedback training, when done properly, is effective in about 80 percent of cases.
My friend’s experience underscores the importance of consulting an expert when constipation persists and fails to respond adequately to self-help measures of diet, exercise and over-the-counter remedies.
Jane E. Brody : NY Times : February 8, 2016
Chronic constipation is an all-too-common problem rarely discussed in polite company and only reluctantly mentioned to doctors during checkups. Although it accounts for eight million doctor visits annually, only “a minority of those with constipation seek medical attention,” Dr. Arnold Wald, a leading expert on the problem, reports.
Yet this hesitance can perpetuate mistaken beliefs about its consequences, causes and treatment, and often results in failure to get effective relief. Most of the time, relatively simple treatments prove adequate. Even more complex cases, like those that involve a disorder of muscle action in the pelvis, usually respond well to currently available remedies.
Chronic constipation can accompany a long list of medical problems – mechanical ones like a stricture or tumor; neurological disorders like Parkinson’s disease or multiple sclerosis; or metabolic conditions like severe low thyroid or low blood levels of magnesium.
Constipation can also be a side effect of medications, especially opiates like Percocet and OxyContin, as well as some antidepressants, anticonvulsants and antihistamines.
As someone who has dealt with constipation, with varying degrees of success, for most of my life, I had more than an academic interest in learning more about it. Hence this column, prompted by a friend’s excruciatingly painful problem that seemed to emerge from nowhere and by a new review of studies on the topic published in JAMA by Dr. Wald, a gastroenterologist at the University of Wisconsin School of Medicine and Public Health.
Many strongly held beliefs about constipation are not based on medical evidence, Dr. Wald and his colleagues have noted.
One of the oldest yet most persistent of these unsubstantiated notions is that failure to empty one’s bowels each and every day can result in so-called autointoxication – the absorption of poisonous substances produced from partially digested food and food byproducts in the intestines. Through the years, autointoxication has been erroneously blamed for a host of ailments, including high blood pressure, arthritis, atherosclerosis, gall bladder disease, various cancers and skin disorders.
Autointoxication is often cited as a reason for the common but mistaken belief that a daily bowel movement is essential to good health. But there’s no evidence that food that sits in the intestine leads to the buildup of toxins. The medically accepted definition of constipation is “fewer than three bowel movements a week, or hard, dry and small bowel movements that are painful or difficult to pass,” often resulting in abdominal pain or bloating.
Unfortunately, as a college freshman, I met those criteria. An astute physician provided advice that has helped to minimize the problem ever since. She gave me a list of “constipating” foods to avoid – white rice and other refined grains, unripe bananas, tea, cheese and chocolate – and even more important, foods to eat regularly: beans, whole grain cereals (especially bran) and breads, vegetables, fruits (especially dried fruits) and nuts. Eating more of these and other high-fiber foods can be very effective in curbing constipation. And she recommended drinking a full glass of water before bed to help soften the stool and another after awakening to stimulate my bowel.
Following this advice I’ve never had to rely on laxatives, although those medications are associated as well with myths and misconceptions that are important to dispel. One mistaken belief Dr. Wald and others have cited is that long-term use of stimulatory laxatives like senna and bisacodyl (Senokot and Dulcolax, respectively) can impair normal function of the colon and cause dependency on the medication.
While it is true that using stimulatory laxatives for many years at more than a dozen times the suggested dosage can damage the colon’s nerves and muscles, Dr. Wald and others say that properly designed studies of these laxatives have shown no harm to the colon when they are taken in recommended amounts.
Yet many doctors still warn – inappropriately, Dr. Wald says — against taking stimulatory laxatives for more than a few days. Indeed, the website FamilyDoctor.org states, “When these laxatives are taken for a long time, the bowel can lose its muscle tone and ‘forget’ how to push the stool out on its own.” Best to forget this outdated idea as long as you stick to the recommended dose if you must take these products.
Short of potent laxatives, other milder remedies often prove helpful. One is exercise, the more vigorously done the better. Another is to establish a regular bathroom time and respond promptly to the urge to defecate. I am among many who have found that a large cup of hot coffee in the morning is often a very effective stimulus.
