Let's talk constipation - here's why should you be concerned
Here is a topic that often gets hushed in conversations, hidden behind closed (bathroom) doors and discreetly tucked away in the back corner of our minds—constipation. The big C that's preventing you from having a nice big BM (bowel movement). An unspoken discomfort that affects millions, yet we tend to tiptoe around discussing it openly. Well, today is the day we break that silence and delve into the complexities of this common digestive problem! Grab a cup of herbal tea, find a comfortable spot, and let's unravel the mysteries of constipation together.
What is constipation?
Constipation is a condition in which a person has uncomfortable or infrequent bowel movements. While we tend to think constipation is solely classified as few bowel movements, a person is also considered to be constipated when stools are small, hard, and dry. Bowel movements every two to three days are seen as "normal" by many people, however someone having such infrequent BM's would be constipated. In fact, even one bowel movement per day indicates constipation. Ideally, if you consume three meals per day, you also want to be having three BM's daily. One meal in, one meal out.
Contrary to popular belief, daily movement of the bowel alone is not evidence of proper bowel function. You could be eliminating multiple times per day and still be constipated. If you are not fully emptying your bowels when having a bowel movement, then this means that you are constipated.
Constipation indicators to keep in mind
You're now probably wondering how you can know whether you're constipated or not. What does fully emptying your bowels even mean? Let's talk about it. Constipation signs to look out for include:
1 out of every 4 bowel movements...
are lumpy or hard
require straining in order to eliminate
result in a sensation of incomplete elimination
result in a sensation of obstruction while trying to go
Next time you have a bowel movement, don't be afraid to take a peak in the toilet and compare what you see to the following Bristol Stool Chart (listed below). If even just one bowel movement per day looks like type 1 or type 2, then you are experiencing some level of constipation. If most of your BM's look like type 1 and 2, this is a sign of chronic constipation.
As stool moves through the colon, fluids are removed and absorbed into the body. The consistency of stool is dependent upon many things including how long the stool sits in the colon. The longer stool sits in the colon, the harder it is to pass. The ideal stools are types 3 and 4, especially type 4, as they are more likely to glide out without any fuss.
The impact of constipation on your health
Constipation is more than being a little backed up on eliminating digested food particles. Being constipated contributes to hormone imbalance, autointoxication, decreased nutrient absorption, and even increases the workload on other organs.
Increased workload on other organs
Other than constipation being an uncomfortable feeling, it is also taxing on the body. Dysfunction in the bowels increases the workload on your other excretory organs such as your skin, kidneys, lymphatic system, and your lungs. The longer waste materials sit in the colon, the more irritated the lining of the colon becomes. This can lead to inflammation of the colon, abdominal cramping, bloating, and nausea. If constipation is chronic, this can further lead to Crohn's disease or ulcerative colitis, both types of inflammatory bowel diseases (IBD).
Increased toxicity and hormone imbalance in the body
Constipation also increases the body's overall toxic load, weakening the body's tissues and organs and, leading to symptoms of autointoxication. The extra time that stool remains in the bowel contributes to the formation of toxic substances, alters intestinal flora (your healthy gut microbes), and ultimately results in intestinal toxemia (a toxic bowel). Before we get any further, it's important to note that stool is made up of much more than food residues. Stool is made up of 75% water and 25% solid waste, including cellular lining, plant fibres, fats, proteins, mucus, bile, hormones, toxins, and bacteria (both living and dead). The longer fecal matter sits in the bowel, the more likely toxic waste will be absorbed through the bowel wall and circulated throughout the bloodstream. Hormones can also be reabsorbed into the bloodstream, contributing to hormonal imbalances and increasing the risk of estrogen-dependent cancers.
Once toxins enter the blood, they circulate throughout the body and can be deposited in tissues, the greatest amounts of which are retained in the body's weakest tissues. As toxins accumulate in these tissues, alterations in cellular function take place. Tissues laced with toxins can't assimilate nutrients well or eliminate waste efficiently. As the body becomes increasingly toxic, proper oxygenation also cannot take place within tissues. Without adequate oxygen, the body loses energy and the tired body continues to downward spiral. A tired body has a reduced ability to detoxify, creating a vicious cycle.
