Estimates suggest anywhere from 15 to 20 percent of the general population experience chronic constipation,1,2,3 characterized by hard, dry and difficult to pass stools, and/or having less than three bowel movements per week.
While temporary constipation can be the result of simply eating poorly for a day or two, chronic constipation has been linked to a number of other, more serious health problems, including:
Causes and Risk Factors
Stool is the end result of digestion, which starts in your mouth and ends in your large intestine. When you chew, the food mixes with saliva, which starts the digestive process to break the food down.
As the food makes its way through your small intestine, nutrients and water are extracted, leaving only the waste products your body cannot use. A number of factors can affect the consistency and mobility of your stool, increasing your risk of developing chronic constipation. These include:
|Lack of beneficial gut microbes, often caused by a lack of fiber in the diet.5
A low-fiber diet also makes your intestines more vulnerable to infection.
Fiber promotes bulkier, softer stools, and helps keep your intestinal walls intact6
|Certain medications and supplements (such as antidepressants, opioids, antacids, blood pressure medications, diuretics and iron supplements)7,8,9,10|
|Excessive or chronic use of laxatives||Frequently ignoring the urge to have a bowel movement (for instance, to avoid using public toilets)|
The following high-risk groups are also more likely to experience chronic constipation:
•Women, especially during pregnancy or after giving birth. The weight of the developing baby normally sits on the intestines and can slow the motility or movement of the stool through the digestive tract.
As the stool slows down more water is extracted by the body, making the stool hard, dry and more difficult to pass. Older adults, due to lower physical activity level and slow-down of the digestive tract.
•Lower-income individuals,11 because they may not be able to afford fresh fruits and vegetables, which provide fiber for their diets
•People who have just had surgery. They may be nervous about pushing, may have reduced physical mobility and/or may not be eating their normal diet, all of which can contribute to constipation.
|Conditions that cause blockage, such as tumors, inflammation or swelling and/or anal fissure||Diabetes|
|Conditions that affect the nerves in your intestines||Spinal cord injuries, brain injuries and stroke|
|Conditions involving the muscles used in elimination.
Weakened pelvic muscles or pelvic muscles which do not coordinate relaxation and contraction (dyssynergia)
|Conditions that slow movement through the intestines, such as autonomic neuropathy and multiple sclerosis (MS)|
|Conditions that affect your hormones, such as hyperparathyroidism and hypothyroidism||Irritable bowel syndrome (IBS) and/or inflammatory bowel disease (IBD)|
Connections Between Constipation and Your Health
Chronic constipation should not be taken lightly. Aside from causing pain and affecting your quality of life, it can have a significant impact on your overall health. For starters, chronic pushing and painful stools may predispose you to large hemorrhoids, which can be quite aggravating and painful.
Your colon was designed to hold a few pounds of stool, but when constipated your colon may hold up to 10 pounds of dry, hard feces. The sheer volume of stool alone can stretch your colon, irritate the lining of the colon (mucosa) and produce toxins while waiting to be eliminated.
Chronic constipation can also lead to tearing of the anus (anal fissure). These fissures are caused by trauma to the inner lining of the anus.14 Pushing out large, hard stools can also result in some of your intestines protruding from the anus (rectal prolapse), which requires surgical intervention.15
Postponing surgery increases your risk of further stretching your anal sphincter, and increases the amount of intestines that protrude. Chronic constipation can also affect the genital and urinary health of women.
Because the colon and female reproductive organs are structurally close, pressure from large amounts of stool in the colon can lead to rectal prolapse in the vagina,16increasing the potential that the bladder will not empty completely, or resulting in reflux of urine from the bladder back into the kidneys, called vesicoureteral reflux.17
Chronic Constipation May Raise Your Risk of Kidney Disease
According to recent research, men and women suffering with constipation had, on average, a 13 percent higher risk of kidney disease than those who were not chronically constipated.18,19,20 The study had a follow-up period of seven years. They also had a 9 percent higher risk of kidney failure.
Overall, severe constipation led to a quicker deterioration of kidney function, although the exact mechanism was undetermined. According to co-author Dr. Csaba Kovesdy, a professor of medicine in nephrology at the University of Tennessee Health Science Center and Memphis VA Medical Center:21
“Our findings highlight the plausible link between the gut and the kidneys and provide additional insights [into the possible causes of kidney disease]. Our results suggest the need for careful observation of kidney function trajectory in patients with constipation, particularly among those with more severe constipation.”
