Constipation: Natural Ways to Get Going

In this article, we’ll tackle a common digestive issue that many people face but may not openly talk about: constipation. About 4 million people in the United States suffer from frequent constipation. Constipation is the most common gastrointestinal complaint, resulting in 2.5 million doctor visits annually. Let’s explore what constipation is, what causes it, and natural ways to get going. And for those times when a little extra help is needed, we’ll look at pharmaceutical treatments too.

What is Constipation?

Some people may be living with chronic constipation and not even realize it. If your bowel habits have been the same for years, you may think that’s normal. Even if your habits differ from others, you may think your elimination routine is normal for you. Just to clarify what constipation is, let’s define it. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), constipation is a condition in which a person has infrequent bowel movements or difficulty passing stools that persists for several weeks or longer. Typically, having fewer than three bowel movements a week indicates constipation.

Ideally, it’s best to have one to two bowel movements daily. This helps eliminate waste and avoids toxins being reabsorbed through your colon. Chronic constipation can also increase the development of hemorrhoids. And that’s no fun.

What Causes Constipation?

The causes of constipation can vary greatly, but here are 8 common factors associated with constipation:

• Inadequate Hydration: Not drinking enough water can lead to hard, dry stools, making them difficult to pass.
• Sedentary Lifestyle: Lack of physical activity can slow down the movement of food through the digestive tract.
• Lack of Fiber: A diet low in fiber is a common cause of constipation. Fiber helps to bulk up stool and make it easier to pass. Aim for 25-30 grams of fiber per day from sources like fruits, vegetables, whole grains, and legumes.
• Ignoring the Urge: Holding in bowel movements can lead to constipation.
• Abusing Laxatives: Using laxatives frequently can result in dependency on them creating a vicious cycle of constipation once laxatives are stopped.
• Underlying Health Conditions: Conditions such as irritable bowel syndrome (IBS), diabetes, hypothyroidism, and neurological disorders can contribute to constipation. Pregnancy also increases the risk. Constipation incidence also increases with age. Any problem with intestinal function may result in constipation.
• Changes in routine: Traveling, changes in diet, changes in routine or altered sleep patterns can affect bowel habits. You may notice this when you go on vacation.
• Medication Side Effects: Certain medications and some supplements can cause constipation.

Medications That Cause Constipation

Here are 8 medications reporting constipation as a common side effect and one commonly prescribed supplement. These include:

• Opiod Pain Meds: morphine, oxycodone, and Tramadol to name a few. These analgesics help alleviate pain but they also slow down your system, including your GI tract making it harder to poop.
• Tricyclic antidepressants like amitryptyline (Elavil) can cause constipation due to its anticholinergic effect which blocks a chemical called acetylcholine. This slows down your intestines. This can be a desirable effect if you suffer from diarrhea, but not so great if you’re already constipated.
• Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen (Aleve), especially if taken in high doses or for extended periods of time, can contribute to constipation. Using the lowest effective dose and limiting how often you take these medications can help.
• Antihistamines – Another drug you may not think about being related to constipation is antihistamines. These medications such as diphenhydramine (Benadryl) have anticholinergic effects similar to tricyclic antidepressants which slow down the intestines. They also tend to dry you out. If you have allergies, fortunately, the newer generation antihistamines like loratadine (Claritin) and fexofenadine (Allegra) are less likely to cause constipation. Antihistamines can be used for more than just treating allergies. A different group of antihistamines are used to manage heartburn symptoms. These histamine-2 receptor antagonists (H2 antagonists) include medications like famotidine (Pepcid) and cimetidine (Tagamet) which can cause constipation. If using these medications become an issue, your doctor may recommend a proton pump inhibitor (PPI) instead to manage acid reflux.
• Blood Pressure Medications – Even though medications to lower blood pressure can be vitally important and greatly reduce the risk of stroke or heart disease, they’re not without side effects, including constipation. Not all blood pressure medications work the same way. Some classes of blood pressure medications like calcium channel blockers and beta blockers are more likely to cause constipation. The blood pressure medications most often linked to constipation includes amlodipine (Norvasc), diltiazem (Cardizem), verapamil, propranolol, and clonidine (Catapres). If you feel your blood pressure medication is contributing to constipation, talk with your doctor for treatment options.
• Antiemetics – also known as nausea medications are also linked to constipation. Typically prescribed to prevent nausea and vomiting after surgery or chemotherapy, they may be prescribed for other causes of nausea/vomiting as well. One common nausea medication (ondansetron or Zofran) may cause constipation, especially with long-term use. Promethazine (Phenegran) can cause constipation  too, but technically it’s an antihistamine.
• Mediations for Overactive Bladder – Two options used to relieve symptoms of an overactive bladder are oxybutynin and tolterodine (Detrol). These anticholinergic medications help treat overactive bladder by reducing muscle spasms in the urinary tract. This means that they can cause constipation, especially if you take them regularly.
• GLP-1 Medications like semaglutide (Ozempic or Wegovy or Rybelsus) and liraglutide (Victoza, Saxenda) used to treat diabetes or for weight loss can also contribute to constipation by slowing down the digestive tract.
• Nutrient supplements – Iron supplements (ferrous sulfate or ferrous gluconate) can cause constipation and make your stool look darker than normal. An iron supplement may be used to treat iron-deficiency anemia but iron may also be present in some multivitamin/mineral supplements. Other supplements containing certain forms of calcium, antacids containing calcium such as Tums, or aluminum-containing antacids could contribute to constipation as well. Taking supplemental magnesium along with calcium can help to alleviate constipation. Magnesium is a natural laxative that relaxes intestinal muscles and helps rehydrate dry feces making elimination much easier.