Autointoxication occurs when the body absorbs too much of its own toxic waste. A good comparison would be to think of a rain barrel overflowing with water, wherein your body is the rain barrel. Toxins are introduced into the body from various sources in our environment, and accumulate until the barrel overflows and the body experiences toxic overload. The body starts to show this overflow through a variety of symptoms.
Symptoms of autointoxication can range from reoccurring headaches, back pain, poor concentration, brain fog, fatigue, bloating, sinus problems, bad breath, joint pain, acne, and inflammatory skin conditions, amongst many others. Diarrhea, in fact, is often another symptom of constipation, which may sound counterintuitive. When the bowel becomes impacted with feces, the body will often liquify the colon's contents in a last-ditch effort to rid itself of the toxic-waste accumulation.
How do we get the bowels moving again?
Increase fibre and water
Getting in the habit of going to the washroom when you feel the need is important. When you ignore your body's urges, the rectum gets used to being stretched and fails to respond normally. A diet rich in fibre and water, as well as getting adequate amounts of fresh air, sunshine, and exercise are great simple habits to help speed up transit time. Bulkiness provided by fibre, and lubrication and moisture from water, combine to create an ideal bowel movement. Bulk fabricates the mass whereby good evacuation is assured whilst lubrication allows an easy flow of materials through the digestive tract, all the way to the anus. Moisture prevents the drying out of feces and the development of constipation.
Adults should aim to eat at least 35g of fibre daily, as fibre helps to add bulk to stool. Strengthening and toning of the bowel cannot be developed or maintained unless there is opposition to muscular action (which is why fibre is so important). To name a few, fibre-rich foods include:
Fruits and vegetables
Whole grains
Legumes such as beans, peas, and lentils
Nuts and seeds
To learn more on the benefits and importance of fibre, check out this blog article: Increase fibre in your diet- your body will thank you.
Fibre and water go hand-in-hand. As you increase your fibre intake, it's extremely important to also increase your water intake; this ensures to keep waste moving smoothly throughout your colon. When not enough water is consumed, the mucous lining in the colon changes in consistency, failing to provide slick lubrication for the passing of stool. As a general guideline, you should aim to drink half your body weight in ounces (oz.) of filtered water daily.
Consume potassium and magnesium-rich foods
A healthy, well-functioning bowel contains both potassium and magnesium. If these micronutrients are lacking in the diet, they will be pulled from the body tissues thereby impacting the functioning of the bowel. Magnesium draws water into the intestines, working as an osmotic laxative. This increase in water stimulates bowel motion, or motility. Potassium is needed in your colon walls to ensure that peristalsis occurs. Peristalsis consists of the series of wave-like muscle contractions in your bowels which move stool through the digestive tract to the anus for elimination. Green leafy vegetables, legumes, nuts, seeds, and whole grains are good sources of magnesium whereas potatoes, winter squash, beans, avocados, and bananas are good sources of potassium. This underlines the importance of eating varied whole foods when dealing with constipation.
Feed your healthy gut bacteria
Poor bowel flora also causes the digestive system to move more sluggishly. Eating cultured and fermented foods like kefir, tempeh, natto, kombucha, miso, kimchi, sauerkraut, and probiotic yogurt can help to rebalance the microbiome. A probiotic supplement can further be used to support bowel health (be sure to consult with your healthcare practitioner before starting a new supplement).
Add movement to your daily routine
Changes in diet and daily activity levels alone can go a long way in supporting bowel health, as movement gets the digestive system moving. Simply incorporating some short walks into your daily routine, or even a yoga session or two throughout the week, can help to get your bowels moving again (especially if you work a sedentary job). An example of how much movement, even the slightest amount, impacts your digestive health: twisting poses in yoga massage your digestive organs which in turn increases blood flow and oxygen delivery, aiding the process of peristalsis, encouraging stools to move through your system.
