What is Constipation?
Physicians have different definitions for constipation, but one commonly accepted description is having three or fewer bowel movements per week. People who experience it, however, often have their own definition, including straining to go; hard stools; infrequent stools; and bloating, cramping, or other abdominal discomforts immediately before or during a bowel movement. You could say “constipation is in the eye of the beholder.” You get the picture.
So why does it happen? The intestines move in a wavelike motion, known as peristalsis, to propel food through your system and out of the body. If the wave slows or the contents are too dry, the stools become hard and difficult to pass. And if constipation becomes chronic, it increases your risk of anal and rectal cracks, breaks, and infections; rectal bleeding; fecal impaction (where stool gets stuck in the intestines, a medical emergency); and hemorrhoids.
Many medications, including more than 100 prescription drugs and some over-the-counter products, can increase the risk of constipation, especially pain medications, such as codeine and hydrocodone, which are notorious for causing severe or chronic constipation. Calcium supplements, anabolic steroids, antihistamines, and antihypertensives also increase the risk of constipation, and the more medications you take, the better your odds of being constipated.
Common (and not so common) causes of constipation include:
- Lifestyle habits (dehydration, lack of fiber, high-protein diets, too little exercise)
- Irritable bowel syndrome
- Neurological causes (spinal cord injury, Parkinson’s disease, multiple sclerosis)
- Obstructive causes (like colon cancer or Crohn’s disease)
- Gynecologic issues (hormonal fluctuations, pelvic relaxation, pregnancy, and childbirth)
- Metabolic/hormonal problems (diabetes, low thyroid levels, low magnesium, low potassium, high calcium, high blood sugar)
- Connective tissue disease (scleroderma)
- Psychological problems (depression, eating disorders, stress)
Women are two to three times more susceptible to constipation, mainly due to gynecologic issues and hormonal changes, and—no surprise here—they are also more likely to schedule a doctor visit for it than men. Some experts also believe that living in colder climates increases the risk of constipation, perhaps from being less active and dehydrated in the winter. Having lived in Michigan most of my life and a few years in Florida, I tend to agree with this.
Chronic constipation (lasting more than 3 months out of the year), sudden constipation, or constipation that’s accompanied by rapid weight loss, bleeding, or fever should be brought to your doctor’s attention. There are a variety of tests available to determine the underlying issues.
Constipation Home Remedies
1. Psyllium 10 to 15 grams a day
I like psyllium (ispaghula husk) because it is one of the only fiber supplements that has enough clinical trials behind it suggesting that it can do all of the following:
- Reduce constipation
- Help control blood glucose
- Reduce LDL (bad) cholesterol levels
- Help with weight loss and reduce appetite in some cases
- Reduce blood pressure slightly in some people with high blood pressure
- Increase stool frequency as good as some prescription drugs (lactulose)
- Help with diarrhea in some cases
- Produce less gas and bloating compared to other commercial soluble fiber sources, such as inulin, since it is a mostly soluble viscous fiber
And psyllium is gluten free (less than 20 ppm gluten) and generally low in calories (45 calories per tablespoon).
Other natural fiber supplements (guar gum, locust bean, inulin) just don’t have the amount of human evidence that psyllium has. I recommend the powdered form over the pills because you would have to take at least six capsules to equal the equivalent dose of 1 tablespoon of psyllium. Plus, the powders are so much cheaper. Always take it with at least 8 ounces of water (per tablespoon) and at least 2 hours before or after other medications or supplements. It works so well and so quickly that it can prevent your other medicines from being absorbed in the intestines.
Finally, fiber supplements are not as helpful in rare types of constipation where there is some kind of underlying physiological disorder, such as slow transit time through the intestines or pelvic floor dysfunction.
2. Magnesium citrate 400 to 600 milligrams a day
Physicians have been using magnesium drinks (magnesium sulfate or Epsom salts) for years to treat constipation. They work by acting like a sponge to draw or attract water into the colon to make the stool softer.
A word of warning: Taking more than the dosage recommended here can cause serious side effects, including cardiac and respiratory toxicity. And individuals with kidney problems should stay away from magnesium supplements unless cleared by a doctor to take them.
Daily doses of 400 to 600 milligrams of elemental magnesium from magnesium oxide, slow-release magnesium, and chelated magnesium appear to be absorbed almost as well as the citrate form and are just as effective; sometimes they’re cheaper than the citrate form, too, so experiment to find what works best for you. Your doctor might allow magnesium citrate for constipation if you’re pregnant or breastfeeding, but always check.
Some people experience constipation because they’re deficient in magnesium. Acid reflux drugs (especially the proton pump inhibitors), metformin (the number one drug used for type 2 diabetes), high-protein or meat-based diets, daily alcohol consumption, daily exercise, and heavy menstrual periods can increase your risk of being magnesium deficient. It’s hard to get enough magnesium in your diet to treat constipation, but high-fiber foods often contain it, so you get a twofer!
3. Senna one to four pills a day
The active ingredient in the senna plant is sennosides (also known as anthraquinone glycosides), which have stimulant laxative properties. This means it works by increasing the activity of the intestines so the muscles contract and keep those stools moving forward.
