Constipation

Normal bowel movements are defined as those which occur anywhere from three times a day to three times a week. Anything less is constipation. Most people feel better with one or two bowel movements a day. Not least because the act itself is satisfying (when we defecate, the brain waves change from alpha to beta, a more meditative and calming state of mind). While you can suffer from an isolated bout of constipation, more commonly it is a long-term condition. A little detective work to find the cause will hopefully cure constipation forever.

Symptoms

• Having less than three bowel movements weekly.
• Straining when you go to the toilet.
• A feeling of incomplete evacuation.
• Lumpy or hard bowel movements.
• Accompanying signs may include bad breath, tiredness, headaches, loss of appetite, coated tongue, bloated tummy, body odour, flatulence and skin problems.

What causes it?

• Not drinking enough fluid is often the most simple and only cause of constipation. Without sufficient fluid, the contents of the bowel become dried out and difficult to pass.
• The fibre connection. When it comes to bowels, much depends on ‘transit time’ (the time it takes for food to pass through your entire nine metres of digestive tubing). In countries where the diet is mostly fibrous grains and vegetables, the transit time is less than 24 hours and up to half a kilogram a day can be eliminated from the bowel. In more highly industrialised countries like ours, transit time may take several days and stools weigh in at a paltry 100 g. The obvious conclusion is that fibre speeds up the transit of body waste. For many people, therefore, fibre is the key to curing constipation.
• Stress tightens many muscles, including the muscles lining the digestive tract. For some people, a stressful situation can cause diarrhoea. However, others react to stress by holding on internally. The tightness of the intestinal muscles causes the stressed stools to look like small pellets or animal droppings (variously described as looking like the droppings of a wallaby, goat or, if extremely stressed, a rabbit).
• Gluten intolerance may cause constipation. Especially if there is bloating, it is well worth trialling a gluten-free diet for a month to see if things improve. See Gluten Intolerance .
• The wrong bugs. The more we find out about the bacteria living within our bowel, the more important they appear to be. For instance, some bacteria secrete substances that can paralyse the bowel wall, putting a stop to peristalsis in that section of the bowel, causing constipation.
• The truism, ‘a change is as good as a holiday’, doesn’t work for many bowels. Changes in routine, travel and work can cause constipation. The bowel is a creature of habit, preferring regular meal and sleep times. For this reason, many shift workers and constant travellers suffer from constipation.
• Some iron supplements can cause constipation, typically iron sulphate. Although well absorbed, which is a good thing, it may bind the bowel. Other iron supplements are available that do not constipate yet will still boost iron stores and blood levels.  Iron Deficiency Anaemia
• The female hormone, progesterone, slows down the peristaltic movement of the bowel. This is why many women become constipated at certain times of their menstrual cycle and early in pregnancy.
• Sufferers of Irritable Bowel Syndrome usually experience an alternation between constipation and diarrhoea. Irritable Bowel Syndrome
• If taken daily for several years, laxatives that have a stimulant effect on the bowel can make the bowel lazy. This includes over-the-counter brands and Epsom salts as well as natural senna and cascara tablets and teas.
• Poor abdominal muscle tone may contribute to constipation.

What to do

Diet

• A high-fibre diet is mandatory. ‘Fibre added’ products are available – usually a refined-flour food with bran added. But why not eat food that has retained its original fibre? Eat bread made from 100 per cent of the grain instead of white bread with a few flakes of added bran, fruit instead of fruit juice, brown instead of white rice, potatoes with their jackets instead of chips, rolled or puffed wholegrains for breakfast rather than highly processed cereals. High-fibre foods include dried fruits, nuts, legumes, seeds (especially chia and linseeds), pears, sprouts, apple, quince, passionfruit, oranges and corn.
• Eat your meals at regular times during the day. Bowels work best with routine.
• Chew each mouthful well. The chug-a-lug downward movement of the bowel, peristalisis, starts when you begin to chew.
• Coffee rarely gets the thumbs up in any book about natural health. However, there are many people who cannot go to the toilet without first drinking a cup of strong coffee and/or smoking a cigarette. If this is true for you, it is a sign that the muscle of your bowel is tense. Caffeine (and nicotine) relax smooth muscle, and the bowel is predominantly smooth muscle. A cup of coffee a day is hardly a problem if this is all you need to have a healthy daily bowel movement.
• Avoid foods that may contribute to constipation including sugar, white-flour products, carob, chocolate, tea, yellow cheese and red meat.
• Try a gluten-free challenge for one month to see if this may be the cause of your constipation. (See Gluten Intolerance Avoid any foods containing wheat, rye, triticale, spelt, barley or oats. If you notice an improvement in your bowel movements, keep gluten to a minimum.
• Prunes are a tried and true constipation remedy. Place 2–3 prunes in hot water and leave overnight. Eat the prunes and drink the remaining fluid the following morning.
• Don’t allow the contents of the bowel to dry out. Be sure to drink 2 litres of fluid every day.
• First thing every morning drink a large glass of warm water containing the juice of half a lemon. The warm water and lemon stimulate the bowel and the liver.
• Increase the amount of good oil in your diet (flaxseed oil, olive oil, any cold-pressed seed or nut oil and coconut oil.) This can help to lubricate things.
• Probiotics and prebiotics. The human bowel contains around 2 kg of bacteria, many of which are necessary for bowel health and function. Increasing probiotic foods such as yoghurt, miso, sauerkraut, kefir, natto, tempeh and the Korean delicacy kimchi often helps constipation. Prebiotics is food for probiotics. Prebiotics are found in certain vegetables (especially asparagus, Jerusalem artichokes, leeks and onions), legumes (such as baked beans, chickpeas and lentils) and supplementary fibres (including psyllium, pectin, guar gum and slippery elm).