Symptoms of Constipation

Each individual may experience different symptoms but the most common symptoms of constipation may include:

• Fewer than three bowel movements a week
• Difficult and painful bowel movements
• Feeling bloated or uncomfortable
• Feeling tired or sluggish
• Abdominal pain

Diagnosing Constipation

If you’re experiencing symptoms but aren’t sure constipation is the problem, your doctor may do some tests. The simplest way is to start with a complete medical history including a list of medications, past surgeries, and symptoms. To rule out other concerns, your doctor may perform an anal exam. If needed, an abdominal x-ray  may be ordered to see if stool is detected in the colon. Depending on the results, other tests may be ordered including a colonoscopy to rule out any anatomical issues or diseases affecting the colon.

Natural Treatments for Constipation

If you’re dealing with constipation, there are several natural remedies you can try. Here are my top 6 recommendations.

1. Increase Fiber Intake: Aim to include more high-fiber foods in your diet, such as fruits, vegetables, whole grains, and legumes.
2. Stay Hydrated: Drink plenty of water throughout the day to help soften stool and facilitate bowel movements.
3. Exercise Regularly: Physical activity can help stimulate the digestive system and promote regular bowel movements.
4. Establish a Routine: Try to use the restroom at the same time every day to train your body to expect regular bowel movements.
5. Prunes and Other Natural Laxatives: Prunes and prune juice contain natural laxative properties and can help relieve constipation.
6. Probiotics: Certain probiotics may support gut health and regular bowel movements. Discuss which ones may be beneficial with your dietitian or healthcare provider.

Over-the-Counter and Prescription Medications

If natural remedies aren’t providing relief, you may need to consider over-the-counter (OTC) or prescription medications:

1. Bulk-Forming Laxatives: OTC medications like psyllium husk and methylcellulose add bulk to the stool, making it easier to pass.
2. Osmotic Laxatives: work by drawing water into the colon to soften stool, examples include polyethylene glycol (MiraLax) and magnesium hydroxide (Milk of Magnesia).
3. Stimulant Laxatives: these stimulate the muscles in the intestines to move the stool through more quickly. Senna and bisacodyl are examples. 
4. Stool Softeners: Docusate sodium can help soften the stool making it easier to pass.
5. Suppositories and enemas: can provide quick relief in certain cases.
6. Prescription Medications: If OTC options aren’t effective, your doctor may prescribe medications such as lubiprostone (Amitiza) or linaclotide (Linzess), which increase fluid secretion in the intestines and stimulates motility.

Always consult your healthcare provider before starting any new medication, especially if you have any underlying health conditions or are taking other medications.

Remember, constipation can be uncomfortable, but it is manageable! By understanding causes and making a few lifestyle adjustments and seeking the appropriate medical help if needed, you can maintain good digestive health.

If you have any questions or would like more information on managing constipation, feel free to reach out.

References:

1. National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Constipation.
2. Mayo Clinic. (n.d.). Constipation.
3. National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Constipation.
4. Academy of Nutrition and Dietetics. (n.d.). Digestive Health.
5. https://www.goodrx.com/conditions/constipation/the-big-8-constipation-causing-medications

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