Acute constipation affects 2 to 30% of the general population at least some of the time. Amongst the elderly, this prevalence is 50-75%. People frequently go straight to laxatives as a solution. This is fine if done briefly and infrequently. But it does carry a risk of physical dependency which can lead to serious difficulties later on.
Of course, constipation itself causes trouble. Toxicity from backed up chemicals is the first issue, but pain, cracks in the anus, hemorrhoids, and bleeding can result.
Definition of Constipation
Basically there are two general types of constipation: mechanical obstruction blocking the intestines, and hypomotility or sluggishness of peristalsis, the involuntary waves of muscular action which moves feces along.
Technically, constipation can be defined 1) by having less than three stools a week, or 2) straining at stool more than 25% of the time. A corollary definition is have three such delayed or straining stools in a month.
Process of Constipation
As you know, we chew our food and swallow, then acid and enzymes digest the food into a liquid soup with bile. Small and large intestines use bacteria to further break down contents and aid absorption of nutrients into the blood stream to be used by the whole body. The colon withdraws a lot of the liquid, leaving soft, formed stool that normally looks like sausage or snake when passed comfortably 1 to 3 times a day, typically in the morning but perhaps any time of day in many people.
A joke that has a lot of truth is that there is a separate brain governing intestinal action — digestion, moving stool along, and triggering the urge to pass stool on a schedule. This process can be trained as a habit — similar to training a dog to respond automatically to commands. It is also affected by emotional stress, dietary changes, liquid intake, sleep habits, exercise, seasonal changes, even travel.
When constipation occurs, the stool becomes hard and requires straining to pass. Pebble-like stool may not be as painful, but it still represents a degree of constipation. And incomplete feeling or fullness after having stool is another sign.
Ironically, there is a paradoxical type of constipation that manifests with soft unformed stool that occurs frequently, yet with a continued feeling of fullness in the rectum. This occurs when there is hard stool that is not moving down. Peristalsis pushes softer content around the block. You pass this soft stool but can still feel fullness up above. This kind of pattern does still need treatment as constipation.
Nontoxic Treatments for Constipation
First, and most important, adequate fiber needs to be in the diet, and refined sugar and flour need to be drastically reduced or eliminated. The idea is that the circular muscles of intestines are squeezing contents; if there is nothing to squeeze upon because of inadequate fiber, contents don’t move along.
Fruits and vegetables are high in fiber. True whole grains are also. Crunchiness suggests fiber, it is true, but there can be a lot of fiber in fruit juices as well. Dairy is mostly devoid of fiber. Meat and chicken have some fiber but not as much as fruits and vegetables. To add more fiber, take a look at flaxseed and psyllium; they both are useful concentrated forms of fiber.
Next, hydration is crucial. Most people tend to be somewhat on the dehydrated side. Inadequate liquid obviously contributes to hard stools. When there is fiber and liquid both, they work together to provide bulk which helps intestinal muscles move contents along.
A corollary to fiber and liquid is having adequate oil in the diet. Many people are paranoid about cholesterol and fat, so they avoid healthy oils, like olive oil. This is a mistake. Oil helps soften hard stools in obvious ways.
Another important factor is exercise. Any kind of jarring exercise, like jogging or walking help enhance gravity to push stool contents downward. Circulation in general affects intestinal motility, so other forms of exercise can help as well.
Squatting to have a stool is an unusual idea but is observed in poverty areas throughout the world. The mechanics of this are obvious. It is actually likely that this posture is optimal evolutionarily considering that modern toilets are an innovation only in the last 2 or 3% of human evolution!
A simple addition is Milk of Magnesia, effective for many generations. Supplemental Magnesium itself can be helpful as long as it is balanced with twice as much calcium as magnesium — say, calcium 500 mg/magnesium 250 mg in citrate form.
Laxatives work either by drawing fluid from outside to inside the intestines, or by mildly irritating the lining and thereby adding liquid. Some cause the lining to make mucous in the process.
Cascara sagrada (Buckthorn tree bark) acts as an irritant. It should be used short-term in order to avoid dependency. Because of the irritant quality, it may cause pain, could induce electrolyte imbalance, and sometimes creates liver dysfunction.
Psyllium (made from a plantain species) is a high-fiber laxative. It is very effective and can usually be taken over a long time. Sometimes, though, there can be nausea, abdominal pain, maybe vomiting.
Rhubarb is another fibrous laxative. It should be used only short-term, as it can also be used as an anti-diarrheal agent due to its tannin content.
Senna is an irritant that helps in acute constipation when used short-term. Longterm use could lead to liver dysfunction in some cases.
Slippery elm works by mucous production and is quite effective. Because it coats intestinal lining, it can potentially interfere with medications you might be taking.
Of course, this blog is talking about acute constipation only. Chronic constipation needs a medical workup. It can be a result of hypothyroidism or even diabetes. Crohns disease and even ulcerative colitis can present with chronic constipation. Most important, colorectal cancer can cause chronic constipation, and it can be fatal!
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