How Constipation Relates to Parkinson’s Disease
Your gut and brain health are closely connected. A number of studies have delved into the role of gut bacteria in the workings of the gut-brain axis, and how they benefit your mental and psychological health.
For instance, anxiety, depression and other mood disorders are increasingly recognized as being, in part, related to an unbalanced microbiome. This interlinking may also shed light on why chronic constipation is associated with a neurological disease such as Parkinson’s.
In one recent mouse study, proteins implicated in the disease were found to travel from the gut into the brain over the course of several weeks. These findings suggest that, in some cases, Parkinson’s disease may have its origins in the gut. The question is, what causes alpha-synuclein to accumulate in the gut? No one knows for sure, but theories include:
- Presence of bacteria that produce curli — a compound that causes an aggregation of alpha-synuclein
- Pesticide exposure
- Acid reflux
- Chronic inflammation
Foods That Relieve Constipation
If you struggle with frequent constipation, reaching for a laxative may be a tempting option. However, doing so may simply exacerbate the problem as chronic laxative use can cause dependency. Your best bet is to address your diet instead.
|Food||Ingredient(s) that help relieve constipation|
|Water and/or warm beverages such as tea or warm water with lemon||Increasing your water intake may resolve the problem if your dry stools are due to dehydration.
Drink enough that your urine is straw colored. If it’s dark yellow, then you’re dehydrated. If it’s colorless you are drinking too much
|Leafy greens such as spinach, Swiss chard and kale||Fiber, magnesium and water|
|Fermented vegetables||Healthy bacteria (probiotics), fiber and digestive enzymes|
|Yogurt from raw organic grass-fed milk (to identify healthier commercial brands, see the Cornucopia Institute’s Yogurt Buyer’s Guide)||Healthy bacteria (probiotics)|
|Prunes||Fiber. The skin also has mild laxative properties|
|Radishes||Compound that promotes healthy peristalsis (relaxation and contraction of your intestines)|
|Flax seeds (freshly ground)||Fiber|
|Dark chocolate (cacao)||Magnesium|
|Olives and olive oil24,25||Promotes bile production, which aids digestion. The fats also promote intestinal wall health and loosen stool.
CONTRAINDICATED for babies and young children. Use small amount of pureed prunes instead and please remember that the vast majority of olive oil sold in the U.S. is adulterated. So be very careful and do your research before you but it
|Figs and fig paste26||Fiber and prebiotics. They also increase production of mucin (proteins that form a physical barrier that protects your intestinal wall from damage) and improve peristalsis|
|Aloe vera27,28||Acts as a stimulant laxative. Aids with protein digestion and helps strengthen intestinal muscles.
CONTRAINDICATED for pregnant or nursing women, children, diabetics and those with hemorrhoids, kidney problems, intestinal diseases such as Crohn’s, and those allergic to plants from the liliaceae family such as onions, garlic and tulips
|Castor oil29||Works as a stimulant laxative, causing increased movement and contractions in the small intestine.
BEWARE: Castor oil is also used to induce vomiting, so should be used sparingly and only as a short-term or occasional remedy in lieu of chemical laxatives. A typical dose is around 15 milliliters (mL), or about 3 teaspoons.
CONTRAINDICATED FOR PREGNANT WOMEN, AS IT STIMULATES UTERINE CONTRACTIONS AND MAY CAUSE FETAL HARM, INCLUDING FETAL ABNORMALITIES.
Also contraindicated if you have rectal bleeding, stomach pain, symptoms of appendicitis, symptoms of blocked intestine and vomiting
Long-term use can result in serious adverse effects, including dehydration, diarrhea, potassium depletion, malnutrition, muscle weakness and swelling of the bowel
Squatting and Exercise Can Also Reduce Constipation
The position you use when going to the bathroom can significantly impact the ease with which you eliminate. It can also influence your risk of bowel and pelvic problems, including constipation, hemorrhoids and more. Most of you reading this probably sit to evacuate your bowel, but this requires you to apply additional force (straining), which has unwanted biological effects, including a temporary disruption in cardiac flow.
Sitting on a modern toilet is designed to place your knees at a 90-degree angle to your abdomen. However, the time-honored natural squat position places your knees much closer to your torso, and this position actually changes the spatial relationships of your intestinal organs and musculature, optimizing the forces involved in defecation.
Squatting straightens your rectum, relaxes your puborectalis muscle and allows for complete emptying of your cecum and appendix without straining, which prevents fecal stagnation and the accumulation of toxins in your intestinal tract.
If you have trouble with bowel movements, especially constipation, I urge you to give the squat position a try.