By Dr. Mercola
For most people, the topic of bowel movements is private and the actual mechanics of how stool is produced is rarely thought about. Unless, of course, you begin to experience constipation.
According to research presented at the American College of Gastroenterology Annual Meeting 2015, at least 15 percent of the general population experiences chronic constipation.
This is equal to approximately 63 million people in the United States. The study1 demonstrated a statistically significant link between people who suffer from chronic constipation and from other health problems, including colorectal cancer and gastric cancer.
Researchers approached this study not expecting to find anything surprising. The link between diverticulitis and chronic constipation has been well documented.
However, the links found in this study between chronic constipation, gastric cancer, rectal cancer, and ischemic colitis were not expected.2
How Is Stool Formed?
Stool is the end result of digestion, which starts in your mouth. Imagine your body as a large solid cylinder, which has a tube running from the top to the bottom of the container.
The inside of the cylinder is inside your body and the tube that runs from top to bottom is actually outside the body. This is a description of your digestive system that runs from your mouth to your anus, but never opens directly to the inside of your body.
In other words, while your digestive system is technically "inside" your body, it contains digestive juices and bacteria that should only live outside your body. Your digestive tract plays a critical role in your overall health. Digestion starts in your mouth as you chew food and the food mixes with saliva.
Digestion ends in the large intestines, after your body has extracted nutrients and water, leaving only the waste products it can't use. The nutrients absorbed contain energy, which you know as calories.
How many calories you eat and, more importantly, the quality and source of those calories are important factors in determining your overall health and wellness.
Another factor that impacts your overall health, and the risk of developing constipation, is the amount and type of bacteria living in your gut.
These microbes are responsible for the breakdown of food, how the calories or energy are processed, and can increase or decrease your risk of allergies,3 obesity, and more.
Researchers have also determined that while your gut responds to stress reactions from your brain, your brain also receives signals from your gut that can trigger feelings of sadness.4
In other words, your digestive tract or gut is fundamentally related to more than just constipation, diarrhea, and weight gain or loss. And, because of this interrelationship with the health of the rest of your body, it should not be surprising that your gut health will affect how you look, feel, and act.
Who Gets Constipated and Why?
Some of the common causes of constipation include laxative abuse, hypothyroidism, irritable bowel syndrome (IBS), and ignoring the urge to go. If you consistently ignore the urge to have a bowel movement – for instance, to avoid using a public toilet – eventually you may stop feeling the urge.
Certain medications, like antidepressants, antacids (like calcium), blood pressure medications, and iron supplements may also contribute to constipation, as can dehydration if you're not drinking enough pure water each day.
However, one of the primary causes of constipation has to do with your diet, particularly if you're eating one high in processed foods and low in fiber.
Within the approximate 15 percent of the population who suffers from chronic constipation, there are groups of individuals who are more likely to experience the condition. These groups include:
- Women, especially during pregnancy or after giving birth. The weight of the developing baby normally sits on the intestines and can slow the motility or movement of the stool through the digestive tract.
As the stool slows down more water is extracted by the body, making the stool hard, dry, and more difficult to pass.
- Older adults are at a higher risk of developing constipation because of both a reduction in activity level and a reduction in movement in the digestive tract.
- Individuals who live in a lower income bracket, due to less access to fresh produce.5
- People who have just had surgery may not move around as well, may be nervous about pushing to have a bowel movement if they had abdominal surgery or may not be eating their normal diet.
