What’s the best way to treat constipation?

First of all, we need to determine the cause of constipation. Constipation can have several causes, and sometimes multiple causes are present. So it might not be as simple as “add some fiber to the diet”. Although that may work for some people, it is usually a bit more complicated. Let’s talk about some of the factors.

CAUSES

The first thing we automatically think of with constipation is the diet. If you are not getting a lot of fiber in the diet, that can easily cause constipation. Foods that are high in fiber include leafy greens, most vegetables, fruit (especially those with skins like apples, plums, or peaches), beans and lentils, whole grains, berries, avocados, ripe or overripe bananas, and nuts. Hydration goes hand in hand with diet. You need water to be going through your system so your stools don’t get dried out by the time they reach the bottom of your gastrointestinal tract! As a general rule, you want to drink at least 64 oz of water a day (That’s 8 glasses or 3 mid-sized YETI water bottles), more if you exercise.

Tight pelvic floor:

Another cause of constipation is mechanical in nature: a tight pelvic floor. This may mean you have the urge to have a bowel movement, but when you get to the toilet, you struggle to get it out, you may strain, and overall feel frustrated with the experience. You may get some out, you may end up with diarrhea, or you may have skinny or small bowel movements. These are all signs that you may be suffering from a tight pelvic floor. 

Stress:

Another reason for constipation is chronic stress or a busy lifestyle. Sometimes, when we go from one thing to the next, we don’t allow our bodies the time to process our food and properly digest! The part of our nervous system that works on digestion is the parasympathetic nervous system. You may have heard it referred to as the “rest and digest” piece. When we are busy and running around, we are downregulating that part of our nervous system and relying on the sympathetic system, or the fight, flight, or freeze piece. Our body must feel safe, and at least somewhat relaxed, in order to digest at the proper speed and time. If you find yourself suffering from bouts of constipation and then diarrhea, it may be IBS, or irritable bowel syndrome, but it may simply be that you are chronically stressed and too busy!! 

Hormones and medication:

The last common cause of constipation is hormone and medications. If you are going through a hormonal shift, such as pregnancy, postpartum, or perimenopause, the hormones may be to blame for your constipation. You can help your body along with some of the recommendations below. Certain medications, such as pain medications, have constipation as a side effect. You may need to be extra diligent about your diet or other supplements so you don’t stay backed up!

SOLUTIONS:

Diet:

If you are looking at the list and realize you aren’t getting many of these foods in your diet, you may want to first consider adding some to see if it helps with your bowel movements. Don’t add them all at once, however! You will have an upset stomach and lots of gas. Fiber needs to be added gradually so your system has some time to adapt to the new foods. Consider adding one food per week to start and try to eat that one food at least once a day.

So what about when dietary fiber isn’t enough? As Americans, it can be difficult to get enough fiber in the diet, even if you are eating a lot of the items off the list above. Where do you go from there? You may want to consider supplementing your diet, but what should you choose? There are many options out there. Let’s discuss them, along with the pros and cons of each.

Fiber supplement

Not getting enough fiber? One option is to take a fiber supplement such as Benefiber or Metamucil. These types of fiber supplements come in many forms these days. There is the classic powder you can add to a drink, gummies, and chewables. 

Pros: These types of fiber supplements help stimulate peristalsis (moving things through your digestive tract) and slow down transit time of food through your digestive tract. A study was done by the  American College of Gastroenterology Chronic Constipation Task Force and they found that Metamucil (psyllium husk) was more effective at absorbing water from the intestines than Benefiber (dextrin) and creating bulky stools that are easier to pass. Metamucil is FDA approved in the treatment of constipation because it is shown to have greater laxative effects due to its properties. They usually work within 12-48 hours.

Cons: The downside to supplements like these is that they can cause gas to build up in the gastrointestinal tract and cause pain or annoying flatulence. They can also be rather expensive if used on a regular basis.

Magnesium

Pros: Magnesium has risen in popularity in recent years and for good reason. It can be helpful for constipation but has other effects as well, such as decreased muscle soreness, decreasing stress, and regulating blood sugar. The thing about magnesium is that it comes in many forms, and the forms do not act the same. Magnesium citrate is commonly used to help with constipation because it increases the amount of water in the stool and acts as a laxative. Magnesium oxide and magnesium chloride also have laxative effects and can be used to help with constipation. Magnesium is easily accessible and usually on the inexpensive side. 

Cons: If magnesium is taken in large amounts it can cause diarrhea or tarry stools.

Miralax

Pros: Miralax is an osmotic laxative, which means it draws water into the colon, softening the stool, and can cause the colon to contract (similar to the fiber supplements we discussed earlier). They usually work within 12-48 hours.

Cons: Miralax does not have any added benefits like fiber supplements do. It can be expensive if used on a regular basis. 

Stool softeners

There are several types of stool softeners, and one popular type is called an emollient. Colace is one well-known brand. 

Pros: Emollients soften the stool by drawing water and fat into the stool to make it easier to pass. They are great for preventative use, such as at the end of pregnancy and in the early postpartum period, when constipation is very common.

Cons: Emollients do not not affect how the digestive tract or colon move the stool, so they are not considered laxatives. If you are already constipated, it can take several days for stool softeners to kick in, which may be too long to wait for relief. 

If you have tried increasing your dietary fiber, you are well-hydrated, and you still find yourself reliant on some form of supplementation, talk to your healthcare provider to determine next steps. Each of these supplements are meant for short term use and not as a sustainable solution.

Tight pelvic floor:

The first thing to try is to elevate your knees above your hips. You can use a squatty potty, a small stool, a tipped over trash can, a stack of books, or whatever you may have. This helps a muscle in your pelvic floor that wraps around your rectum to loosen up and allows the poop to come out easier! If that doesn’t quite do the trick, check out our post here to learn how to relax the pelvic floor before having a bowel movement to see if you can get things moving better!

Stress or busy lifestyle:

Try meditating for 10-15 minutes a day and see if your bowel habits improve.

Hormones and medications:

You may consider trying a combination of the things listed above, but you should check in with your healthcare provider if you are experiencing more long-term constipation. There may be more factors to consider and it is important to discuss all options with your doctor.