However, as my ability to prevent constipation has diminished with age, I’ve added two other over-the-counter aids: a daily soluble fiber supplement of psyllium dissolved in juice or water (other fiber products like methyl cellulose, calcium polycarbophil and wheat dextrin can also be effective) and a twice-daily dose of a stool softener, both of which can safely be used indefinitely.
However good dietary fiber normally is for maintaining a healthy gut, it can be harmful when the cause of constipation is muscle weakness or a nerve problem, Dr. Wald said. Such patients often do better by eating less fiber and instead taking a secretory drug like lubiprostone (Amitiza) or linaclotide (Linzess) that adds water to the colon and softens the stool.
Sometimes, too, standard remedies for chronic constipation are ineffective. None worked for my friend, a New Yorker who suddenly developed an extremely painful problem at age 73 that was finally diagnosed as a failure of her pelvic floor muscles to relax when they are supposed to and allow the stool to pass through. Instead of relaxing, the muscles around the rectum contract. “It is a learned unconscious act that can be unlearned,” Dr. Wald explained.
Despite the usual remedies of diet, exercise and a costly prescription-only stool softener, the problem has recurred every eight days or so, she said. She is now being treated with deep breathing exercises 10 times a day and abdominal massage above the colon twice a day, and has begun biofeedback to “retrain” the muscles that are responsible for normal colorectal action. Dr. Wald said that biofeedback training, when done properly, is effective in about 80 percent of cases.
My friend’s experience underscores the importance of consulting an expert when constipation persists and fails to respond adequately to self-help measures of diet, exercise and over-the-counter remedies.
Safe Medications for Constipation
1. Stool softener (Colace/docusate 100 mg twice a day)
2. Fiber supplement (Benefiber/Metamucil/Citrucel) daily
3. Milk of Magnesia
4. Miralax
Home Remedies to Relieve Constipation
1. Coffee is our friend (sometimes)
A lot of people love their morning coffee, but it does more than just give off heavenly aromas and help you perk up. Caffeine is a natural stimulant for the digestive system, so indulging in a cup of joe will help get you up and running in more ways than one. 1-2 cups is fine, but make sure you don’t overdo it-too much can actually have the opposite effect. Coffee is a diuretic and makes you urinate more frequently, and if you drink it an excess, it can cause constipation by dehydrating your body and drawing out water that would normally soften your stool.
2. Get moving
If you want stuff to move through your body, you need to move too! Our lifestyle these days not only involves dietary changes that increase constipation, but we’re often sitting much more than we’re active. While there isn’t an exact scientific reason as to why lack of exercise is linked with getting clogged up, we can assume that moving the body helps get the smooth muscle in the colon moving as well. Keep in mind, however, that you should wait an hour after big meals before exercising. There are also specific stretches and workouts that are supposed to help with getting good old number 2 out the door.
3. Go natural (aka fiber, fiber, and more fiber)
You’ll hear people talk a lot about how a natural diet helps relieve and prevent constipation. An overall healthy diet just improves everything, and our bodies know how to process fruits, veggies, grains and roughage more than the refined or artificial foods that don’t pass as easily. To get more specific, natural foods tend to contain boatloads of fiber-that magical word that signifies the end of toilet suffrage. In short, fiber is material that cannot be digested, and it acts like a sponge. It draws water from its surroundings, making it swell, which softens stool and adds bulk to it, which in turn helps it pass. Like coffee, some kinds of fiber (like beans) can contribute to constipation, so always drink plenty of water. Some good fiber-filled foods include-
-Beans
-Dried fruit (prunes, figs, apricots)
-Whole grain bread
-Berries
-Broccoli
-Plums, pears, and apples
-nuts
-Potatoes (skip the fries though)
4. Get some FLAXitive
Flaxseed oil is a pretty simple home remedy for constipation. It sort of coats the walls of the intestine, as well as stool, and increases the number of bowel movements you are having. Enjoying your oil with orange juice is a double whammy when it comes to constipation, since oranges have a good amount of fiber in them (make sure to get orange juice with pulp, which is what has most of the fiber.)
