can be defined as the infrequent and difficult passage
of stool. There is a wide range of opinion as to what
constitutes normal or “ideal” in terms of
frequency of bowel movements with various authorities
saying that a healthy person should have one or two
or three bowel movements a day. Others, taking into
account variations in activity and metabolic levels
of various population groups, use a threshold of three
bowel movements a week with fewer than three indicating
some degree of constipation. Another measure is bowel
transit time – the amount of time food takes to
pass through the system from consumption of a meal to
evacuation. Many feel that an ideal bowel transit time
would be in the 16 to 24 hour range (one bowel movement
16 to 24 hours after each meal). Unfortunately, in reality,
the average bowel transit time for Americans is believed
to be closer to 96 hours. With longer bowel transit
times the intestinal contents may harden and a person
may have difficulty or even pain during elimination.
In severe cases, the colon walls can be lined with layers
of fecal matter imbedded in toxic mucus which can take
on the consistency of hard rubber. Blockage can be so
severe, feces can barely pass through. In less severe
instances where there is a shorter interval between
bowel movements; stool may still harden to some degree
and be painful to pass. Often also associated with constipation
is straining during bowel movements, the feeling of
incomplete evacuation, pain in passing stool, feeling
bloated, pot belly, weight gain, and feeling uncomfortable
and sluggish. While there is disagreement as to what
is “ideal” among healthy people a good basic
rule is that you may be constipated if:
than three days pass without a bowel movement and/or
often have a difficult time passing stools and/or
is pain involved.
any measure, constipation is widespread in the US population
with estimates of as high as 8.7 million people affected
to some degree making it the most common chronic digestive
disorder in US and resulting in about 2 million doctor
visits annnually. Populations most often affected are
women, especially pregnant woman, adults over 65 and
constipation is a common problem following childbirth
and surgery. Most people treat themselves without seeking
medical help, as is evident from the fact that Americans
spend over $500 million a year for laxatives.
diarrhea and constipation signify serious bowel problems
and warning of worse things to come. When constipation
occurs and bowel transit time increases, putrefied waste
stays in the colon longer and toxins have more time
to enter the bloodstream through intestinal walls. Toxins
can then settle into the tissues throughout the body,
causing many disease states including autoimmune disorders.
Colon cancer, the second leading cause of death in US,
can result from the autointoxication these toxins create.
Another consequence is symptoms of fatigue and depression
as toxins build up on the intestinal walls and reduce
nutrient absorption. Overall, there is a strong causal
link between chronic constipation and serious disease.
Treatment & Prevention of Constipation
Constipation is a symptom, not a disease and like a
fever it can be caused by a variety of factors. Here
are some of the most common causes of constipation:
The most important causal factor in most cases of constipation
is a low fiber diet. Modern diets are often low in the
natural fiber found in vegetables, fruits, and whole
grains and high in fats and refined carbohydrates. Individuals
who eat plenty of high-fiber foods or use fiber
supplements are much less likely to become constipated.
Fiber, both soluble and insoluble, is the part of fruits,
vegetables, and grains that the body cannot digest.
Soluble fiber dissolves easily in water and takes on
a soft, gel-like texture in the intestines. Insoluble
fiber passes through the intestines almost unchanged.
The bulk and soft texture of fiber help prevent hard,
dry stools that are difficult to pass. According to
the National Center for Health Statistics, Americans
eat an average of 5 to 14 grams of fiber daily, less
than half of the 20 to 35 grams recommended by the American
Dietetic Association. Both children and adults eat too
many refined and processed foods from which the natural
fiber has been removed. The research indicates that
high fiber diets result in larger stools, more frequent
bowel movements and less constipation.
Liquids like water and juice add fluid to the colon
and bulk to stools, making bowel movements softer and
easier to pass. People who have problems with constipation
should drink enough of these liquids every day (about
eight 8-ounce glasses). Liquids that contain caffeine,
like coffee and cola drinks, and alcohol have a dehydrating
Lack of exercise can lead to constipation, although
doctors do not know precisely how this works. Constipation
often occurs after an accident or during an illness
when one must stay in bed and cannot exercise and a
regular exercise regimen seems to improve bowel transit
Bowel Syndrome (IBS)
Irritable Bowel Syndrome (IBS)
is the name given to a group of persistent symptoms
characterized by abdominal distress and abnormal bowel
patterns where there is no detectable organic disease
present. As much as 20% of the adult US population has
IBS symptoms which can include constipation, diarrhea,
gas, and bloating. Causal factors for IBS include overall
diet, specific foods, stress and bacterial infection
and treatment usually focuses on the specific symptoms,
including fiber for constipation and probiotic
supplementation to restore bacterial balance.
People who ignore the urge to have a bowel movement
may eventually stop feeling the urge, which can lead
to constipation. Some people delay having a bowel movement
because they do not want to use toilets outside the
home. Others ignore the urge because of emotional stress
or because they are too busy. Children may postpone
having a bowel movement because of stressful toilet
training or because they do not want to interrupt their
play. After a period of time a person may stop feeling
the urge. This leads to progressive constipation.
When used properly, for a specific problem on a short
term basis, laxatives help the colon to restore its
natural ability to contract. Used improperly over a
longer period of time, laxatives can be habit-forming.
