It accounts for 2.5 million doctor visits per year, with patients over 65 representing the largest proportion. Constipation is not a disease itself but rather, a symptom and it can have many causes. One of the most common causes is functional which could include dietary factors (not enough fiber), issues with motility (movement of food through the digestive system) and not enough exercise. In order to get to the root cause of your constipation, a doctor will assess your overall health (both mental and physical), your diet and any use of medications [1].
Although constipation can be defined by a person’s own experience with their changes in bowel habits [1], there is criteria that can be used to guide assessment and treatment:
Rome IV Criteria for Functional Constipation [2][3] Two or more of the following over the last 3 months with symptoms starting 6 months ago:
Straining during more than one-fourth (25%) of defecations
Lumpy or hard stools (Bristol stool form scale 1 or 2) more than one-fourth (25%) of defecations
Sensation of incomplete evacuation more than one-fourth (25%) of defecations
Sensation of anorectal obstruction/blockage more than one-fourth (25%) of defecations
Manual maneuvers to facilitate more than one-fourth (25%) of defecations (such as digital evacuation or support of the pelvic floor)
Fewer than 3 spontaneous bowel movements per week
In addition to the above, an individual should not meet the criteria for irritable bowel syndrome and should rarely have loose stools without laxatives.
The Bristol stool chart mentioned above categorizes feces into 7 groups. A doctor may ask you to describe your stool and this chart could come in handy (See https://www.webmd.com/digestive-disorders/poop-chart-bristol-stool-scale).
Types 1-2: constipation
Types 3-4: ideal stool
Types 5-7: diarrhea
Definitions and images of poop aside, just one day of not having a bowel movement can be a real pain with some people reporting more bloating and gas, and no one wants that!
One easy tip I give my patients is to take a tablespoon of olive oil on an empty stomach in the morning which helps to coat and soothe the intestines for smoother passage of stool. You likely already have this in your cabinetry so it’s an easy initial step you can take before turning to supplements.
Other recommendations may include:
Getting more fiber in the diet
Avoiding dairy
Drinking at least 8 glasses of water per day
Magnesium citrate
Probiotics
It’s important to talk to a healthcare practitioner to make sure you are tackling your constipation the right way. A doctor can further assess whether there are underlying causes for the changes in your bowel habits. If supplements are chosen, a Naturopathic Doctor can give you guidance on the best ones to use along with appropriate dosages.
References:
Arce, D.A., Ermocilla, C.A. and Costa, H. 2002. Evaluation of Constipation. American Family Physician. 65(11):2283-2291. https://www.aafp.org/afp/2002/0601/p2283.html
Basson, M.D. 2019. Constipation. Accessed from https://emedicine.medscape.com/article/184704-overview#a2
Sood, R. and Ford, A.C. 2016. Rome IV criteria for FGIDs – an improvement or more of the same. Nature Reviews. 13:501-502. Rome IV criteria can be found in the supplementary information: https://media.nature.com/full/nature-assets/nrgastro/journal/v13/n9/extref/nrgastro.2016.110-s1.pdf