Health Tips / Constipation

Just the way lots of people seem perpetually dissatisfied with their weight, some days everyone’s complaining about their bowels. It’s not the frequency, I tell them, or the failure to experience a daily movement that’s most important, but, rather, the comfort and ease of passage of your stool. If your passage is a struggle (and by this I mean a dried, hard movement with a lot of uncomfortable straining or a dependence on laxatives), then, yes, you are “officially” constipated. Hopefully, our WholeHealth Chicago suggestions will bring you relief.
Just remember that on some, fortunately rare occasions, new constipation is a warning sign. If your diet has remained unchanged, but suddenly your bathroom schedule has changed and the movement itself is “unfamiliar,” then of course these symptoms merit a doctor’s office visit. Thankfully, such a scenario is not commonplace. Mainly we find that a few supplements, coupled with a moderate change in eating, will bring most constipation to an end.

What is Constipation?

The most common gastrointestinal complaint in the U.S., constipation is defined by many people as moving their bowels a certain number of times in a week. In fact, frequency is of less importance than the degree of discomfort associated with the passage of stools or the total absence of an urge to have a bowel movement. When a person is constipated, intestinal contractions slow down, allowing more time for fluids to be absorbed. This results in dry, hard stools that are difficult to pass. When it comes to regularity, however, there really is no norm. For some people, it is perfectly normal to have as many as three bowel movements a day; for others, it is not uncommon to have as few as three a week. Since bowel movements vary so much from person to person, constipation applies not so much to the infrequency of bowel movements, as to the fact that they are accompanied by hard stools that may be painful to pass, and occasionally, by abdominal bloating.
Constipation in itself is not serious, and can easily be remedied by dietary changes and other measures. In some cases, however, an abrupt change in bowel movements can signal a more serious underlying health problem. A sudden change in bowel movements, with or without pain or abdominal swelling, could be a sign of bowel obstruction or blockage. Red blood in or on the stools or dark tarry stools could signal a serious risk due to bleeding from some part of the intestinal tract. These signs require medical evaluation.

Key Symptoms

Infrequent, difficult, and possibly painful bowel movements
The passage of small, hard, dry stools
The need to strain during defecation
A continued sensation of fullness after a bowel movement
Abdominal swelling
No bowel movements for three or more days in adults, or four or more days in children

What Causes Constipation?

Constipation can be the result of a number of circumstances, including:

Lack of fiber or fluids in the diet
Lack of exercise or prolonged inactivity
Failure to move the bowels when the urge strikes. (This can lead to impaction and hardening of stools.)
Overuse of aspirin, laxatives, or some antacids
Certain medical disorders, such as irritable bowel syndrome (IBS), diabetes, high blood calcium levels (hypercalcemia), sluggish thyroid (hypothyroidism), or colorectal cancer
Certain medications, including narcotic pain relievers, antidepressants, and drugs used for high blood pressure
Severe depression, which is often associated with a loss of appetite and a low level of physical activity.

Treatment and Prevention

Constipation is simple to prevent: Just include adequate amounts of water and fiber in your diet. The optimal stool pattern is to have bulky and soft but well-formed stools at least once a day. The stools should float in the toilet. If they sink, eat more fiber-rich fools or take a natural fiber supplement. For problems that occur because of temporary irregularity, mild laxatives that gently stimulate bowel contractions can be taken occasionally.

For most people, natural supplements, available as over-the-counter (OTC) aids, should remedy a constipation problem in a day or two. While common OTC chemically based laxatives and purgatives are effective, their overuse can lead to a laxative dependence. For this reason, if you have a long-term problem, stick with the natural fiber and plant–based stimulant supplements.

Just a reminder: If you have a serious medical condition, it’s always wise to check with your doctor before beginning any supplement program.

Acupuncture may be useful if your bowel movements have become so irregular that dietary supplementation is not effective. In addition, a practitioner of traditional Chinese medicine, using a combination of acupuncture and Chinese herbs, may be able to provide help with constipation associated with irritable bowel syndrome or chronic laxative dependence. Massage therapy, by a therapist skilled in abdominal massage, can also help mobilize fluids and stimulate contractions in the bowels.

How Supplements Can Help

Start with a daily dose of psyllium powder, ground flaxseed, oat bran, or ground fenugreek seeds mixed into water or juice. All provide the fiber necessary to soften stools and make them easier to pass. Be sure to take these supplements with plenty of water, and check to see if your stools become “floaters.”

Prune juice (as well as dried prunes, figs, and raisins) is also a good source of fiber, and a gentle enough stimulant to use with other supplements daily. Senna, a mildly stimulating herbal laxative, can be used in cases where the prunes or other fruit are not strong enough.

A tea made from dandelion root, which stimulates your natural bile production from the liver, is known to have a mild laxative effect.

Vitamin C, in doses of 3,000 mg a day (more or less), serves as a gentle laxative. In fact, as doses of vitamin C are slowly increased, almost everyone will eventually develop loose stools. If you have a medical condition for which vitamin C is recommended, the reduction of constipation may be a beneficial side effect of the supplement program for the other condition.

