Sometimes, constipation gets really played down in our health world. “At least it’s not diarrhea, right?” I’ve heard people say. But unless you’ve dealt with severe constipation, it’s hard to know painful, unpleasant, and persistent chronic constipation can be…and how much of a struggle it can be to effectively relieve it and keep it at bay.
Since I’ve struggled with this personally (sorry, but you’re in the presence of someone who thinks bowel health should be more openly discussed), I’ve compiled a list that I hope can be of use to someone still struggling with this unpleasant (to say the least) condition. I don’t claim that the things on this list will help everyone–though I’ve tried to include references so that you can check out the efficacy for yourself–but I’m hoping it can be a helpful start.
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Prebiotics are a fascinating topic and I’ll be devoting an entire post to the scientific literature that speaks to the effectiveness of resistant starch and non-starch polysaccharides for digestive and metabolic health. And there’s a whole boat-load of data! Which is always reassuring. However, in this particular post, I want to focus on the actionable items that people with constipation can explore. If you’re curious in the meantime, this is a really great article on the subject.
This, personally, has been the most effective addition for me. I started out with an absolute minuscule dose (about a 1/16 of a tsp) of potato starch. I increased the dose by 1/16 of a teaspoon every week or so (mostly I listened to what my body was telling me)…so it took me months to get up to even a tablespoon. I’ve tried doing more than a tablespoon but honestly, I didn’t really find any added benefit so I’ve just stuck to about a tablespoon each day.
I also try to regularly eat sweet potatoes or regular potatoes that have been cooked and then cooled (that’s a type 3 resistant starch, for all the science-y folks out there), as well as recipes made with green bananas and plantains. Undoubtedly, most people are aware of the importance of eating soluble fiber via plant matter…and I obviously try to get my fill of vegetables each day.
Several studies have shown that probiotics can decrease intestinal transit time (the length of time that matter takes to make its way though the digestive tract) in people with constipation. (1)
I actually like this Prescript-Assist brand because it has pre- and probiotics in it. But I also have had good luck taking this Raw Probiotics brand. In either case, I’ll add the beneficial yeast supplement Saccharomyces Boulardii + MOS to the mix. Again, these are just the things that have worked for me…and it’s important to keep in mind that I started everything at a much lower dose than is recommended on the bottles and worked my way up over several months, so as to not cause more problems that I already had along the way to better bowel health.
3. Glycerin Suppositories
I can totally see why people stay away from suppositories like they’re the plague. But glycerin suppositories have long been anectodally successful and safe for people with chronic constipation and dysfunction in the motility of the lower gastrointestinal tract (as well as pelvic floor dysfunction, for that matter).
Unfortunately, there is a lack of clinical trials to back up this finding, so anyone interested in this approach needs to do their homework in terms reading the anectodal evidence and deciding if it is an appropriate strategy for them.
4. Proper Posture
The Squatty Potty has long been discussed in the paleo community as a great bathroom aide. I’d argue that, while the Squatty Potty can put you in an optimal position, putting anything under your feet while you go to the bathroom can really help. That is to say: if you have the funds to buy a Squatty Potty, that’s fantastic…but if you don’t, a step stool or a pile of books can go a long way.
It doesn’t take long to explain while this “squatting” phenomenon works. Check out the illustration below:
Squatting allows for the relaxation of the puborectalis muscle, a muscle that attaches to the pubic bone (or symphysis) and loops around the rectum, which lets the rectum be in a straightened (ahem, “poop-friendly”) position. Basically, sitting on the toilet like you’re sitting in a chair forces you to eliminate “around a bend” in your rectum…not the most ideal, as you can imagine. (Note that the puborectalis muscle is still generally your friend, since it’s just another thing that helps keep you from untimely bathroom surprises in your day to day life. The pelvic floor is a wonderful thing!)
5. Setting Aside Time
This is a point that I think is often too neglected in constipation discussions. If you’re someone who tends to have a bowel movement in the morning but you leave yourself 15 minutes to shower, get dressed, and shove some food in your face, it’s just not going to be an effective strategy for improving your bowel habits. Regardless of your personal bathroom clock, it is important to set aside a consistent time to get your business done. This allows your body to get into the habit, and it’ll require less efforts on your part to get this moving along regularly.
Taking some time also allows your parasympathetic system to kick in to take care of your “rest and digest” functions. When you’re all go-go-go, your body is simply not primed to attend to this type of bodily function. The end of the digestive process–much like the beginning–often works better when you take a minute to let your body and mind be in a relaxed state.
Studies have found that regular movement in people with chronic constipation can increase the colonic transit time (the time matter spends in the colon) and improve effective bowel emptying (3). In most of the studies, they counted “regular exercise” as something like 30 minutes of a brisk walk per day…which seems quite reasonable. This is especially true because I don’t personally think it has to be all at the same time, nor does it necessarily have to be a walk…just being active in some capacity throughout the day (yoga, weights, rowing, etc.) has been a huge help for me.
7. Food Intolerances
As with all difficult to treat health problems, I think it’s important to at least think about the possibility of food intolerences. While most people on a paleo/primal-type plan have already removed grains and possibly dairy from their diet, it can be beneficial to consider other sources of food irritants. For example, it’s been suggested in multiple studies that FODMAPs can be a common culprits in people with digestive problems, such as IBS (2).
When I looked into this, I discovered I had a problem when I eat apples (on top of the grains that I already knew of). I never would have guessed! And as much as I love apples, I’ve since then removed them from my diet until I have made more progress when it comes to my gut health.
8. Water Intake
While the small intestine is where most of the nutrient absorption happens, the colon is where the most of the water absorption happens. (This is one reason why diarrhea–which decreases time in the colon–is watery.) If your water intake is low, your body will try to absorb as much water from your gastrointestinal tract as it possibly can. What you are left with, however, is a bunch of really hard, dry stool…that isn’t easy to pass.
I feel like folks (including some health care professionals) try to pass drinking water off as some magical cure-all for constipation. In my experience, that hasn’t been true. But the converse does apply, in my personal opinion: being dehydrated can derail even the most well-intentioned efforts at relieving constipation.