Many Drugs Increase Your Risk of Constipation
The risk factor for constipation also increases when you take a large number of medications. A wide range of medications, both prescription and over the counter, appear to increase your risk of constipation. These can include Synthroid, ibuprofen, aspirin, antacids, iron supplements, and narcotics.6,7,8
Other medical conditions can also affect the ability of the intestinal tract to function normally.9,10
Conditions that cause blockage Tumors, inflammation, or swelling from conditions such as diverticulitis or inflammatory bowel disease, and anal fissure Conditions that affect the nerves in the intestines Parkinson's disease, spinal cord injuries, brain injuries, stroke, slow motility or movement through the intestines, autonomic neuropathy, and multiple sclerosis Conditions involving the muscles used in elimination Weakened pelvic muscles or pelvic muscles which do not coordinate relaxation and contraction (dyssynergia) Conditions that affect your hormones Hypothyroidism, diabetes, hyperparathyroidism, and pregnancy
Connections Between Constipation and Your Physical Health
Although the study presented at the American College of Gastroenterology Annual Meeting found links between chronic constipation and rectal cancer, gastric cancer, diverticulitis, and ischemic colitis, there are also other connections between suffering from constipation and your overall health.
For instance, chronic pushing and painful stools may predispose you to large hemorrhoids which are irritating and painful. Your colon was designed to hold a few pounds of stool, but when constipated your colon may hold up to 10 pounds of dry, hard feces.
Just the sheer volume of stool can stretch your colon, irritate the lining of the colon (mucosa), and produce toxins while waiting to be eliminated from the body. Chronic constipation can also lead to tearing of the anus, called an anal fissure.
These fissures are caused by trauma to the inner lining of the anus, often before a large, dry stool.11
Chronic constipation can also affect the genital and urinary health of women.
Because the colon and female reproductive organs are structurally close in the body, pressure from large amounts of stool in the colon can lead to rectal prolapse in the vagina,12 and increase the potential that the bladder will not empty completely or result in reflux of urine from the bladder back into the kidneys, called vesicoureteral reflux.13
This reflux causes permanent kidney damage and increases the risk of kidney infections.
Pushing large, hard stool from the rectum can result in some of your intestines protruding from the anus, called rectal prolapse. Chronic constipation is a recurring problem in 30 to 67 percent of patients who suffer from rectal prolapse.14 This requires surgery to repair.
When people decide to postpone the surgery they risk stretching the anal sphincter even further, and increasing the amount of intestines that protrude from the body.
Lifestyle Approaches to Treatment
If you're suffering from chronic constipation, there are changes you can make to your daily habits which can improve your bowel habits. Your first, and easiest, step is to ensure that you're drinking enough water. As the stool travels through your intestines your body removes water. If you are well hydrated, less water may be removed, leaving the stool softer and easier to pass. Drink enough that your urine is straw colored. If it's dark yellow then you're dehydrated and if it's colorless you are drinking too much.
The fiber in your stool will help to draw more water and keep the stool soft. This is why your doctor recommends increasing the amount of fiber in your diet to help relieve constipation. However, if you're eating a high-fiber diet but not staying hydrated the stool will still get hard and be more difficult to pass. The recommended amount of fiber in your diet is 20 to 30 grams per day; I believe that 32 grams each day is ideal.
Organic psyllium dietary fiber is important to the health of your colon. Psyllium also has other health benefits, including helping to control your blood sugar, reducing your risk of heart attack, stroke, gallstones, kidney stones, and diverticulitis, improving your skin health and helping you to lose or maintain your weight.
Vegetables are the best way to fortify your diet with fiber. If you can't reach the recommended amount of fiber per day then supplementing with organic whole husk psyllium is simple and cost effective.
Regular exercise can also help reduce constipation.15 The movement helps increase the motility in your digestive tract and can stimulate the urge to have a bowel movement. When you do feel the urge, don't wait. The longer the stool sits in your colon, the more water is removed and the more difficult it is to pass.
Reducing Your Risk of Constipation
There are several ways to reduce your risk of constipation. I strongly recommend eating traditionally fermented and cultured foods on a daily basis to help to "reseed" your body with good bacteria. It's easy to make them. For a demonstration, please see the video above. If you don't eat fermented foods, taking a high quality probiotic supplement is advisable.
