Constipation 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:

• more than three days pass without a bowel movement and/or
• you often have a difficult time passing stools and/or
• there is pain involved.

By 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.

Both 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.

Causes of constipation
Treatment & Prevention of Constipation

Causes

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:

Low Fiber Diet
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.

Not Enough Liquids
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 effect.

Lack of Exercise
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 time.

Irritable 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.

Poor Bowel Habits
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.

Laxative Abuse
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.

Changes 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.

Medications
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, antidepressants,
iron supplements, diuretics, tranquilizers, iron supplements, anticonvulsants for epilepsy and antihypertensive calcium channel blockers.

Specific Diseases
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.

Problems 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.

Treatment & Prevention

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.

For severe symptoms, solution is PBL: Peristalsis, Bulk and Lubrication.

Peristalsis - 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.

Bulk - 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 supplements.

Lubricant 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 fatty acids.

Chronic constipation 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:

• Know what is normal and do not rely unnecessarily on laxatives.
• Eat 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.
• Drink plenty of fluids.
• Supplement your daily diet with fiber products to improve bowel transit time.
• Take probiotic supplements to restore and maintain healthy intestinal microflora balance.
• Regular exercise - ideally 30 minute daily. Special exercises may be necessary to tone up abdominal muscles after pregnancy or whenever abdominal muscles are lax.
• Enhance digestion by taking digestive enzymes with each meal.
• Don’t 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.
• Whenever 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.
• Lubricate the colon by taking essential fatty acids in oils such as fish, borage and flax.
• Do bi-annual cleanses using herbal combinations to support overall body and intestinal detoxification.