Stress management
Reducing overall stress can greatly improve bowel health and transit time. In states of stress and anxiety, disruption to the gut-brain axis can reduce the speed at which food moves through the gastrointestinal tract. Deep breathing exercises are a great way to pull the body out of a stressed fight or flight response and into the rest and digest state which allows the body to properly eliminate.
Should you try a laxative to help speed up transit time?
Roughly 95% of all laxatives are irritating to the bowel, forcing peristaltic action by means of this irritation. Any time the bowel is artificially stimulated, an undesirable result is a loss of muscle tone, eventually producing a weakness in that muscle structure. With this, turning to laxatives as your first solution to constipation is not recommended.
If you find that you are still experiencing some constipation with the diet and lifestyle changes mentioned above, you can try incorporating psyllium seed husks instead of laxatives. Psyllium is high in mucilage and helps to regulate bowel function and is beneficial for both constipation and diarrhea. It acts by drawing water to the colon, serving to soften the stool and give it bulk. Psyllium does not cause harmful dependencies the way laxatives do. You should gradually build up to 1 tsp of psyllium seed husk with each meal to avoid any gas or cramping from a sudden introduction of additional fibre. Alternatively, marshmallow root is a moistening demulcent herb that is also high in mucilage and can be taken as a tea to help support proper bowel functioning and elimination.
How to track your bowel transit time
If you're interested in tracking improvements in your bowel health, you can learn to track your bowel transit time. Transit time consists of how long it takes from the time you eat a food until it comes out the other end. To test bowel transit time, you can buy charcoal tablets at a pharmacy or health food store and take about 1000mg. Note exactly when you take the charcoal, then again when you see darkened stool. Calculate how many hours have passed since you took the charcoal tablets- this is your transit time. Alternatively, beets can be consumed instead of charcoal tablets as these will turn stool a reddish colour.
A range between 12 and 24 hours is an optimal transit time. More than 24hrs indicates that wastes are sitting in your colon for too long and putrefying. Less than 12 hours usually indicates that you are not absorbing all the nutrients you should be absorbing from your food. In this case, it is recommended to work with your healthcare practitioner to resolve this digestive concern.
How to determine if you're having an ideal bowel movement
You may now be asking yourself how you can determine whether you're having a good bowel movement. Generally speaking, the feeling that you need to "go" should be definite but not sudden or irresistible. Once you sit down on the toilet, there should be no delay, nor conscious effort or straining. The stool should glide out smoothly and comfortably. Afterwards, there is only a pleasant feeling of relief. There should be no pain, no straining and no cramping. You should not feel the pressure of more stool still remaining in the colon. Your stool should look like a sausage or snake, smooth and soft (type 4 on The Bristol Stool Chart). The diameter of your stool should be 1 to 2 cm. A larger diameter suggests a longer transit time.
The bottom line
Here's your TLDR: Constipation, often a hushed topic, is a topic that deserves your attention for its widespread impact on well-being. It's important to recognize that constipation goes beyond the mere frequency of bowel movements; understanding that the quality of bowel movements is essential. Ultimately, a good bowel movement is defined by the bulk and shape of the stool (see Bristol Stool Chart above), ease, regularity, and the absence of discomfort. Chronic constipation not only disrupts daily life but also poses health risks, contributing to autointoxication and a myriad of associated symptoms. Addressing constipation involves lifestyle changes, emphasizing the importance of a fibre-rich diet, hydration, and regular exercise. Tracking bowel transit time offers insight into digestive health, with an optimal range of 12-24 hours. It's time to break the silence, prioritize digestive health, and embrace the path to smoother, more comfortable bowel movements.
References
Haas, E. M., & Levin, B. (2006). Staying healthy with nutrition: The Complete Guide to diet and Nutritional Medicine. Celestial Arts.
Jensen, B. (1999). Dr. Jensen’s guide to better bowel care. Avery.
Lipski, E. (2020). Digestive wellness: Strengthen the immune system and prevent disease through healthy digestion (5th ed.). McGraw-Hill.
Rabbe , C. (2023). Herbal Medicine - The Digestive System. Toronto; Institute of Holistic Nutrition.
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