In a previous blog on regularity we touched on some of the causes of bowel dysfunction focusing on diarrhea. In this part the discussion will move to the opposite end of the spectrum to constipation. Contrary to popular belief daily bowel movements may not be required for a healthy colon. There is some ongoing debate on this topic but the general consensus is that there isn’t one universal number of bowel movements that is appropriate for everyone. Instead a range of three per day all the way to three per week is considered normal. To this point the National Institutes of Health suggests that constipation implies fewer than three bowel movements per week. 

The bottom line is don’t just look at the frequency of bowel movements in determining whether or not constipation is an issue. If you feel healthy and your stools are well-formed and easy to pass you shouldn’t feel obligated to resort to heroic measures such as employing laxatives or gritty fiber supplements in order to eliminate more frequently. But if you’re eliminating less frequently than three times per week or if your stools are hard and difficult or painful to pass (a critical factor here) you should discuss this with your healthcare practitioner. Besides being uncomfortable chronic constipation can be a sign of dysfunction elsewhere in the body.

Just like when you’re working to improve any aspect of your health and wellness the first step should involve low-level non-invasive strategies known to be highly effective. When it comes to constipation a good place to start is making sure you’re adequately hydrated and are consuming enough fiber. The best sources of fiber are vegetables and fruits and modest amounts of whole grains if you tolerate them. If you’re already drinking sufficient water—about half your body weight (in pounds) in ounces of water—and consuming healthy amounts of fiber then it’s likely those aren’t the factors causing the constipation so adding more water and/or fiber won’t necessarily relieve it. Several other variables influence bowel motility so if you’ve addressed diet and fluid intake and are still experiencing constipation looking for clues in other parts of your body might reveal the true culprits.

An often overlooked but very common cause of chronic constipation is low thyroid function. The thyroid gland regulates the body’s basal metabolic rate—basically how hot the body’s engine runs and how quickly it burns through fuel. (This is why people with a sluggish thyroid tend to have difficulty losing weight despite exercise and a healthy diet.) Suboptimal thyroid function means many processes slow down including the movement of waste through the colon. If you have some of the common symptoms of low thyroid consider asking your practitioner to evaluate your thyroid health as a possible cause of constipation that hasn’t responded to increased fiber and water.

Another avenue for relief from chronic constipation is repopulating your bowel with pre- and probiotics. In our over-sterilized and sometimes germ-phobic modern world we’ve moved away from fermented probiotic foods that traditional cultures around the globe consumed regularly. Probiotics—the “good bacteria” that inhabit the digestive tract—help you digest food and keep things moving along smoothly. A number of things can interfere with adequate levels of these beneficial organisms such as stress and courses of antibiotics. (Antibiotics don’t just kill the “bad bugs” they get the good ones too.) When this gut flora is imbalanced or inadequate it can take longer to break food down and move it through the intestine.

If live cultured foods aren’t a regular part of your diet think about adding a probiotic supplement to your routine and consider one that includes prebiotics. Prebiotics are carbohydrate-derived fibers and sugars that humans cannot digest so they serve as food for the gut flora which helps maintain their healthy population in the colon. (Look for inulin pectin chicory or FOS on the label.) 

Conventional constipation remedies such as stool softeners and saline laxatives can help alleviate acute discomfort in the short term but bowel distress can be a sign of suboptimal functioning elsewhere in the body and these other factors should always be evaluated to identify and correct the underlying cause.