The use of probiotics are so important to your overall health that some researchers are comparing them to a "newly recognized organ." Research links the health and variety of the bacteria in your gut to your behavior, diabetes, gene expression, autism, and obesity.16 The bacteria in your gut plays an essential role in the digestion of your food, the motility of your intestines, and ultimately the development of constipation.
Another way to reduce your risk is to speak with your physician about the medications you're currently using. Explore options to reduce the amount of medications you may need or the brands you're currently using if they are linked to triggering constipation. Be particularly wary of using laxatives on a regular basis, as it may exacerbate constipation.
Remember, when you travel your daily regimen is often disrupted. The differences in food, changes to your regular exercise routine, or reduction in water intake can all negatively impact your body's ability to maintain a healthy bowel routine. Try to stay as close to your regular routine as possible. Bring organic whole husk psyllium to supplement your diet on the days you don't get enough fiber. Try to get your regular exercise each day and drink enough water to keep your urine a light straw color.
Squatting Can Help If You're Constipated
The last thing most people think about when using the bathroom is position, but this can significantly impact the ease with which you eliminate and even increase your risk of bowel and pelvic problems, including constipation, hemorrhoids, and more. Most of you reading this probably sit to evacuate your bowel, but this requires you to apply additional force (straining), which has some unwanted biological effects, including a temporary disruption in cardiac flow.
Sitting on a modern toilet is designed to place your knees at a 90-degree angle to your abdomen. However, the time-honored natural squat position (which is still used by the majority of the world's population) places your knees much closer to your torso, and this position actually changes the spatial relationships of your intestinal organs and musculature, optimizing the forces involved in defecation.
Squatting straightens your rectum, relaxes your puborectalis muscle, and allows for complete emptying of your cecum and appendix without straining, which prevents fecal stagnation and the accumulation of toxins in your intestinal tract. It is instructive that non-westernized societies, in which people squat, do not have the high prevalence of bowel disease seen in developed nations; in some cultures with traditional lifestyles, these diseases are uncommon or almost unknown.
If you have trouble with bowel movements, especially constipation, I urge you to give the squat position a try. Squatting does involve strength and flexibility that adults tend to lose over time (but children have naturally). Special toilets and stools that get your body into a more "squatty" position can help you get closer to the ideal even if you've been sitting for decades.
Medical Treatment Options
In some circumstances these lifestyle choices and preventative measures are not enough to alleviate constipation. Talk with your doctor about being tested for hypothyroidism. In hypothyroidism your body doesn't secrete enough of the thyroid hormone. This hormone has a significant impact on the motility and movement of the intestinal tract, which is why constipation is one of the hallmark symptoms of hypothyroidism.
While it might be tempting to use over-the-counter remedies and laxatives, these remedies are not without risk. When too much is taken, too much water is drawn into the intestines, resulting in dehydration and an abnormal number of electrolytes in your blood. Both dehydration and imbalanced electrolytes can lead to kidney and heart damage, which can lead to death.
Your body can also become dependent on the use of laxatives to have a normal bowel movement. This is especially true of laxatives that use stimulants to increase the motility of the intestines and digestive tract. Stimulant laxatives include medications like Exlax, or laxatives marked as "natural" and include senna or cassia laxatives.
An underlying cause of constipation can also be a magnesium deficiency. Although primarily thought of as the mineral that affects your bones, magnesium plays a role in smooth muscle relaxation and contraction, production of neurotransmitters, building blocks of DNA, and the digestion of carbohydrates, proteins, and fats. The recommended daily amount of magnesium is 310 to 320 mg for women and 400 to 420 mg for men, although this amount may be just enough to prevent outright deficiency.
If your muscles that coordinate defecation are not working together, called dyssynergic defecation, then an anorectal biofeedback mechanism may be the most effective treatment to reteach your muscles to empty the rectum completely. In other cases of rectal prolapse or a rectocele caused by chronic constipation, surgery may be indicated to repair the area.17