With every single patient that I see, I always ask about bowel movements. Why? Because the frequency, consistency, and appearance of bowel movements matter. This may not be the most appealing subject to discuss, but it’s important (and satisfying) to have regular and consistent bowel function.
So, what is considered regular in regards to bowel movements? Is passing stool every other day normal? What about passing harder stools, which may cause you to strain? What about going to the bathroom more than three times a dayis that considered too much?
What I will provide for you in this article is based on my clinical experience treating thousands of patients over the last 15 years. I realize there is a plethora of information available on the web about what is considered regular, and I am sure a lot of that information is valid and helpful.
My findings and suggestions here are just repeated observations of cause and effect, and really represent my opinion on what I consider to be normal and regular. First, I’ll discuss constipation and the common causes, and then I’ll give you some treatments that I find effective.
Are You Experiencing Constipation?
Epidemiological studies in the United States and United Kingdom have shown that constipation is defined as stool frequency of less than three times per week. One common problem in trying to determine constipation rates in the general public, however, is that people often underestimate bowel movements.
In one survey, even though people were having daily bowel movements, they reported constipation because of incomplete defecation and/or straining. Due to reports like this, an international working committee has introduced a more expansive criteria of constipation known as the Rome IV criteria.
According to the Rome IV criteria, constipation is defined as any two of the following issues for greater than a three-month duration with symptom onset at least six months prior to diagnosis:
- Straining
- Decrease in stool frequency (less than three bowel movements per week)
- Sensation of incomplete evacuation
- Hard lumpy stools
- Use of digital maneuvers to remove stool
- Sensation of anorectal obstruction, or blockage from 25% of bowel movements
The criteria also state that loose stools are rarely present without the use of laxatives, and lastly there is insufficient evidence to suggest a diagnosis of irritable bowel syndrome (IBS).
Common Causes of Constipation
There are many factors that can cause constipation, including diet and lifestyle choices, and I’ll talk about some of these factors shortly. Some of the more common secondary causes of constipation that should be ruled out include the following:
- Diabetes
- Parkinson’s disease
- Multiple sclerosis
- Anorexia
- Hypothyroidism
- SIBO (small intestine bacterial overgrowth)
- Diverticulitis
Also, there are medications that can cause constipation, and some of these medications are as follows:
- Antihistamines
- Antidepressants
- Antispasmotics
- Antihypertensives (e.g. calcium channel blockers)
- Aluminum (e.g. antacids)
- Opiates
- Iron supplements
Could Foods That I’m Eating be Causing Irregularity of Bowels?
Of all the foods that may lead to constipation in one form or another, I typically see wheat and dairy products as being major culprits. If you don’t have one of the secondary causes of constipation listed above, consider eliminating wheat products and/or dairy for three weeks and see what changes you notice in your stools.
You have the option of eliminating one or both food groups. Take note of any changes or reactions. Then after three weeks, start reintroducing these foods slowly, one at a time, back into your diet, and again take note of any change or reaction. If you suspect you may have a gluten sensitivity, eliminate all gluten-containing foods as well to cover all bases.
Natural Ways to Alleviate Constipation
Okay, once I’ve determined that a patient is actually constipated by running through a list of signs and symptoms similar to the Rome IV criteria, I’ll rule out the common causes listed above and determine if any foods may be to blame. Also, assuming there is no physical cause to the constipation like a stricture or obstruction, I’ll suggest the following treatment ideas to get the bowels moving more efficiently.
1. Drink More Water Than You Think You Need!
Simply drinking more water consistently every day can help improve constipation. Many of us are dehydrated and don’t even know it!
2. Eat More Fruits and Vegetables
You would be amazed at how effective this simple tip is. For example, try sautéing a chopped onion on medium heat with coconut or olive oil and then adding some chopped collard greens, kale, or swiss chard. Or eat more salads loaded with cooked beats, artichokes, cucumbers, bell peppers, and crushed-up walnuts. Eating 2 cups of blueberries a day provides you with over 7 grams of fiber. I love to add blueberries to my grain-free granola that I usually eat in the morning.
3. Exercise
Most of us are aware of the benefits of regular exercise, but you may not know that exercise can improve constipation. Exercise helps bring blood flow into and through the GI tract, helps tone the muscles in and around the abdominal cavity (including the pelvic floor), and helps stimulate the bowels. If you don’t exercise at all, try walking for 20-30 minutes a day.
4. Try Not to Ignore the Urge to Go
As simple as this recommendation may sound, the bowels like routine and should to be evacuated ASAP when you feel the urge to have a bowel movement. It’s common to be at work in a business meeting, or traveling where a bathroom isn’t as available, but do your best to quickly find a toilet when you feel the sensation to go.
5. Fiber Supplements
- Psyllium husks are mainly a form of soluble fiber that help bulk up stool with a mild laxative effect. They are the main ingredient in the over the counter supplement Metamucil. I usually advise patients take 1 tsp of psyllium in 1-2 cups of water. Then after a few days, you can increase the dose to 1-2 Tbsp. The key here is to drink PLENTY of water before and after as not doing so may worsen the constipation.
- Chia seeds work by soaking up water, which makes it easier to pass stool. My favorite way to consume chia seeds is to make coconut milk chia seed pudding (see recipe below), or they can be ground up and added to almond milk, yogurt, or cereals.
- 2 cans of coconut milk
- 1/4 to 1/2 cup of chia seeds (depending on how thick you like your pudding)
- 1 tablespoons of maple syrup
- 1 teaspoons of ground cinnamon
- Pinch of ground cardamom
- Pinch of salt
Put all ingredients into a glass Pyrex or any other container with a sealed top. Shake vigorously for 30 seconds and then place in refrigerator. Will be ready to eat within 3 hours. Can add any fresh fruit like mango, blueberries, blackberries, raspberries, or banana for added flavor and fiber.
6. Slippery Elm (Ulmus)
This “demulcent” herb can be taken in powder form and combined in water and is helpful for some cases of constipation. Try adding one tsp to one cup of water and drink daily.
7. Magnesium
Magnesium helps soften up stool and improves bowel regularity. I like to recommend a powered magnesium citrate that dissolves well in warm or cold water. The dose is 1 tsp per cup of water at night before bed. Then after a couple of days, you can increase the dose to 1-2 tbsp or more to achieve desired effect.
8. Probiotics
Certain probiotic strains like Bifidobacteria have been shown to improve constipation according to a study out of the American Journal of Clinical Nutrition. You may need to try many different probiotic strains and/or formulas to achieve a desired result and remember to take them for at least two months to give them enough time to exert any benefits.
Based on my clinical experience and knowledge of normal and healthy bowel function, I believe that having 1 to 3 well-formed bowel movements a day is considered regular. I am not a fan of laxatives (including the herbal varieties like senna or cascara sagrada) as people can become dependent on their use, and it can be very difficult to retrain the bowel to evacuate normally again.
Try some of the above suggestions for a least a month, and if you don’t see any benefit, consider seeing your doctor to be checked out for other causes.
Resources:
https://link.springer.com/article/10.1007/s11894-017-0554-0
https://www.uptodate.com/contents/constipation-in-the-older-adult
