Everybody poops. Yet most people are not willing to ask questions about it to their healthcare provider. However, if you walk down the laxative/ hemorrhoid aisle at the store, you see hundreds of products and a couple of customers all the time. You will see the young man walking through the aisle like he’s lost or buying condoms for the first time. Some guy who wants to tell you all about his colonoscopy rationalizing his presence in the store. And perhaps a couple of middle aged women discussing the virtues of probiotics. For the most part, it’s a strange fraternity of hemorrhoid sufferers, GI patients, and those who have no clue about what’s going on with their bodies.

“How many years have you been dealing with this issue?” is one of the questions I ask in every patient interview. Years? Yes, years. We all have a sense of independence that keeps us out of doctors’ offices. Yet that same sense leaves us often suffering needlessly. That is especially true when we believe the symptom or condition is embarrassing or a relative inconvenience versus a true medical condition. The secret is, medical providers are not snickering about you behind your back. It is safe to say that most practitioners have pretty much seen it all so don’t be nervous, scared, or embarrassed; get those funny questions resolved. This is especially true when it comes to bowel movements.

Many people do not know or think they are constipated. If you have used or considered laxatives or stool softeners (drug or herbal), have hemorrhoids, or do not have a healthy voluminous bowel movement every day, consider yourself constipated. Think about who has nearly perfect digestive systems – babies and dogs. And how often do they normally have a bowel movement? Nearly every time they eat! So we know that if our digestive system is working well, we should be similar. It should take about one day for a bite of food to travel through the digestive system. So, the bowel movement you just had should be the meal you had yesterday at about the same time.

Regular bowel movements and a healthy digestive system are critical as they are the foundation of our immune system. Most people do not realize that most of the immune system is developed and “lives” in the gut and a slow bowel may also indicate a sluggish immune system.  Interestingly, some physicians believe that inflammation is really repair deficit and the immune system is in charge of reducing inflammation. Now we know that systemic inflammation is involved in a plethora of chronic conditions and disease states including, but not limited to arthritis, diabetes, lung conditions, weight gain, cancer, cognitive conditions, and chronic pain. Healthy people have healthy stools.

1. Hydration: One of the main causes of constipation is dehydration.  Interestingly, that does not always mean just drinking more. Demineralized water has a diuretic effect as does coffee and tea. Reverse osmosis or distilled water contain no minerals. The answer is pure, clean water with important minerals added to it which improves both the hydration of water into the cells. High quality charcoal filters work well too. Regarding volume, there are several “rules of thumb,” but what I have consistently found to be helpful is setting a goal of 16 ounces first thing in the morning, 48 more ounces by 1:00pm followed by an additional 32 ounces throughout the rest of the day.  This applies to anyone who is 150 pounds and has two functioning kidneys.

2. Dietary fiber: Fiber is critical for constipation, but it must be approached gradually.  Fiber ultimately must be increased to about 35 grams per day to ensure long-term success and relief, but excessive fiber can cause pain and even potentially make it worse which many people don’t know understand.  I recommend add one “extra” fibrous serving (ideally of a food) per day for a week and then add in a second additional fiber serving in the second week and so on.  Fiber containing foods include legumes (black beans, pinto beans, lima beans, lentils), nuts and seeds (almonds, pistachios, and pecans), vegetables (broccoli, peas, Brussels sprouts), and select fruits (raspberries, pears).

3. Medications: These are very common causes of constipation because, for example, pain medications change the way water is absorbed and reabsorbed in the gut. Less water in the intestine causes the stool to harden which in turn slows its pace. Serotonin, a neurotransmitter is responsible for helping the muscles of the intestine move the stool. Therefore, medications that change levels of serotonin, as many antidepressant medications do, cause constipation. Long-term use of laxatives and stool softeners also can cause constipation. My recommendation is to carefully read your medication package inserts, work with your prescribing physician to determine if the medication and dose is appropriate, and consulting a pharmacist regarding any drug-drug interactions you may be experiencing.

4. Being active, having an exercise regimen, and just moving one’s body typically supports healthy bowel habits. Walking, running, weight training, swimming all seems to help. What doesn’t help is never getting out from behind the computer.

5. Oils (fatty acids) are useful in just about every case of constipation.  Just think of the same way we use oil to lubricate our car. Same idea works with our bowels and intestines. We need these oils so that everything flows smoothly. Use a high quality fish oil product that has been tested to be free of heavy metals and pollutants not to mention all the other health benefits gained for heart and brain health.

6. Our gut has good (probiotics) and bad bacteria when this is out of balance it impacts our digestion and ability to absorb vitamins and minerals from our food, inflammation in our body to stop things flowing and our immune system. Getting the right balance is critical I always recommend high doses to start, get the microbiome in balance and then we can reduce to a lower maintenance dose. Be aware each probiotic product on the market has different strains of bacteria. Currently, a broad spectrum, high dose probiotic of 20 billion CFU (colony forming units) is a good place to start.

7. To regulate the digestive system, I recommend frequent small meals. Each meal should contain protein.  Be careful about your proteins.  You want to make sure your eggs and meat are free of added hormones and antibiotics. Other sources of protein are nuts, seeds, fish, and beans.  You don’t need excessive protein, but some at each meal ensures metabolic function that is largely protein or amino acid dependent. Consider “palm of hand” sized portions for two meals and half that for the other three.  The smaller your hand, the smaller your portion. Neurotransmitters and the immune system both “live” in the gut and require protein. Each meal should include carbohydrates, but they should come from vegetables instead of grains.  Brown and wild rice are occasionally suitable but not necessary on a daily basis. I strongly recommend vegetables like broccoli, Brussels sprouts and leafy greens like spinach, Romaine lettuce, and mustard greens (preferably organic) which can impact your health in a positive way. 

8. If possible, determine food sensitivities. These foods increase inflammation and impact your immune system. As Lucretius said, “One man’s food is another man’s poison.” The University of Wisconsin has made available a nice handout on the modified elimination diet. This is a preferred method over blood or skin tests which are often incomplete. If you tolerate dairy after doing the modified elimination diet, it is still recommended that you choose wisely and in small portions.  Dairy (milk and cheese) is notorious for causing constipation as it thickens mucous and the intestine creates enough mucous on its own typically. It can also have ill effects on the immune system. Yogurt and kefir are better choices because they are fermented and contain healthy gut flora but wisdom suggests temperance.

Bathroom talk shouldn’t be embarrassing. In fact, the bowel is a wonderful window into the health of the person as it offers a multitude of clues of one’s constitutional health. Ask your questions and become a part of a new fraternity: the healthy living club! Let me leave you with a thought from health poet Marcia Glatfelter, “Everything is a flow of intelligence. The digestive system is like a good story, an epic of tales of deliverance, and we all enjoy a good ending and packed with intelligent action, so taking away from the story by screwing up the plot is disappointing. It all starts with the Author...to choose the best words to keep the readers interested. So keep your colon interested...if it has no plot, then it stops reading. If you put intelligent foods in the mouth, the colon will be glad to keep healthy and flowing.”