Constipation affects four million Americans each year. Physicians write more than a million prescriptions for constipation annually, and we spend $725 million a year on laxatives. Constipation is a big problem. People are constipated when they strain to have a bowel movement, have hard stools, infrequent or incomplete bowel movements, discomfort, or a perception that bowel habits are different from usual.

Some people feel fatigue, aches, and mental sluggishness from constipation; others get headachy. Constipation affects women twice as often as men and is more common in people over age sixty-five. Although aging is commonly listed as a cause of constipation, it is due more to the results of lifestyle.

Elderly people often eat low-fiber foods, rely on packaged and prepared foods, take medications that interfere with normal bowel function, and have decreased mobility. Each of these factors by itself increases the risk of chronic constipation and is not necessarily a progression of aging.

Many other factors can be the underlying cause of constipation. Hormones play a role. Women often notice that their bowel habits change at various times in their menstrual cycles. Pregnancy is a common, but temporary, cause of constipation. Constipation can also be caused by an underactive thyroid.

Some diseases can affect the body’s ability to have bowel movements. Parkinson’s disease, scleroderma, lupus, strokes, diabetes, kidney disease, low or high thyroid function, and certain neurological or muscular diseases, such as multiple sclerosis or spinal cord injuries, can cause constipation.

Colon cancer can also cause it. Neurological problems, such as injuries to the spinal column, tumors that sit on nerves, nerve disorders of the bowel, and certain brain disorders are other causes. Bowel movements should be painless. If you experience pain, see your physician.

You may have a structural abnormality, fissure, hemorrhoid, or more serious problem. Pain during bowel movements can cause a muscle spasm in the sphincter, which can delay a stool. Magnesium helps relieve and prevent muscle spasms. Bowel transit time is a newer parameter of constipation that is widely used in preventive health care.

Bowel transit time is the amount of time it takes for food to go from the mouth, through the digestive system, and out in stool. Reports from the National Institutes of Health suggest that a “normal” range of bowel movements is from three to twenty-one each week.

While this may show what is “average,” it is not a good indicator of what is “normal.” It is normal to have one to three soft bowel movements each day. Optimal bowel transit time is twelve to twenty-four hours, so if you are only having three bowel movements each week, you have a transit time of fifty-six hours, which is way too long.

Slow bowel transit times raise the risk of colon diseases and contribute to other health problems due to the reabsorption of toxins back into the body. A recent study showed an increased risk of colon cancer in people who are chronically constipated. This makes sense in light of current theories about fecal transit time.

If you haven’t done the transit time self-test, now would be a good time. Dennis Burkitt, M.D., studied bowel habits of Africans living in small towns and large cities. He found that people who ate indigenous, local foods had an average of a pound of feces each day, with twelve-hour transit times.

Burkitt found that those who lived in cities on Western diets only excreted five-and-a-half ounces of stool each day, with average transit times of forty-eight to seventy-two hours. People on native diets had extremely low incidences of diseases common to Western civilization, such as appendicitis, diabetes, diverticulitis, gallstones, coronary heart disease, hiatal hernia, varicose veins, hemorrhoids, colon cancer, and obesity.

When these people moved into cities and ate a Westernized diet, they too developed these diseases. Dr. Burkitt attributed much of this disease to poor dietary fiber intake in a modernized diet. For most people, a diet high in fiber and fluids solves the problem.

Be sure to drink six to eight glasses of water, juices, or herbal teas and eat at least five servings of fruits and vegetables each day. Brussels sprouts, asparagus, cabbage, cauliflower, corn, peas, kale, parsnips, and potatoes contain high amounts of fiber.

Make whole grains the rule and processed grains the exception. The addition of high-fiber cereals at breakfast can make a big difference. Legumes, like kidney, navy, pinto, and lima beans, have a large amount of dietary fiber. Make these dietary changes slowly.

A quick change to a highfiber diet can cause gas and bloating. As your body gets used to this new way of eating, it will adapt. Remember that the requirements for most of us are to double our daily fiber intake. Cut back on low-fiber foods, including meats, dairy products, pastries, candy, soft drinks, and white bread.

Exercise helps relieve constipation by massaging the intestines. Many of my clients have found that regular exercise keeps their bowels regular. Overuse of laxatives is common and compounds the problem. Chronic use of laxatives, even herbal laxatives, causes the bowels to become lazy, and the muscles become dependent on laxatives to constrict.

People often find they need more and more laxatives to have the same effect. Some laxatives can cause damage to the nerve cells in the wall of the colon. If you have used laxatives, you need to retrain your body to have bowel movements on its own.

