Chronic constipation is an incredibly frustrating condition that can become a vicious cycle if left untreated which can result in recirculation of toxins. Thankfully, it responds really well to nutrition and naturopathic interventions - for most people, there are very effective solutions within reach. I've compiled my top 12 tips for constipation based on successful treatment for my clients.
An unfortunate group of people may not respond to these – so if that is the case for you, I have provided some advanced suggestions. I regularly treat people with constipation, so if you are struggling, get in contact with me to get some relief.
- Defining constipation
- Top 12 natural suggestions for constipation
- Regular Movement
- Squatty Potty for correct posture on the toilet
- Gentle laxative foods
- Look at your overall diet
- Kiwi Fruit
- Gentle Herbal Laxatives
- Prebiotics for constipation
- If these tips for constipation don’t work
- If you have chronic constipation and need help - I am here to help
Constipation is defined a number of ways and can be very unpleasant indeed, especially if it becomes a chronic complaint.
Constipation is defined as:
- Less than 3 bowel movements per week
- Straining to pass a bowel movement
- Feeling of incomplete evacuation
- Lumpy, hard or dry stool
Constipation often has associated symptoms such as excess gas, fatigue, bloating or distension and headaches.
The longer constipation goes on, the worse it gets because it can lead to a buildup of bacteria that produce methane gas which slows down transit time. This creates a nasty vicious cycle.
Top 12 natural suggestions for constipation
Below are my top 12 tips for constipation. These cover the essentials that everyone benefits from and some more advanced options you may not have heard of before.
I also give some additional recommendations at the end for additional areas to explore if you find these tips don’t resolve your constipation. For these cases, I still recommend implementing the following tips long term since they cover the foundations and are as important as the more advanced treatment methods.
Just as pot plants need to be watered, so do humans. Being dehydrated can cause the stool to be too dry which makes it difficult to pass. Not everyone needs 8 glasses of water a day, but pay attention to thirst signals and don’t ignore them. Many people need to add some electrolytes to their water as dehydration is not just about water - it's about water and mineral status. I like the Trace Minerals 40,000 volts product.
Movement helps to wake up our organs and oxygenate tissues. Routinely moving – whether it’s formal exercise or any other form of movement – is incredibly important when constipation is present. Humans are not designed to be sitting down for many hours a day. Choose movement that you enjoy and commit to it every day – once you get in to a routine it will be a habit you don’t need to think about. If you have chronic illness or disability and therefore have limitations, consider seeing a physical therapist for ideas suitable to your circumstances.
If you tolerate caffeine, it can be a very helpful tool in passing a bowel movement because it relaxes the rectal muscles to stimulate a bowel movement. This suggestion sometimes needs to be used along with other interventions if the constipation is severe.
Squatty Potty for correct posture on the toilet
Humans weren’t designed to pass bowel movements in a sitting position. Using a Squatty Potty mimics a more natural squatting posture that helps pass bowel movements more comfortably and completely. A cheaper option is to use a stepping stool in front of the toilet bowl to put feet on. Once you set this up, you won’t ever want to go back!
High fibre foods add bulk to the stool and also feed the microbiome. I recommend fruits, vegetables and legumes to form the foundation of the diet when someone has constipation. If the person has SIBO (small intestinal bacterial overgrowth), then a custom and treatment plan is required – for these people, high fibre foods can exacerbate constipation or other digestive symptoms while the overgrowth is present.
A great option for fibre is a carrot salad. Eaten once or twice a day away from meals, the carrot salad has a nice sweeping action in the gut. I have clients for whom this works very well. This idea is from Ray Peat, a nutrition researcher.
To make a carrot salad:
- Peel and grate 1 carrot and then mix with ½ tablespoon vinegar and 2 teaspoons melted coconut oil.
- Consume once or twice per day 15 minutes before a meal.
- Efficiency tip: grate 4-6 carrots at once and store this in water in the fridge. Then take some out and drain it before making the salad.
Please note that if you find fibre makes your constipation worse, that's a classic sign of methane SIBO or IMO (Intestinal Methanogen Overgrowth). This needs accurate diagnosis and treatment - I have completed advanced SIBO training and would love to help you feel better.
Gentle laxative foods
These foods are very helpful for constipation for different reasons:
- freshly ground flax meal – up to 3 teaspoons in a glass of water per day
- fruits such as berries, pears, figs, papaya, cherries, prunes, apple, peaches - especially if they are cooked and eaten warm
- nuts, seeds, coconut oil
- probiotic foods such as kimchi, kefir, sauerkraut, miso, kombucha, tempeh
Depending on your personal situation, not all of the above should be taken (eg. the probiotic foods may not be suitable if you are quite histamine intolerant).
