Let’s be honest. Few things are as important to our sense of happiness and well-being as a good bowel movement. Bowel movements may be an uncomfortable topic, but it says a lot about how well the body is functioning.

Constipation is exceedingly common in developed countries, leading to frequent self-medication, and one third of cases leading to a doctor’s appointment.  Appropriate management requires an evaluation for causes of constipation, which include underlying intestinal lesions, a pseudo-obstruction, or a systemic disorder such as hypothyroidism or diabetes mellitus. 

Treatment for chronic constipation depends on whether there is a normal or slowed colonic transit (the time it takes for food to get to the other side) or if there is defecatory dysfunction (the nerves of your gut are affected, pelvic floor dysfunction, etc.). For the sake of the article, we will focus on the factors that influence transit time. Before diving into the treatment options for constipation, let’s look at some of the factors that can lead to constipation. 

Fluid intake – The large intestine absorbs excess water so not drinking enough fluids can harden stool and make it difficult to go. Fluids that are excellent at keeping you hydrated include: water, herbal tea, naturally sweetened juices, and water-dense fruits such as grapes and melon. Consumption of alcohol can lead to both dehydration and reduced peristalsis (the movement of intestines that cause a bowel movement).

Medications – Antibiotics, antacids, proton-pump inhibitors, antidepressants, some blood pressure medications, can cause both diarrhea and constipation by altering intestinal microflora and changing GI physiology. This list is not all inclusive. Be sure to consult your doctor or pharmacist for additional information about the effects of medication.

Medical history – Have your healthcare provider check for underlying an food allergy or sensitivity, Inflammatory bowel disease (Crohn’s disease, ulcerative colitis), irritable bowel syndrome, low thyroid function, celiac disease, which can all contribute to alternating bowel movements, frequency, and appearance of stool. Significant changes in the frequency of bowel movements or in the appearance of the feces can indicate a problem, particularly when these changes accompany other symptoms such as abdominal pain/cramps, nausea, bloating, gas, fatigue, weight loss, bloody stools, anemia, muscle cramps, mood fluctuations.

Hormones –  Increases in GI symptoms happen around the time of menses and early menopause due to changes in ovarian hormones (estrogen and progesterone). Buildup of the hormone progesterone can cause constipation. Progesterone is responsible for growth and thickening of uterine walls and it peaks right around ovulation. Diarrhea can happen when prostaglandins (fatty acids responsible for inflammation) begin to relax smooth muscle tissues in the uterus as menstruation begins.

Age – As we get older, the contractions of the muscles in the intestines slow down which can cause the food to move slowly through the colon causing constipation.

Activity –  Exercise helps constipation by lowering the transit time it takes for the food to move through the intestines via stimulating the contractions of muscles in the intestines. Stay active to stay regular!

Diet – High fiber foods found in veggies, fruits, and legumes (beans, lentils) make it easier for feces to pass through the intestines. On the contrary, processed foods devoid of nutrients and fiber, such as processed grains, red meat, milk, cheese, fried foods, alcohol, may all cause constipation. The best foods to relieve constipation include dried prunes, apples, figs, spinach, kale, and other greens, citrus fruits, etc.  Also add probiotic foods to your diet: unsweetened yogurt, kefir, sauerkraut for optimal bowel movement daily.

Social factors – Traveling for a vacation or a job can be exciting but can also wreak havoc on your GI system. Both diarrhea and constipation can result from not being in the comfort of your own bathroom, psychologically speaking. Jet lag, stress, and changes in lifestyle and diet can affect bowel movement.  

Seven tips and tricks to ensure success!

After waking, relax for a few moments. Don’t think about the hectic day ahead and do not start reading the news. The anal sphincter is a muscle that responds to tension, so keep it relaxed. Think relaxing thoughts.

2. Drink a tall glass of warm water, preferably with a teaspoon of lemon juice or apple cider vinegar. This awakens the digestive system and stimulates peristalsis in the intestines.

3. If you still need an assist, practice deep breathing by visualizing breath filling your abdomen and exhale visualizing breath going out and downward as you relax and release.

Eat dietary fiber and use bulk-forming laxatives. High fiber foods such as fresh veggies, legumes, and fruits should be eaten daily. Aim for 25-35 grams of fiber daily. Bulk-forming laxatives such as psyllium husk (Metamucil) contain natural polysaccharides or cellulose derivatives that exert their laxative effect by absorbing water in the colon and increasing fecal mass.  Make sure to drink copious amounts of water when taking bulk-forming laxatives because large amounts of fiber can cause bloating, cramping, flatulence, and even increased constipation with minimal water intake, so start with small amounts and slowly increase fiber intake according to tolerance and efficacy.

Osmotic Laxatives: For those who do not respond to fiber intake and/or are intolerant, there are other types of laxatives that can be used. Hyperosmotic agents such as polyethylene glycol (MiraLax) can be used in improving stool consistency and frequency. Milk of Magnesia or magnesium citrate both act by drawing water into the bowel from nearby tissues (intestinal lumen) thereby softening the stool. Some of these laxatives can cause electrolyte imbalances as they draw out nutrients and other contents with the water, which increases thirst and dehydration.

Stimulants such as bisacodyl (Ex-lax, Dulcolax, castor oil, senna) should only be used short-term. Stimulants increase muscle contractions (peristalsis) to move contents along, facilitating a shorter colonic transit time.

Stay relaxed and let it all out! By trying to keep your bowel movements consistent from day-to-day, you will feel much better overall by eliminating the unpleasant symptoms you may have. If you find that you are experiencing a change in bowel movements, keep track of how often and the symptoms you are having so that you can make your doctor aware. Share any concerns you have with your physician so that you can work together to alleviate discomfort and rule out underlying causes of GI distress.