In holistic medicine, disease (and dis-ease) is generally caused by one (or a combination) of two things: too much of the bad stuff, or not enough of the good. This series deals with the first part of that equation. Earlier articles include What Detox Really Means and Kid-Friendly Everyday Detox Strategies.

“Sweetie, we need to go soon. You get to eat your chocolate today!”

Turning to the other playground moms, the four-year old’s parent explains with a shrug, “it’s laxative day.” Two moms nod knowingly, and the conversation veers toward what helps their family members poop. It’s playground banter at its best–and its most revealing.

Bloating. Cramping. Headaches. Grumpiness. Hemorrhoids. Rectal pain. Flatulence. Constipation is no fun.

Constipation lacks a singular medically qualifying definition, which makes its prevalence difficult to pinpoint. Common markers used in surveys and studies include frequency of bowel movements, stool consistency and presence or absence of straining or pain. In 2015, over the counter laxative sales topped $400 million. Studies suggest that up to almost 30% of Americans suffer from constipation at any given time. That is a huge percentage when you consider that the colon is one of our five primary emunctories!

Naturopathic medicine prefers to focus on how things should be rather than how they shouldn’t. In that light, rather than defining constipation, we outline healthy bowel habits: For most people, optimal bowel movements consist of at least one daily bowel movement that is solid but soft and easy to pass, that feels satisfying and complete, and that requires little cleanup. To take it a step further, NDs often expect a “transit time” of about a day. That is, the corn you ate at dinner last night should show up in the toilet sometime today, or tomorrow morning at the latest.

Test your Transit Time: Consume a meal containing whole corn, such as corn on the cob or frozen corn kernels, cooked beets (not beet juice), or two to three activated charcoal capsules. (For its myriad of benefits, beets are our first choice!) Note the time of that meal. Then, keep an eye on your stool and note when that meal is evacuated: for corn, look for kernels; for beets, the stool will look reddish or will turn the toilet paper red; charcoal makes stool appear black. With a normal transit time, your test food should only be apparent between 12-48 hours after consumption. However, in our constipated society it is not uncommon for transit to take 72 hours or more; if you don’t notice the food within a day, keep looking!

Constipation is a double whammy when it comes to detoxification and depuration. Clearly, impaired elimination of stool is impaired depuration; there is difficulty getting the toxins out of the body! The other impact is a little less obvious. Recall that toxin-laden bile is dumped into the intestines for elimination with the stool. When that bile does not readily leave the system, as is the case in a constipated individual, the toxins are actually re-absorbed into the bloodstream and sent back to the liver…

It is for good reason that your naturopathic doctor asks about your digestion and elimination at every visit.

Preventing Constipation

How you eat. Proper colon function requires good digestion throughout the GI tract, which in part requires proper eating habits. Or, as NDs call it, “good food hygiene.” This means sitting down to eat one’s meals in peace, and chewing food thoroughly. Bonus: good food hygiene may result in better nutrient absorption and utilization across the board!

What you eat. For optimal functioning, the digestive tract requires plenty of fiber and lots of variety. Both fiber and food variety contribute to a healthy gut microbiome–the population of bacteria living in the small and large intestines. Lacto-fermented vegetables such as sauerkraut (it’s easy to make your own!) and other naturally cultured foods like yogurt further contribute to the health of one’s gut bacteria, which can play an important role in eliminating constipation. Fiber, in addition to being food for probiotics, adds important bulk to the stool which encourages peristalsis, the muscular contractions that move food along the GI tract. Vegetables, nuts, seeds and legumes are great sources of fiber that also add important minerals and fatty acids for optimal bowel health.

Other things to consider:

  • Adequate hydration – When the body is thirsty, it efficiently pulls moisture out of the colon. Dried out stool is hard to pass! To keep stools soft, consuming adequate amounts of clean water is essential. (If you’ve been following along, do you notice a trend? Water is important! If you aren’t sure your water is clean, give Sunrise a call.) For some people, drinking a full glass of warm water first thing in the morning is good insurance against constipation: in addition to providing hydration, the fullness of the stomach can induce emptying of the colon and a satisfying morning bowel movement.
  • Physical activity – Besides being great for every other part of you, physical activity has been shown to reduce symptoms of constipation. This can be as simple as a daily walk, or as vigorous as high-intensity interval training a few times per week. Individuals who struggle with constipation often find that a brisk morning walk or a few Sun Salutations (this kids song makes it easy to remember the steps to this popular yoga flow) on waking helps stimulate a healthy BM.
  • Deep breathing – Belly breathing provides physical stimulation to the intestines via the motion of the diaphragm. Deep, conscious breathing also increases the parasympathetic “rest and digest” nervous system, helping to suppress the “fight or flight” sympathetic response that most of us live in far too much.
  • Castor oil – You’ve heard it before! Castor oil applied topically over the abdomen has been shown to reduce constipation. (Source.) Increase its effect by coupling the castor oil application with a clockwise abdominal massage that follows the colon. To do this, begin in the lower right region of the abdomen, near the hip bone. Move upward along the right side to the bottom of the ribs, across the abdomen just below the rib line, and down on the left side. Note: Although castor oil is known as a laxative, NDs do not typically suggest using it internally! Castor oil is an irritant; do not ingest it unless instructed to do so by your licensed medical provider.

Treating Constipation: When the basics aren’t enough

When good food hygiene, a varied, fiber rich diet, adequate hydration, topical castor oil and physical activity fail to resolve digestive complaints, further investigation and intervention are warranted.

Constipation, although exceedingly common, is what is known as a “functional disease” in the vast majority of cases. That is, the problem is related to the function of the gut and cannot be permanently corrected by surgery or medications. Functional diseases, also referred to as lifestyle diseases, make up the vast majority of the disabling conditions in our modern society. Successful treatment options for these disorders are severely lacking in the conventional medical model.

Fortunately, many people find permanent, laxative-free constipation relief and are able to restore optimal bowel function under the care of a naturopathic doctor. Interventions are always personalized to the patient in question and may include:

  • Oral Magnesium Supplementation – 200-350mg of magnesium citrate or malate will often support detoxification at the cellular level while drawing water into the colon for softer, easier to pass stools.
  • A high quality probiotic – While Food Is the Best Medicine and everyone benefits from natural, diet-based probiotics, in our world of antibiotics, pesticides and convenience foods sometimes the addition of a selected-for-you, professional brand probiotic is very helpful toward restoring proper gut flora and associated gut motility.
  • Identification and elimination of food intolerances and sensitivities.
  • Testing for SIBO (small intestinal bacterial overgrowth) and subsequent treatment if indicated.
  • Improving digestion “upstream” in the stomach and small intestine when weak areas are identified.
  • Utilization of herbs, homeopathic remedies, drainage therapies and other supplements to restore and optimize healthy gut function.
  • Identifying other underlying causes via physical exam and labs or imaging as indicated