Chronic constipation affects about 16% of the population worldwide and more than 1/3 of elderly. It is characterised by hard, dry and difficult to pass stools, or having less than 3 bowel movements per week - although 1 or more per day is optimal.
The most common causes of constipation include a poor diet (high in processed foods, sugar, refined carbohydrates, unhealthy fats and additives), a sedentary lifestyle, dehydration, an inadequate fibre intake (too little or too much), high stress levels, poor sleep, certain medications and health issues (diabetes, thyroid disorders, neurological issues…).
Fortunately, a few simple healthy habits can help you get and stay regular.
A word on laxatives
Most people suffering from constipation take laxatives. Laxatives are indeed efficient at relieving constipation in the short term, but they can be overused and cause side effects.
They work by making the muscles of the digestive system contract or by increasing the water content of the stools, softening them to facilitate evacuation.
Unfortunately, over time, they can interfere with the body’s ability to be regular on its own and create a dependency. Some can weaken the muscles needed for bowel movements. Others can lead to water retention, bloating, dehydration, electrolyte or pH imbalances, digestive enzyme deficiency or other complications.
In other words, they can make things worse in the long term and do not solve the underlying issue. So instead, consider adapting your nutrition, move more and manage your stress.
Stay hydrated
If you are dehydrated, drinking more water might be the easiest and quickest way to relieve constipation. As a ballpark rule, you should drink at least 2 litres of water a day, urinate 7 times or more and your urine should be light yellow. If this is not your case or if you have not urinated for several hours, you are probably dehydrated and drinking more should improve your transit. However, if your water intake is sufficient and you are not dehydrated, drinking more will not reduce your constipation.
First thing in the morning, before breakfast, drinking a cup of warm or hot water with freshly squeezed lemon juice is a great way to stimulate digestion and increase hydration. During the day, sparkling water, teas, herbal teas, dandelion and chicory root infusions are all good options to keep you hydrated. Sparkling water has been shown to be more effective than tap water at relieving constipation. Coffee can help as well, by stimulating intestinal muscle contractions and improving the balance of the gut bacteria.
On the other hand, sodas, juices, sugary beverages and alcohol can worsen constipation. Consume alcohol in moderation and drink plenty of water at the same time, as alcohol accelerates dehydration.
Balance your fibre intake
One of the most common recommendations to people who are constipated is to eat more fibre-rich foods, to increase the bulk of their stools, making them easier and quicker to pass. This is actually much more complicated than that: it depends on your current fibre intake as well as on the type of fibre. Let me explain.
If your current diet is very low in fibre, then, yes, increasing your intake is likely to help. On the other hand, if you are already eating lots of cereals, oatmeal, bread, baked goods, fruits and vegetables, further increasing your intake is more likely to worsen your constipation. This might be the reason why studies show conflicting results of fibre supplementation.
So, if you are constipated, use a free app like MyFitnessPal to estimate your current fibre intake and try adjusting (up or down) from there. To give you a reference point, the US Department of Health and Human Services and the Academy of Nutrition and Dietetics recommend a daily fibre intake of about 14g per 1000 kcal, or about 25g for women and 38g for men.
Be aware that most people following a standard Western diet eat a lot of grains, which typically results in excessive fibre intake, leading to constipation, bloating, cramping and gas. Too much fibre means too much bulk, which slows down bowel movements.
Now, let’s talk about the 2 main categories of fibres: soluble and insoluble. Soluble fibres absorb water and form a gelatinous substance that softens the stools. Insoluble fibres add bulk to the stools, which may help them pass more quickly and easily through the digestive system. Soluble fibres are more fermentable than insoluble fibres.
In the soluble family, resistant starch (green bananas, white beans, lentils), pectin (pears, apples, citrus fruits), inulin (chicory root, Jerusalem artichokes), guar gum, beans and legumes are highly fermentable and can cause flatulence, whereas fibres found in psyllium husk, ispaghula, oat bran, barley, nuts and seeds are less soluble and less fermentable. Some studies showed that soluble fibres can improve the symptoms of constipation (straining, pain, stool frequency and consistency). The less fermentable ones seem to lead to better results.
In the insoluble family, wheat bran, whole grains, lignin (flax), fruits and vegetables are slowly fermentable and cellulose and sterculia are non-fermentable. Studies examining the effects of insoluble fibres on constipation have been inconclusive. Some showed benefits of eating fruits and vegetables, but others found that excessive consumption of wheat bran could worsen constipation or even result in irritable bowel syndrome.
If you think that your diet is low in fibre, consider adjusting your nutrition rather than buying supplements. Add moderate amounts of fibrous vegetables, fruits, nuts and seeds and see how you feel. And make sure to drink plenty of water to move the fibres along. Cereals, bread, grains, beans and legumes are not the best options to get more fibre, as they are much higher in carbohydrates (and sometimes sugar) and poor in nutrients. As mentioned before, a diet rich in grains and legumes can deliver too much fibre and lead to constipation and other digestive problems.
The Society for Pediatric Gastroenterology, Hepatology and Nutrition does not support the use of fibre supplements to treat constipation. However, if you really want to try a supplement, the best choice based on the research seems to be a non-fermentable soluble fibre, such as psyllium husk. It swells in liquid, produces bulk that stimulates the intestines to contract, softens the stools and fastens the transit through the digestive tract. Buy organic psyllium to avoid pesticides, herbicides and fertilisers. That said, not all the studies agree that psyllium is effective, and fruits such as prunes or kiwis are a much more likely to help. So, if supplements don't work or exacerbate bloating, gas, constipation or diarrhea, you are better off trying other solutions.
