Twenty Strategies to Kick Constipation to the Curb

celiac disease and constipation

Constipation can be a real debbie downer.  It can make you feel lethargic, bloated, gassy and may even cause intestinal cramping.   People are sometimes embarrassed to talk about their bathroom habits, but as a dietitian, that’s all I do all day long!  I have no problems with it.  I’m so comfortable talking about it, I can eat at the same time.  Yeah, you’re probably thinking ‘ugh, gross!’.

In all seriousness, your bowels tell you so much about your overall health.  They can tell you how much you are absorbing or not absorbing of your food and give you subtle hints towards your overall health. It’s worth taking peek down there in the toilet every so often.

When it comes to constipation, it’s important to know the definition of constipation and what constipation looks like.  Constipation is defined as bowels that are hard like nuts, hard to pass (causes you to strain and push them out), may cause digestive symptoms like those listed above,  and happen less often than your normal.  Now, everyone is going to have a different normal.  Some people go every other day, everyday, or every 3 days or even longer.  Usually, if you are going less than every three days, that’s too long (as per WebMD).  However, it is through my experience and my client’s experience, that they feel best by going at least once/day.  So, in my practice, my goal is to ensure that clients are emptying their bowels daily.

Here are my top 20 strategies to kick constipation to the curb!

The MOST important thing when trying these strategies, is start with 1 or 2 at a time.  Because if something doesn’t feel right or it causes you to feel worse, you will know what caused it.  On the other end of this, if something does work, you will know what strategy/ies to include on a daily basis.