The colon can begin to rely on laxatives to bring on
bowel movements. Over time, laxatives can damage nerve
cells in the colon and interfere with the colon's natural
ability to contract. For the same reason, regular use
of enemas can also lead to a loss of normal bowel function.
People who habitually take laxatives become dependent
upon them and may require increasing dosages until,
finally, the intestine becomes insensitive and fails
to work properly. For this reason, laxatives should
only be used to treat a specific short term problem,
preferably under a doctor’s supervision. People
who are dependent on laxatives should seek their doctor’s
advice on how to gradually stop using them.
in Life or Routine
People often become constipated when traveling because
their normal diet, water intake, schedules and daily
routines are disrupted. During pregnancy, women may
be constipated because of hormonal changes or because
the heavy uterus compresses the intestine. Aging may
also affect bowel regularity because a slower metabolism
results in less intestinal activity and muscle tone.
Many medications can cause constipation including pain
medications (especially narcotics), antacids that contain
aluminum and calcium, blood pressure medications (calcium
channel blockers), anti-Parkinson drugs, antispasmodics,
iron supplements, diuretics, tranquilizers, iron supplements,
anticonvulsants for epilepsy and antihypertensive calcium
There are many diseases that can directly or indirectly
cause constipation. They include: neurological disorders,
metabolic and endocrine disorders and systemic conditions
that affect organ systems, Multiple Sclerosis, Parkinson's
disease, Stroke, spinal cord injuries, endocrine conditions,
Diabetes, underactive or overactive thyroid gland, Uremia,
Hypercalcemia and Lupus.
with the Colon and Rectum
Intestinal obstruction, scar tissue (adhesions), diverticulosis,
tumors, colorectal stricture, Hirschsprung's disease,
or cancer can compress, squeeze, or narrow the intestine
and rectum and cause constipation. Painful conditions
of the anus can produce a spasm of the anal sphincter
muscle, which can delay a bowel movement. Functional
constipation that stems from abnormalities in the structure
of the anus and rectum is known as anorectal dysfunction
or anismus. These abnormalities result in an inability
to relax the rectal and anal muscles that allow stool
to exit. Scarring, inflammation around diverticula,
tumors, and cancer can produce mechanical compression
of the intestine and result in constipation.
For most people, dietary and lifestyle improvements
can relieve symptoms of constipation. A well-balanced
diet that includes fiber-rich foods, such as unprocessed
bran, whole-grain bread, and fresh fruits and vegetables,
is recommended. Drinking plenty of fluids and exercising
regularly will help to stimulate intestinal activity.
Probiotic and fiber supplementation
where indicated can restore bacterial balance and increase
digestive efficiency. In addition, the urge to have
a bowel movement should not be ignored.
severe symptoms, solution is PBL: Peristalsis,
Bulk and Lubrication.
- To maintain the regular movement, the peristaltic
action of the bowel must be regular and vigorous. The
ideally functioning digestive system has an approximate
24 hour transit time and hydration is an important part
of this. In addition, hydrating minerals such as
magnesium and gentle, non-laxative, herbs like
cape alone and rhubarb can be used
to jump start the peristaltic action of the colon. Cascara
sagrada and senna are herbs that are often
used either alone or with other herbs to induce peristalsis.
- The right amount and kind of fiber is critical to
bowel function... A diet with enough fiber (20 to 40
grams) helps form soft, bulky stool. A doctor or dietitian
can help plan an appropriate high-fiber diet that includes
beans, whole grains and bran cereals, fresh fruits and
vegetables including asparagus, brussels sprouts, cabbage
and carrots. For people prone to constipation, limiting
foods that have little or no fiber, such as ice cream,
cheese, meat, and processed foods is also important.
Where the diet is lacking the recommended fiber level
it can be supplemented by introducing high fiber
meal replacements or fiber
of the colon – flax, borage and fish
oils are very effective in providing necessary
lubrication for smooth and gentle elimination. Because
these fats are hard to digest, it’s important
to use an oil supplement that includes lipase, the digestive
enzyme that assists in the breakdown of oils into essential
develops over time and in seeking a long term, healthy
solution one needs to understand that some time and
attention will be required. Doctors agree that prevention
is the best approach to constipation. While there is
no way to ensure constipation will never occur, the
following guidelines should help:
what is normal and do not rely unnecessarily on laxatives.
a well-balanced diet that includes unprocessed bran,
whole-wheat grains, fresh fruits and vegetables. Add
more fruits and vegetables. Lower the amount of refined
starches, sugar and processed foods.
plenty of fluids.
your daily diet with fiber
products to improve bowel transit time.
supplements to restore and maintain healthy intestinal
exercise - ideally 30 minute daily. Special exercises
may be necessary to tone up abdominal muscles after
pregnancy or whenever abdominal muscles are lax.
digestion by taking digestive
enzymes with each meal.
ignore the urge to defecate. Set aside time after
breakfast or dinner for undisturbed visits to the
toilet. Ignoring the urge repeatedly can actually
suppress the natural urges.
there is a significant or prolonged change in bowel
habits, check with a doctor. There is a chance that
an underlying disorder is causing constipation. Then
treatment should be directed toward the specific cause.
the colon by taking essential fatty acids in oils
such as fish, borage and flax.
bi-annual cleanses using herbal combinations to support
overall body and intestinal detoxification.