Eat your fruits, vegetables, nuts and seeds
Vegetables that are high in fibre include leafy greens, cruciferous vegetables (broccoli, Brussels sprouts, cauliflowers…), asparagus, zucchinis, capsicums and artichokes and should ideally be consumed daily. They are also a good source of magnesium and have a high water content, which can facilitate intestinal transit. Artichokes also contain inulin, a prebiotic that feeds the good gut bacteria and has been proven to reduce constipation. Mushrooms are another very healthy option to add fibre to your meals. On the other hand, starchy vegetables such as potatoes and sweet potatoes are much higher in carbohydrates and should be consumed in moderation.
The two fruits with the strongest laxative effect (stronger than psyllium husk) are prunes and kiwis. They are very effective against constipation and are one of the best natural solutions to accelerate transit. Other fibre-rich fruits include figs, dates, apples, pears, berries and bananas, but they are also very high in sugar. Avocados and coconut flakes are also high in fibre and can be healthier low-carb options. Bananas show mixed results: they can aggravate constipation when they are unripe and are probably best avoided.
If you want to try something different, aloe vera juice is a traditional and very efficient natural laxative, stronger than certain laxative supplements.
Last, nuts and seeds are also rich in fibre and healthy fats and deserve to be regularly added to your meals. In particular, chia seeds and flaxseeds absorb a lot of water and work well as natural laxatives. Ground them and sprinkle them on your savoury dishes, smoothies or desserts. Flaxseed oil also helps lubricate the colon.
Add probiotics and prebiotics to your meals
Probiotics are good bacteria that help create a healthy and balanced intestinal flora, which can prevent or alleviate digestive issues and constipation. Certain probiotics such as lactobacilli and bifidobacteria have been found to improve transit time, stool frequency and consistency. However, other probiotics can work in the opposite way and be more helpful for diarrhea.
Natural sources of probiotics include yogurt, kefir, sauerkraut, kimchi or fermented (organic non-GMO) soy products. Add them regularly to your meals. Alternatively, consider taking a daily probiotic supplement for a month and see whether it has any beneficial effect.
Prebiotics are fibres that improve digestive health by feeding the friendly gut bacteria. They have also been shown to increase the frequency of bowel movements and to make stools softer. Prebiotic-rich foods include garlic, onions, leeks, asparagus, Jerusalem artichokes, dandelion greens, chicory root and bananas.
Supplement with magnesium citrate
Magnesium citrate is one of the most popular natural supplements against constipation, well-known for its laxative properties. It softens the stools by drawing water into the intestines, which facilitates elimination.
If you are deficient in magnesium, start by taking 200 mg of magnesium citrate powder in the evening (as it also helps you relax). Gradually increase the dose until the consistency of your stool improves, but cut back if it causes diarrhea.
Avoid gluten and dairy products
Gluten is one of the most common allergenic foods. It can trigger bloating, diarrhea, constipation, gas, abdominal pain and much more. Up to 13% of the population may have a gluten intolerance without knowing it.
Lactose intolerance can also cause constipation and other digestive issues and about 70% of adults have some level of intolerance, usually without knowing it.
If you think that you might not tolerate well gluten or dairy products, or if you experience abdominal pain, bloating or gas, try eliminating them from your diet for a few weeks to see if it improves your symptoms.
Other foods that can create imbalances in the intestinal flora and promote constipation (as well as other gastrointestinal and health issues) include: processed vegetable oils, excess sugar and carbohydrates, preservatives and additives - all commonly found in processed/packaged foods - as well as pesticides and fertilisers found in non-organic plants and plant-based products.
Exercise regularly
Inactivity is one of the main causes of constipation and exercise is essential for regular bowel movements. It accelerates the transit time and stimulates the contraction of intestinal muscles, which helps evacuate stools quickly and easily.
Any moderate aerobic exercise such as brisk walking, jogging, rebounding on a mini-trampoline, swimming or cycling can help speeding up your bowel movements. So, be physically active most days of the week. If you are currently sedentary, even a few brisk walks several times a day can help support the digestive system.
That said, avoid exercising right after a meal, when the blood flow increases in the stomach and intestines to help digestion. Exercising takes the blood flow to the heart and muscles, which interferes with proper digestion and slows down intestinal transit.
Don't delay, relax and try squatting
When you feel the urge to go to the toilets, don't delay. The longer you wait, the harder and dryer your stools can become, making them more difficult to pass.
Be mindful of chronic stress that can negatively impact the intestinal flora, enzymes production and the overall digestive function. Add yoga or stretching to your weekly routine, spend more time outdoors or practicing activities that you enjoy and help you relax.
Another very helpful trick to facilitate evacuation is to squat: it allows your knees to be closer to your abdomen and positions your body in a way that relaxes your rectum. Too much information, you may think! Well, you may change your mind if you try using a small foot stool to achieve the proper and natural body position. Several studies found that between 70% and 90% of those who used a foot stool reported less straining and faster bowel movements.
This article gives you plenty of simple options to consider to alleviate your constipation. However, if after optimising your water intake and your nutrition and adopting a regular exercise regimen, you still suffer from chronic constipation, make an appointment with a qualified healthcare practitioner to rule out any underlying disorder. Long-term constipation can lead to serious health issues and should not be left untreated.
This article is for educational purposes only. It is not a substitute for professional medical advice and is not intended to diagnose, treat, cure, heal or prevent any disease or medical condition. See full Disclaimer here. I encourage you to do your own research and to discuss with a qualified healthcare practitioner the options that could work the best for your specific circumstances.
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