3 Simple Remedies for Constipation

Hint: Fiber is not one of them.

45 minutes into this epic battle, I was sweating, fatigued, and grinding out every last bite of energy in order to finish the task. I wasn’t going to let this obstacle win. I wasn’t going to let it ruin my day. Did I mention this all happened on the toilet? Seriously, that was a rough battle. What made the battle so rough you may ask? Why were you fighting so hard? The answer? Constipation. Post ACL surgery I took several doses of the pain medication hydrocodone; one of the potential side effects being constipation. Potential was an understatement. But enough about my toilet tails; the whole reason I bring this up is to highlight the fact that for many people I know, this toilet battle can be a daily occurrence. Instead of being an outlier event, this heavy straining for bowel movements is all too much the norm for some. If that is you reading this, first let me say I feel for you, no one deserves to go through that. Secondly, there are many simple, free and easy solutions that can turn your toilet adventures into a smooth Keanu Reeves movie (solely talking about the Matrix here).

Let’s Set the Stage

Let’s first go over some brief gut/digestion physiology and the prevalence of constipation. Constipation can happen as a side effect in certain conditions, such as Irritable Bowl Syndrome, prescription opioids (see the top paragraph), and hormonal imbalances. It can also happen independently, in what the medical community likes to term “Functional Constipation (FC).” Functional because it is not related to any underlying diseases, but it sure can impact daily function. Estimates for FC’s prevalence ranges from 7%-20% of the US population.1. Odds are either you, or someone you care about deals with this.

Now, for the oh so fun part of understanding how and why it is we poop. Going number two is a well orchestrated interplay factoring in how much food there is in our large intestines, the entry of new food into our system (actually eating food), and the coordinated contractions of surrounding muscles (even those 6 pack abs we all want). Why do we poop? Basically a way for our body to get rid of ‘stuff’ it didn’t use or need and to make room for excess food (mainly almond butter if you’re like me).

Awesome. Great to know for my next dinner party. Now help me poop.

1. Drink More Water

This may seem like the most obvious and easy to give answer, and that’s because it is. In an analysis of over 10,000 study participants, low liquid consumption was the greatest predictor of constipation, even beating out low fiber intake. But why is it that something as easy as drinking more water is helpful? Here’s another quick digestive physiology lesson on the large intestine (LI).

One of the main roles of the LI is to absorb water from our diet so the water can be used in many processes throughout our body. But, at the same time, enough water needs to be left over in the LI so the stool isn’t too dehydrated. Not enough moisture for the stool could potentially make it very hard, clumpy, and highly difficult to pass. Just as your body can become dehydrated, so can your LI without enough liquids.

Now, if you’re looking for a prescription for how much water YOU should drink, that is way beyond the scope of this article. But we can always look to data to guide us on, maybe, the minimum amount we should drink. Researchers hypothesized that our body’s “water defense mechanisms” kick off when we consume less than 1.8 liters in a 24 hour period (roughly a half gallon) . For this reason I shoot for at the bare minimum, a half gallon of water and my daily goal is around a gallon. I’m also getting a fare amount from my foods, and depending on my activity level losing some liquids through sweat, respiration, and urine output.

2. Frequent Low Level Physical Activity

I mentioned earlier how part of what helps us poop is muscle contraction, specifically the muscles within our digestive system. They work without us thinking about them, the fancy term for this is peristalsis. Low intensity movements such as walking and yoga can assist the muscles of our digestive tract propel stool to its final destination. That’s part of the reason I go on 10–30 minute walks after meals, to help “move things through” if you will.

Notice that I did not say doing a CrossFit workout everyday (even though I love me some burpees and muscle ups). At a certain exercise intensity we actually start to hinder digestion, by taking blood flow away from our intestines. It is for this reason that many people wait 1–2 hours after eating before doing a more traditional workout, in order to give their bodies enough time to digest.

If you’re someone who likes to hit numerical goals (like me), maybe shoot for a certain amount of steps per day, or a certain amount of time doing stretching and mobility work, or a certain number of conscious breathing sessions. What do you mean by conscious breathing? Perfect segway.

3. Conscious Breathing.

If you’ve ever read the book Extreme Ownership by Jocko Willink, you know that inevitably, in some way, everything that happens in our lives is within our control. Of every vital sign we humans have, heart rate, blood pressure, body temperature, our breathing rate is the only function we have direct control over. That is to say we can consciously alter our breath, whereas we can’t consciously alter our temperature or blood pressure. I guess you could say breathing is the ultimate form of Extreme Ownership.