You will need…
-1 glass of orange juice with pulp (8 oz.)
-1 tablespoon of flaxseed oil
Directions
Mix 1 tablespoon of flaxseed oil with 1 glass of orange juice. Drink as needed, but give it time (up to 5 hours) to start working so you don’t overdo it.
5. Aloe-it’s benefits aren’t just skin deep
Aloe is known to soothe minor cuts and burns, but it can also soothe your tummy. It’s best to use pure aloe vera gel from the plant. The gel straight from the plant is more concentrated than commercial aloe juice so don’t use more than 2 tablespoons. If you don’t have an aloe plant, than drinking aloe juice can accomplish similar results.
You will need…
-2 tablespoons of pure aloe gel or 1 cup of aloe vera juice
Directions
Mix two tablespoons of pure gel with fruit juice and drink in the morning, OR drink one cup of aloe vera juice as needed.
6. Establish a routine
Potty schedules aren’t just for puppies, they’re a great way to relieve and prevent constipation in humans too. Regulating the timing of when you go to the bathroom will regulate your bowel movements as well. Set aside about 15 minutes anywhere from 1-3 times a day, and take your time, even if nothing happens. Make sure you stay relaxed, and eventually your body will catch on.
7. Magnesium citrate
This is what is used in high doses to prep for a colonoscopy…helps get things moving on out!
8. Bacteria is necessary
Healthy gut flora is vital to keep our digestive system working properly, especially in these times, when our stomach is getting pounded with all sorts of processed sugars and foods. Working to keep the good bacteria in our bodies strong and plentiful will help prevent constipation, and lessen its severity should it still occur. There are a number of ways to go about helping your bacteria flourish, but one simple method is to enjoy a cup of greek yogurt, which is filled with probiotics, with breakfast and during the day.
You will need…
-1-3 cups of plain yogurt
Directions
Eat a cup of yogurt with breakfast, and then on its own or with snacks throughout the day.
9. Rock the squat
It sounds a tad awkward, but literally squatting over the toilet can help relieve constipation and kick start your colon. It’s a natural position that our bodies understand means “it’s time to go!”
American’s spend a little less than $1 billion dollars a year on laxatives that will ultimately only contribute to the problem, and wreak havoc on the body. Know that you do not have to have a bowel movement every single day to be regular-that is a myth that contributes to the dependency on laxatives. Some people only poop every few days and that’s normal for them, while others go multiple times a day. We’re all different, and there are too many factors to decide how often every single person should be going-just know your body and use common sense.
Constipation may be something that people like to keep to themselves, but whether you don’t tell a soul, or announce it on graduation day via the loudspeaker, it all comes down to the fact that it can seriously impede day to day life. It is also, thankfully, something that can often be effectively treated naturally and at home. As a bonus, many of the lifestyle changes that help constipation (diet, exercise, etc.) simply make you an overall happier, healthier human being.
1. Stool softener (Colace/docusate 100 mg twice a day)
2. Fiber supplement (Benefiber/Metamucil/Citrucel) daily
3. Milk of Magnesia
4. Miralax
Home Remedies to Relieve Constipation
1. Coffee is our friend (sometimes)
A lot of people love their morning coffee, but it does more than just give off heavenly aromas and help you perk up. Caffeine is a natural stimulant for the digestive system, so indulging in a cup of joe will help get you up and running in more ways than one. 1-2 cups is fine, but make sure you don’t overdo it-too much can actually have the opposite effect. Coffee is a diuretic and makes you urinate more frequently, and if you drink it an excess, it can cause constipation by dehydrating your body and drawing out water that would normally soften your stool.
2. Get moving
If you want stuff to move through your body, you need to move too! Our lifestyle these days not only involves dietary changes that increase constipation, but we’re often sitting much more than we’re active. While there isn’t an exact scientific reason as to why lack of exercise is linked with getting clogged up, we can assume that moving the body helps get the smooth muscle in the colon moving as well. Keep in mind, however, that you should wait an hour after big meals before exercising. There are also specific stretches and workouts that are supposed to help with getting good old number 2 out the door.