Senna is frequently found in tea or herbal products and often with cascara (a.k.a. sacred bark or California buckthorn), but due to quality control issues, I am more comfortable recommending known commercial senna products, such as Senokot (or a pharmacy generic), that contain sennosides or a standardized senna concentrate.
Although this is a “natural” plant-based supplement, you should take it only as needed and for no more than a week. Again, it’s easy to become dependent on these stimulant laxatives and then your bowels won’t work without them.
What Supplements Are Useless For Constipation?
They’re the hot topic these days, but probiotics are not a cure-all by any means. They’re being overhyped for all sorts of problems, especially constipation. Let me say this right now: There is no probiotic pill that has enough evidence to recommend it for constipation prevention or treatment.
Bifidobacterium lactis DN-173 010 (the probiotic strain found in Dannon Activia yogurt) may slightly increase the number of bowel movements. Many people don’t notice any change at all, but they’re still paying a lot of money. (I feel the same way about Bifidobacterium lactis BB-12, a probiotic supplement strain found in various products.) You’re much better off just eating more fiber, which does so much more for you than just moving your bowels.
All calcium dietary supplements—carbonate, citrate, and even antacids with calcium—have a high risk of gastrointestinal side effects, including constipation! I see this all the time, especially now that so many men and women are getting enough calcium from food and also taking calcium supplements. Please check with a dietitian or do your own calculation over 3 days to determine how much calcium you’re getting before taking any supplements. If you need to take calcium supplements, try to find a brand that contains some magnesium (50 to 100 milligrams) because it could reduce the risk of constipation.
Again, one of the most common side effects of iron supplementation is constipation and nausea. If this occurs, talk with your doctor about reducing the dose or changing the type of iron you’re taking. One option that is gaining popularity and has been studied many times is “intermittent iron supplementation.” You take the supplements once, twice, or three times a week on nonconsecutive days to reduce side effects.
The aloe plant contains compounds called anthraquinones, which have a laxative effect when they interact with intestinal bacteria on their way through your system (some of the sugars in aloe may also act as a laxative). But research on these effects is scarce and inconsistent, and aloe supplements rarely work better than fiber or magnesium, in my experience.
The other problem is that they can cause severe potassium reductions that could lead to abnormal heart rhythms. It’s for this and other reasons that the FDA believes aloe supplements need more research on safety and efficacy before they can be promoted for improving constipation.
What Are The Supplements For Kids To Treat Constipation?
Fiber, such as psyllium, is your safest option for kids, based on the research. Studies have found that it helps reduce abdominal pain and increase the frequency and consistency of stools. Probiotics and other supplements have not been found to be helpful in kids, and I do not recommend them. One of the better clinical trials tested a probiotic in 159 constipated children. There were no serious side effects, but the commercial probiotic product did not work any better than a placebo.
What Lifestyle Changes Can Help With Constipation?
Diversify your diet
Powders and bars are okay sources of fiber, but they’re usually soluble fiber and only a few of them match what you can get in high- fiber foods or cereal. Getting the recommended 20 to 30 grams of fiber a day from diet alone is not easy unless you find diverse sources, such as cereals, fruits, veggies, beans, and nuts. Remember, most healthy foods are a mix of soluble and insoluble fiber, which is ideal. Soluble fiber dissolves in water, slows the absorption of some foods, and interacts with bacteria in the intestines, often causing gas. Insoluble fiber absorbs water and helps to rapidly move stool through the colon. It’s like having a brake and a gas pedal in a car—one without the other is useless.
Individuals who are sedentary have a higher risk of constipation than people who work out regularly. Exercise helps stimulate digestion, but it’s also dehydrating, which can make constipation worse. If you work out, as we all should, make sure you drink more fluids (especially water). (Note: Excessive exercise, where you’re working out for many hours and can become extremely dehydrated, can make constipation worse!)
Limit processed foods
Whenever you take a fruit or veggie and manipulate or process it, you end up with little to no fiber. Packaged/processed foods in general often provide calories without adding fiber, so opt for fresh, “real” foods.
Watch your protein intake
It’s an essential part of your diet, but eating too much—especially if you’re cutting out high-fiber foods—can cause constipation. It’s the primary complaint I hear from people on high-protein diets.
Go tiny for more power
While nuts and seeds in general aren’t high in fiber, ground flaxseed and chia seeds are great sources that can be added to foods or beverages. (There are some claims that taking 1 to 2 tablespoons of flaxseed oil or olive oil can help lubricate the stool, which may be the case, but there is no fiber in the oils.)
It’s been shown to stimulate or maintain peristalsis after surgery, so it may also keep the bowels moving when you have a mild case of constipation or are just trying to get them to operate normally again.
Grab a cup of Joe
Caffeine is a stimulant, and in moderation it can keep your colon moving.
Eat this bug
The only real probiotic I trust for constipation is Lactobacillus casei Shirota. It’s sold around the world under the brand name Yakult, but it was created in Japan by fermenting the live L. casei Shirota strain with skim milk. In one study, people with chronic constipation who drank 2 to 3 ounces of Yakult daily experienced relief within 2 weeks. This product has also been tested in kids with chronic constipation at even lower dosages and appears to be helpful.
Just chill out
Abdominal massage? Biofeedback? Maybe. If stress is contributing to your chronic constipation problem or if constipation is stressing you out, then light abdominal massage or other tension-busting therapies might help.