The digestive tract is mostly composed of muscle. Stress can cause these muscles to tighten and not function well. Also, the parasympathetic nervous system is known as the “rest and digest” side of the nervous system. Nurturing a more relaxed state helps to switch this side on.
Choose something that works for your preferences and schedule – it could be yoga, breathing exercises as you go about your day, playing with pets or going for a walk in nature. It can be simple and inexpensive. I often recommend 4-7-8 breathing from Andrew Weil to assist this process.
You can be stressed from just about anything, including the constipation itself. One common mistake I see people making is not acknowledging their mental health and assuming that supplements will fix everything. We can’t avoid all stress, so we need to learn how to view some of it in a different way - as something that could help us grow - or manage it better if it is purely a negative. This TED Talk from Kelly McGonigal is a really great watch if you want to learn more about reframing how we view stress.
Also, slow down and chew your food well at meals.
Magnesium is a muscle relaxant – the bowel is predominantly made of muscle that can be sensitive to psychological tension. Citrate and glycinate are my preferred forms – for adults I recommend 600mg/day. Magnesium oxide can also be used and it's particularly good for constipation because it's poorly absorbed - for this reason, this type of magnesium is only good for constipation and nothing else.
More recently, I've been prescribing ozonated magnesium (eg. Mag07) for use once or twice a week which works very well - taking it at night time usually produces a bowel movement by the morning.
Look at your overall diet
Some foods such as cheese and wheat can be constipating, especially if there is a lack of fibre to round out the diet. There’s no harm in experimenting with simple diet changes such as adding in extra vegetables or replacing a chocolate bar with a juicy piece of fruit.
Very low carb or keto diets can also cause or worsen constipation for a few reasons. Firstly, they can lack sufficient fibre because most fibre is found in carbohydrate foods, and these diets also downregulate thyroid function which then has knock-on effects on digestion. Lastly, they can be low in potassium, an essential mineral which is essential to muscle health and has been linked to constipation.
If you want to stay on a very low carb diet (though there are many reasons it may not be a good idea), then adding in some prebiotic fibres is a good idea. They won’t affect your net carbohydrate intake and will also give you essential prebiotic fibre to support your microbiome which can suffer on these diets. In this situation, I recommend partially hydrolyzed guar gum (PHGG) which may be found as Sunfiber™ in the US or as PHGG in other countries. Lactulose is another great prebiotic which is also indicated for constipation, but shouldn't be used in cases where the individual has returned a postive lactulose SIBO test. Starting low on these and slowly increasing the dose is helpful in avoiding startup effects such as gas. The gas usually settles once the microbiome adjusts so don’t give up on using them.
Kiwi fruit contains a substance called actinidin which has been shown in research studies to reduce bowel transit time. A long transit time is associated with constipation as it means fecal matter is sitting too long in the bowel and drying out, therefore becoming harder to pass. I recommend clients eat 2 to 3 kiwifruits per day in the morning or afternoon if they have constipation.
Gentle Herbal Laxatives
Always work with a qualified practitioner when using herbal medicines as they often interact with medications.
Cascara sagrada is a very gentle laxative that won’t produce gas while it’s doing its thing. This shouldn't be taken all the time though - it's important to take breaks from it and avoid using it long term.
Rhubarb helps to stimulate bile flow which is essential for good digestion, including preventing constipation.
Prebiotics for constipation
I mentioned two prebiotics under point 9 for those on a low carb diet and they are also very helpful for those who are not on a low carb diet. These prebiotics are Partially Hydrolyzed Guar Gum and lactulose. I recommend starting these on a low dose to let your microbiome adjust, although the lactulose can be taken at a full dose (as per the label) for quick results – though there will be a lot of rumbling happening while it moves through the bowel. I also recommend if using a full dose of lactulose to stay near a bathroom until you have passed a bowel movement as it can come on quite suddenly as it speeds gut transit. Lactulose is available over the counter in Australia at pharmacies – often sold as Actilax. In some countries, lactulose requires a prescription. These prebiotics not only help constipation, but they also feed the beneficial bacteria in your microbiome so they are a great addition to your schedule. Caution: if you have lactulose-positive SIBO, then it's not a good idea to use it until the SIBO is under control. PHGG on the other hand is actually beneficial to SIBO treatment.
If these tips for constipation don’t work
If these suggestions for constipation don’t work, I highly recommend working with a healthcare practitioner to assess if other factors that cause constipation are at play such as:
- low serotonin levels in the gut
- high levels of clostridia bacteria
- high levels of methane gas (either in the small intestine, large intestine, or both)
- hypothyroidism (surprisingly common)
- impaired bile flow or poor bile composition
- low potassium or magnesium intake
As always, it's important to also work with your medical practitioner for assessment and before trying any new supplements.
If you have chronic constipation and need help - I am here to help
If you suffer from chronic constipation, get in touch. I have plenty of experience assessing the above factors to help you.