3. Go natural (aka fiber, fiber, and more fiber)
You’ll hear people talk a lot about how a natural diet helps relieve and prevent constipation. An overall healthy diet just improves everything, and our bodies know how to process fruits, veggies, grains and roughage more than the refined or artificial foods that don’t pass as easily. To get more specific, natural foods tend to contain boatloads of fiber-that magical word that signifies the end of toilet suffrage. In short, fiber is material that cannot be digested, and it acts like a sponge. It draws water from its surroundings, making it swell, which softens stool and adds bulk to it, which in turn helps it pass. Like coffee, some kinds of fiber (like beans) can contribute to constipation, so always drink plenty of water. Some good fiber-filled foods include-
-Beans
-Dried fruit (prunes, figs, apricots)
-Whole grain bread
-Berries
-Broccoli
-Plums, pears, and apples
-nuts
-Potatoes (skip the fries though)
4. Get some FLAXitive
Flaxseed oil is a pretty simple home remedy for constipation. It sort of coats the walls of the intestine, as well as stool, and increases the number of bowel movements you are having. Enjoying your oil with orange juice is a double whammy when it comes to constipation, since oranges have a good amount of fiber in them (make sure to get orange juice with pulp, which is what has most of the fiber.)
You will need…
-1 glass of orange juice with pulp (8 oz.)
-1 tablespoon of flaxseed oil
Directions
Mix 1 tablespoon of flaxseed oil with 1 glass of orange juice. Drink as needed, but give it time (up to 5 hours) to start working so you don’t overdo it.
5. Aloe-it’s benefits aren’t just skin deep
Aloe is known to soothe minor cuts and burns, but it can also soothe your tummy. It’s best to use pure aloe vera gel from the plant. The gel straight from the plant is more concentrated than commercial aloe juice so don’t use more than 2 tablespoons. If you don’t have an aloe plant, than drinking aloe juice can accomplish similar results.
You will need…
-2 tablespoons of pure aloe gel or 1 cup of aloe vera juice
Directions
Mix two tablespoons of pure gel with fruit juice and drink in the morning, OR drink one cup of aloe vera juice as needed.
6. Establish a routine
Potty schedules aren’t just for puppies, they’re a great way to relieve and prevent constipation in humans too. Regulating the timing of when you go to the bathroom will regulate your bowel movements as well. Set aside about 15 minutes anywhere from 1-3 times a day, and take your time, even if nothing happens. Make sure you stay relaxed, and eventually your body will catch on.
7. Magnesium citrate
This is what is used in high doses to prep for a colonoscopy…helps get things moving on out!
8. Bacteria is necessary
Healthy gut flora is vital to keep our digestive system working properly, especially in these times, when our stomach is getting pounded with all sorts of processed sugars and foods. Working to keep the good bacteria in our bodies strong and plentiful will help prevent constipation, and lessen its severity should it still occur. There are a number of ways to go about helping your bacteria flourish, but one simple method is to enjoy a cup of greek yogurt, which is filled with probiotics, with breakfast and during the day.
You will need…
-1-3 cups of plain yogurt
Directions
Eat a cup of yogurt with breakfast, and then on its own or with snacks throughout the day.
9. Rock the squat
It sounds a tad awkward, but literally squatting over the toilet can help relieve constipation and kick start your colon. It’s a natural position that our bodies understand means “it’s time to go!”
American’s spend a little less than $1 billion dollars a year on laxatives that will ultimately only contribute to the problem, and wreak havoc on the body. Know that you do not have to have a bowel movement every single day to be regular-that is a myth that contributes to the dependency on laxatives. Some people only poop every few days and that’s normal for them, while others go multiple times a day. We’re all different, and there are too many factors to decide how often every single person should be going-just know your body and use common sense.
Constipation may be something that people like to keep to themselves, but whether you don’t tell a soul, or announce it on graduation day via the loudspeaker, it all comes down to the fact that it can seriously impede day to day life. It is also, thankfully, something that can often be effectively treated naturally and at home. As a bonus, many of the lifestyle changes that help constipation (diet, exercise, etc.) simply make you an overall happier, healthier human being.