  1.  Aim for at least 30g of fiber per day, consistently:  Fiber provides bulk to move things through your system.  There are two types of fiber, insoluble and soluble fiber.  Insoluble fiber helps to provide bulk to the stool and moves the food through the intestines.  Soluble fiber retains water and make the stool easier to pass.  Not enough fiber (of either one) can cause a back up.   A few good ideas to bump up the fiber is to start with a fiber rich breakfast.  Another one, is to have beans/legumes (like gluten free lentils) as your protein source at either lunch or dinner.   
  2. Adequate hydration:  If there isn’t enough fluids to move the bulk through, it essentially, gets stuck.  If there isn’t enough fluid in the system, the body will pull water from the stool making the stool hard.  Aim for half your body weight in ounces for your water goal.  For example, if you weight 150lbs, aim for 75 ounces of fluid/day.  Milk, tea and coffee can contribute.  However, milk can be constipating itself.  And, limit caffeinated beverages to 2 cups/day (approx 16 oz).  Water should be the main source of fluid.
  3. Move your body for at least 30 minutes, everyday:  If you don’t move, your digestion system won’t move (or at least, it will move very poorly!!). Movement helps to move things downward faster, which is what you want. If there is no movement, food will not move as quickly, and your body has the chance to reabsorb the water from your stool, resulting in harder stools.
  4. Establish a morning routine:  Ever notice when you travel, you get constipated?  This could be in part due to a change of routine. Our bodies love routine. Don’t ignore the urge to go to the bathroom as this can make constipation worse over time.  Establish a morning routine by going to the bathroom at the same time every morning for at least 5 minutes, regardless of whether need to ‘go’ or not.   Join this with the tip #6 below for a better effect.
  5. Drink 16 oz warm water in the morning on an empty stomach:  This helps to give a head start on meeting your fluid requirements in the day.  Also, Felice Schnoll-Sussman, a gastroenterologist at the Weill Medical College of Cornell University reports that hot drinks help to widen blood vessels, aiding digestion.
  6. Reduce stress, anxiety, and depression:  Stress makes the bowels back up in some individuals.   In others, it may do the opposite.  Make time for stress reduction techniques such as going for a walk after work, exercising, doing some deep breathing for 5 minutes, meditation, taking a warm bath, doing a yoga class, reading a book, taking 15 minutes and lying down, calling a friend or just doing absolutely anything that brings you enjoyment.  Find an activity you like and work towards doing something daily. Work with a clinical counsellor if anxiety and depression are severe.
  7. Work with your MD to rule out serious conditions (especially if this has been chronic condition):  IBS-constipation dominant, celiac disease, SIBO-constipation dominant, hypothyroid, hormone imbalances, diabetes, neurological conditions.
  8. Pelvic floor dysfunction: Female athletes are more prone to this especially runners, dancers, gymnasts, hockey players.  Read here for symptoms of pelvic floor dysfunction. In this instance, a squatty potty can be very beneficial as it helps to move the pelvic floor into the right position for a bowel moment.
  9. Chronic constipation: Try reducing your fiber intake to 20g/day until things start moving again and then slowly work to increase it by 5g every 3-5 days, until you are back up to 30g/day.
  10. Food base laxative:  I read about this Beverley-Travis Natural Laxative Mixture a while ago.  Combine one cup each of: raisins, pitted prunes, figs, pitted dates, currents, and prune juice. Mix all the ingredients in a blender or food processor until pulverized and thickened. Store in your fridge to keep it fresh. Take two tablespoons daily.
  11. Iberogast supplement: This is a blend of nine different herbs from Germany,  It can be quite helpful in improving a sluggish digestive system by speeding up the transit time.   The dose is 20 drops in a beverage three times/day.
  12. Get things moving by using magnesium citrate: Start with 250mg once/day taken at night.  You can go up to 800mg/day to produce a bowel movement.  Vitamin C can also help move the bowels, so you can combine the magnesium with 500 mg Vitamin C once/day.
  13. Gut soothing herbs:  aloe, sippery elm and DGL (deglycyrrhizinated licorice) can help tame and sooth the GI tract. These are especially helpful for those with digestive conditions including GERD, constipation, IBS-C and celiac disease.  Sometimes, they are also helpful for crohns or colitis but aloe can have a laxative type of effect so would not be good for diarrhea.  Refer to your integrative MD or Registered Dietitian for recommendations and dosages.
  14. Mindful eating: Slow down and eat until only 80 percent full.  Eating too quickly will result in food that is not chewed well and put more digestive strain on your system.  It can also result in overeating, again, putting strain on your digestive system to digest all that food.  It takes 20 minutes for the stretch receptors in your stomach to send the signal to your brain that you are full.  If you gulp your food down, you will likely miss that memo.   Try chewing your food at least 15 times before you swallow and try putting the fork/knife down every few bites.
  15. Eat fermented foods:  Kefir, lactofermented vegetables, kombucha, gluten free miso, and gluten free soy sauce.  Some of my favorite ways to get these in consistently everyday include fermented salsa on top of eggs (I like Wildbrine brand), using part kefir for the liquid called for in overnight oats (about 2 TBP usually) and aiming for 1/2 cup of low sugar kombucha/day.  Remember to start small when introducing fermented foods, especially for those experiencing digestive symptoms.
  16. Try probiotic supplements that are known for helping with constipation: Brands that have clinical evidence to help support constipation include BioGaia drops, 5 drops/day or one chew tab/day, VisBiome 1-2 sachets/day, or VSL#3 1-4 sachets/day.
  17. Elimination diet:  If you have tried multiple strategies already and ruled out serious causes and are still suffering, this is sign that it is likely something you are consistently eating that is bothering your digestive system.  A general elimination diet can be a good start in this case.  A FODMAP elimination diet may be another approach as well.  Be sure to seek out a Registered Dietitian specializing in food sensitivities who will recommend a specific elimination diet based on your symptoms, lifestyle, and current conditions.
  18. Supplement use that can cause constipation: Iron, calcium, stimulant laxatives (such as senna), are some common ones.  Ensure to bring this up with your doctor to come up with strategies to avoid constipation.  Sometimes, increased magnesium to calcium ratio to a 1:1 ratio can help (e.g. 500mg calcium to 500mg magnesium).  Also, including magnesium citrate may be helpful when on iron supplements.  Be sure to take the iron supplement away from the magnesium.
  19. Avoid overuse of caffeine (tea or coffee), alcohol
  20. Too many tannin rich foods:  Tannins help to bind stools.  With the popularity of the paleo diet, I see this often.  People’s diets are heavy in nut based products which can be hard to digest and also high in tannins.  Tannins are found in the brown skins of nuts.  They are also found in red wine, banana, apple, berries, grapes, pomegranate, dark chocolate, sorghum, squash and legumes.  If individuals are sensitive to tannins, it is more about being mindful of the total dose eaten at one time or throughout the day, rather than avoiding them all together.  Some easy steps to reduce tannin load is to switch to white wine versus red wine, eating more white beans versus dark coloured beans, steeping your tea weak versus strong, peeling your apple, and eating milk chocolate versus dark chocolate.

I wish you happy bowels!


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