Bringing awareness to our breath, such as in many kinds of meditation practices, increases the activity of our vagus nerve. Well what’s that? The body has nerves right, you know, the stuff that makes you feel things. Some of these nerves go to our feet, our hands, and some have to go to our internal organs (heart, liver, gut, etc). The vagus nerve goes to those same internal organs, and by activating this nerve we can enhance digestion, better handle stress, and bring down our heart rate to retain more of a calm like state.

In one of my previous articles, I talked about doing some breath work immediately before meals to get that Vagus Nerve firing and all those digestive juices flowing. For example, 4 seconds breath in, 4 seconds hold, 4 seconds exhale and then another 4 seconds holding the exhale. Going through that whole sequence would be one round, so I’ve found 3–4 rounds of that helps tremendously. I can say with a lot of confidence that improving overall digestion will have a positive impact on constipation.

Soooooooooo Fiber.

Some of you may be wondering, why didn’t he talk about eating more fiber? Hasn’t that been the mainstream remedy for constipation? That’s because for some individuals, fiber can actually make their constipation worse, and in certain cases, complete removal of fiber can improve constipation. One study found that in a group of 63 patients with constipation of unknown causes, 65% went on a NO FIBER DIET for 6 months and saw an increase in their frequency of bowel movements. Those on the no fiber diet also saw a complete reduction in symptoms such as bloating, anal bleeding and straining during bowel movements.

Advocates for fiber will say that adding fiber helps retain water in the large intestine, thus making stools more hydrated and easier to pass. However, stool water content remains at roughly 75% regardless of how much fiber one eats. That means ¾ of the water content of your stool will always be there, even if you eat no fiber or a pound and a half of spinach. I like to think of it like this, adding more fiber to try and help elicit a bowel movement is like suggesting adding more cars on the road to make traffic flow faster. The problem isn’t a lack of volume of cars (stool), but rather too much volume or volume that isn’t moving fast enough.

I’m not saying that no one should ever eat fiber, I believe and evidence will show that there are many health promoting benefits for fiber. I heard one gut specific doctor describe it as, the healthier someone’s gut is, the more fiber they can handle. Which makes total sense considering how many people with IBS and constipation get better with the removal of fiber. Then once someone’s gut is in order, they can likely better handle adding fiber back into their diet.

Other Remedies

Now I just provided you with the ‘low hanging fruit’ remedies for constipation (even though some may do better without the fiber from this fruit). All these are free of charge, can hopefully be incorporated into any lifestyle, and may actually give you the biggest bang for your buck. If you’re someone already doing these and still struggling, I can’t stress enough how important it is to seek out a qualified medical practitioner who has experience treating constipation. Up to you whether you decide to go the more conventional route of a Gastroenterologist, or the alternative approach from a Functional Medicine Practitioner, Acupuncturist, or any physician trained in natural remedies for supporting the gut.

I came across an interesting article from just last year that looked at Acupuncture and constipation. Patients with constipation received either Electroacupuncture (adding tiny electric currents with normal Acupuncture) vs sham acupuncture for 8 weeks, and then they were followed for 12 weeks after their last treatment. What they found was that those who received the real treatment showed a better improvement in their constipation during the 8 weeks of care, and continued to show more improved benefits after treatment ended compared to the sham group.

I know first hand how frustrating and helpless being constipated feels sometimes. You may say to yourself, self, ‘I wonder if anyone else feels like this on the toilet.’ Based on the 7%-20% prevalence of constipation in the US, I can almost assure you that’s a yes.

As always, trust in Your Gut.

Disclaimer: This is not meant to convey medical advice, if you’re looking for such please consult a qualified medical practitioner.

References

Armstrong, L. et Johnson, E. (2018). Water intake, water balance, and the elusive daily water requirement. Nutrients, 10(12). DOI: 10.3390/nu10121928

Eastwood, M., Robertson, J., Brydon, W., MacDonaold, D. (1983). Measurements of water-holding properties of fiber and their faecal bulking ability in man. British Journal of Nutrition, 50: 539–547.

Ho, K., Tan, C., Daud, M., Seow-Choen, F.(2012). Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms. World of Journal of Gastroenterology, 18 (33): 4593–4596. DOI: 10.3748/wjg.v18.i33.4593

Markland, A., Palsson, O., Goode, P., Burgio, K., Busby-Whitehead, J, et al. (2013). Association of low dietary intake of fiber and liquids with constipation: Evidence from the national health and nutrition examination survey. American Journal of Gastroenterology, 108 (5): 796–803. DOI: 10.1038/ajg.2013.73.

Wang, Y., Liu, Y., Zhou, K., Bauer, B., Liu B, et al. (2019). The duration of acupuncture effects and its associated factors in chronic severe functional constipation: secondary analysis of a randomized controlled trial. Therapeutic Advances in Gastroenterology, 12:1–9. DOI: 10.1177/1756284819881859