Laxatives

Laxatives increase peristalsis, the rhythmic downward movement of the muscles lining the bowel. Peristalsis means that it’s theoretically possible for you to eat a meal standing on your head and the food will still travel in a downwards (or in this case, upwards) direction.

There are several sorts of laxatives including stimulant, osmotic and bulking. The stimulant kind (for example, the herbs cascara and senna) irritates the bowel, causing it to contract and spasm, increasing the rate of peristalsis. This often causes diarrhoea and tummy cramps. While they are ok to use from time to time, if stimulant laxatives are used daily, the bowel will become reliant on them, creating a ‘lazy bowel’.

Osmotic laxatives (such as Epsom salts) cause body fluids to enter the bowel due to a difference in osmotic pressure. These are the laxatives of choice before a colonoscopy as they cause a complete and often urgent evacuation of the bowel contents. This is a concern for two reasons: diarrhoea leaves you at risk of dehydration and the bowel is not meant to be empty. You may not like to think of it, but the bowel should be full of bacteria, fibre and poo.

Bulking laxatives work more slowly than stimulant or osmotic laxatives. The fibres soak up fluid causing the stool to increase in volume and weight. This allows the bowel wall to be stretched, in particular the rectum. There are nerve endings in the rectum that relay the information to the brain that a bowel movement is desirable and imminent. Additionally, the soluble fibres that create the bulking of the stool are utilised by resident bowel bacteria to create beneficial substances for the health of the bowel. The one thing to keep in mind with bulking laxatives is that you need to drink plenty of fluids, otherwise the stool will dry out and further increase constipation.

Remedies

• For a tense bowel, magnesium can reduce muscle spasm and tension. Take a large dose (over 400 mg) twice daily. Smaller doses for children, or perhaps the tissue salt Mag phos
• The herbs valerian, passionflower, skullcap, chamomile and kava can help when stress is a causative factor.
• Herbal bitters are a traditional herbal treatment for many digestive complaints. Take one teaspoon of herbal bitters in water before dinner each night. The bitter taste stimulates the vagus nerve, which improves the functioning of all digestive organs including the liver. As the liver produces and excretes bile into the intestine, this promotes peristalsis. Just what the naturopath ordered. Bile is the body’s own laxative.
• Herbs that can improve the healthy functioning of the bowel include licorice, yellow dock, dandelion root and rhubarb. Take in tablet, tincture or tea form daily.
• Several fibres have the capacity to swell considerably in the bowel making the stool softer and easier to pass. These are known as soluble fibres due to their capacity to dissolve in water. These include psyllium husks, chia seeds, linseeds, slippery elm, oats and oat bran. Start with one teaspoon and build up to three after dinner each night. Ensure you are drinking at least 2 litres of water each day as these fibres soak up a lot of liquid.
• The right bugs. Just as there are malevolent bacteria in the bowel that can cause constipation by halting peristalsis, there are beneficial bacteria that improve functioning of the bowel. Take a good broad-based probiotic supplement that includes a bug called lactobacillus plantarum every morning.
• If your iron supplement is causing constipation, switch to another.
• If your routine is upset by holiday, work or travel, try taking a cup of weak senna-pod tea (available in tea bags) after dinner the night before you travel, and once again on the first evening. The very occasional stimulant laxative will not cause a dependency.

Other

• The bowel is lined with smooth muscle. This type of muscle is not under your conscious control so when it is tense or holding stress, it may interfere with peristalsis, resulting in constipation. Belly (diaphragmatic) breathing, however, switches on the parasympathetic nervous system, which in turn relaxes smooth muscle, thereby assisting peristaltic movement of the bowel. To do this, breathe through your nose, inflating the lower abdomen with your breath on the inhalation, and relaxing the abdomen on the exhalation. The downward movement of the diaphragm will also massage the bowel.
• Try to visit the toilet at the same time each day. Many people find that after breakfast works well. Make sure you allow enough time: no bowel likes to be rushed.
• There are lengthy naturopathic discourses on toilet technique. The Western style toilet – a contraption that is not well suited to its task – has transformed what should be a natural act of nature. Squatting has been the favoured position for millennia. It activates the abdominal muscles and the rectum and anus to widen out, making a more efficient funnel shape. While I do not suggest crouching over the rim of porcelain in stilettos or ripping out your toilet in favour of a simple hole, there are some alternatives. Try putting a few old phone books or blocks on either side of the loo so that your knees are slightly raised. (Or look for the commercially marketed plastic shapes that fit around the toilet).
• An invaluable titbit of anatomical curiosity is that our sphincters – oral and anal – are said to copy one another. So instead of pursing your lips, relax them.
• Any exercise that uses the abdominals will help build muscle tone. Lack of tone in the pelvic floor muscles – common after pregnancy or abdominal surgery – also contributes to constipation. Try pilates, yoga or the martial arts – any of these emphasise switching on the internal muscles that can help move things along.
• A brisk walk – the old-fashioned constitutional – may be just the thing to bring those bowels into line.

Aromatherapy

Mix the following blend of aromatherapy oils with 30 g of warm coconut oil and massage into the abdomen in a clockwise direction. Massage to the lower back can also be helpful. Alternatively, sprinkle 6–8 drops onto a face washer rinsed in some cool or warm water and use as a compress on the abdomen.

• 3 drops of carrot seed oil – stimulating to the digestive system and smooth muscle relaxant
• 2 drops of cardamom oil – digestive carminative, stomachic and diuretic
• 4 drops of black pepper oil – laxative, diuretic, calming, stomachic and tonifying
• 4 drops of grapefruit oil – digestive stimulant, purifying and cleansing
• 2 drops of juniper oil – diuretic, calming, detoxifying and stomachic