Try sitting on the toilet each morning for twenty minutes and relax. Over time your body will remember how to relax and function normally. A recent study compared the use of psyllium seeds, a fiber supplement, with the use of docusate sodium, a common stool softener.

The psyllium was more effective at relieving constipation than the stool softener. So use psyllium and eat more fiber. Pay attention to your body’s needs. When your body gives you the signals that it’s time to defecate, stop what you are doing and go to the bathroom.

When you ignore your body’s urges, the rectum gets used to being stretched and fails to respond normally. Feces back up into the colon, causing discomfort. If you dislike having a bowel movement at work, school, or in a public restroom, readjust your attitude and get used to the idea. Everybody’s doing it.

Healing Options

• Double your fiber intake. Fresh produce, organically grown if possible, gives life to our cells. Eat a minimum of five fruits and vegetables every day. More is better. They are rich in fiber, vitamins, minerals, trace nutrients, fluids, and vitality.

Eat whole grains such as whole wheat berries, oatmeal, millet, amaranth, quinoa, rye berries, and brown rice. Eat bran or whole grain cereals at breakfast; they can significantly boost your fiber intake in just one meal. Beans and peas are also loaded with healthful fibers. They are a low-fat protein source, and their soluble fiber and sitosterols help normalize cholesterol levels.

• Try psyllium seed husks. Stop using laxatives and enemas and start using psyllium seeds. They add bulk and water to stool, which allows for easy passage. Though not a laxative, psyllium seeds do regulate bowel function, are beneficial for both diarrhea and constipation, and do not cause harmful dependencies.

Build up gradually to 1 teaspoon of psyllium with each meal to avoid gas and cramping from sudden introduction of fiber. As your dietary fiber increases, you will probably find that you no longer need psyllium seeds.

• Try wheat bran or corn bran. Wheat and corn bran can be used in the same way as psyllium seeds. They add bulk and moisture to stool, which allow it to pass more easily. Use 1 teaspoon with meals.

• Increase fluids and start exercising. Drink at least six to eight glasses of water, fruit juice, or herbal teas each day. Alcoholic beverages and soft drinks have a dehydrating effect on the body. Improve bowel habits: Ignoring your body’s natural urge to defecate can cause constipation. Take time each morning to have a bowel movement. If you go when nature calls, it takes just a minute or two. Additionally, begin an exercise or movement program.

• Improve bowel flora. Poor bowel flora causes the digestive system to move sluggishly. Use of antibiotics, hormones, and steroid drugs; high stress levels; and poor diet can also cause an imbalance of intestinal flora. Bifidobacteria help regulate peristalsis. Take a probiotic supplement two to three times daily. If you are able to digest yogurt, it has a normalizing effect on the bowels and can be helpful for either constipation or diarrhea.

• Add magnesium. Magnesium helps keep peristalsis—rhythmic muscle relaxation and contraction—working by proper relaxation of muscles. Americans have widespread magnesium deficiency that contributes to constipation.

According to recent studies, 75 percent of magnesium is lost during food processing, and 40 percent of Americans fail to meet the RDA levels for daily magnesium intake. When magnesium deficiency or a calcium-magnesium imbalance is present, poor bowel tone can occur.

On the other hand, too much magnesium can cause diarrhea. Take at least 400 milligrams daily. I’ve had clients who initially needed 2,000 milligrams of magnesium. Eventually, their deficiency lessens and they need less. If you need large amounts of magnesium, you may want to use 1 teaspoon daily of choline citrate to increase absorption.

• Address lactose intolerance. People with lactose intolerance sometimes become constipated from dairy products. Avoid milk and dairy foods for two to three weeks and see if there is a change. Read the section on lactose intolerance in Chapter 6 to find hidden sources of lactose. Take the lactose breath test to determine if you are intolerant. Use Lactaid or Digestive Advantage LI to increase your tolerance to dairy.

• Evaluate medications. Many medications can cause constipation: pain relievers, antacids that contain aluminum, antispasmodic drugs, antidepressants, tranquilizers, iron supplements, anticonvulsants, diuretics, anesthetics, anticholinergics, blood pressure medication, bismuth salts, and laxatives. If you noticed that constipation occurred suddenly after you began to take a new medication, discuss it with your doctor.

• Investigate food sensitivities, dysbiosis, leaky gut syndrome. People with chronic constipation who do not respond to diet, fiber, liquids, and exercise should have digestive testing to see if dysbiosis, food allergies, or parasites are the underlying problem.

• Take vitamin C. Vitamin C can help soften stool. The amount varies depending on individual needs. Use a vitamin C flush to determine your daily needs.

• Try biofeedback. Biofeedback has been used successfully to treat constipation in people who have problems relaxing the pelvic floor muscles.