Likewise, a deficiency of the mineral magnesium can lead to constipation. If you have other conditions that suggest you may be low in magnesium (such as muscle cramps, severe menstrual cramps, panic attacks, depression or chronic muscle pain), consider adding supplemental magnesium in almost any form. There’s a good reason why one well-known OTC laxative is called Milk of Magnesia!

If none of these remedies provides relief in a day or two, consider the herb cascara sagrada, or a dose of castor oil. These powerful laxatives can irritate the gut lining, however. They should be taken only intermittently, as repeated use can lead to dependency as chemical laxatives do. Neither of these herbal laxatives should be used by pregnant or nursing women.

Self-Care Remedies

Drinking a cup of hot liquid (such as herbal tea) first thing in the morning may stimulate the colon and induce a bowel movement.

Eat plenty of high-fiber, low-fat foods–at least five servings a day of raw fruits and vegetables; whole grain breads and cereals; bran; and dried beans can prevent constipation. Increase your fiber intake gradually to avoid bloating and gas.

Drink at least eight 8-ounce glasses of water or juice daily. Clear soups are also good for replenishing fluids.

Avoid alcohol and caffeinated beverages, which increase fluid loss and worsen constipation.

Exercise regularly.

Repeated use of over-the-counter stimulant laxatives should be a last resort, taken only after evaluation by your doctor. Mineral oil should never be used as a laxative as it can deplete your body of fat-soluble vitamins (A, D, E, and K).

Simple OTC enemas can be used if the constipation occurs during a mild illness, such as a cold or the flu. Follow the package directions. Any long-term use of enemas can lead to disruption of healthy bowel function, so consult your doctor if constipation is an ongoing problem.

Move your bowels whenever you feel the urge to do so. A very common cause of chronic constipation is perpetual postponement.

When to Call a Doctor

If you notice a sudden change in bowel habits
If constipation persists for two weeks or more, despite self-treatment with fluids, fiber, and mild natural stimulants
If constipation is accompanied by fever or abdominal pain
If cramping or pain is severe enough to disrupt your daily routine
If there is blood in the stool
If you have become “hooked” on repeated use of natural or chemical stimulants to have normal bowel function
If you experience constipation shortly after starting a new medication or supplement

Supplement Recommendations

From David Edelberg, M.D. at WholeHealth Chicago: If it seems you’re constantly struggling with constipation, a straightforward diet change should resolve it: Eat a high-fiber diet (which means lots of fruits, vegetables, and whole grains) and drink 2 to 3 quarts of water or herbal tea a day.
For help while you’re changing your eating habits, we’ve recommended some gentle supplements, which should work within a day or two.

One caution: If your bowel habits have undergone a gradual but seemingly permanent change–especially when accompanied by other symptoms, such as severe fatigue, abdominal pain, or weight loss–make sure you tell your doctor. Such a permanent alteration in your elimination can be a sign of a more serious cancer or bowel obstruction.

How to Take the Supplements

Unlike laxatives (which tend to make your colon “lazy” and dependent on them), the natural supplements listed below (with the exception of the herb cascara) are actually healthful additions to your everyday nutritional program. Because of this, you can safely take them on a long-term basis if necessary. But if you add enough bulk to your diet with fiber-rich foods, (or by taking some psyllium each and every day), you may only need the other supplements occasionally.

Start with vitamin C, which in addition to being a leading antioxidant is also a gentle laxative when taken in a sufficiently high dose. If this doesn’t work, either increase the dose of C or add the mineral magnesium, another gentle laxative. I like to recommend magnesium citrate in capsules, but any magnesium can be effective if the pills or capsules dissolve easily.

Psyllium is the ground seeds of a plant found in such popular over-the-counter fiber laxatives as Metamucil. Follow the directions for use on the package and make sure you take plenty of water. (Psyllium has the added benefit of helping your total cholesterol levels.) For best results, I recommend psyllium products that don’t contain a lot of sugar or artificial sweeteners (check the labels).

For more natural fiber, start your day with a tall glass of prune juice, or munch on dried prunes as a snack. You can also try dandelion root tea, another mild laxative.

If these remedies don’t work, then try the herb cascara sagrada. Though not as potent as some of the other popular herbal laxatives, such as senna and aloe, cascara is still strong enough that it shouldn’t be used for more than one or two weeks at a time.


We at WholeHealth Chicago strongly recommend that everyone take a high-potency multivitamin/mineral and well-balanced antioxidant complex every day. It may be necessary to adjust the dosages outlined below to account for your own daily vitamin regimen. All of our supplement recommendations also assume you are eating a healthful diet.

Be aware that certain cautions are associated with taking individual supplements, especially if you have other medical conditions and/or you’re taking medications. Key cautions are given in the listing below, but you need to see the WholeHealth Chicago Reference Library for a comprehensive discussion of each supplement’s cautions and drug/nutrient interactions.

For product recommendations and orders click here for the Natural Apothecary or call 773-296-6700 ext. 2001.

Be well,
David Edelberg, MD