Constipation
Okay, constipation is a big thing. Constipation is the term used to describe infrequent bowel movements or difficulty in passing them. There are numerous reasons a person may struggle with this. Although the Merck Manual, a basic medical text used as a guiding book in conventional medicine, says that it can be completely normal for an individual to have only 2-3 BMs a week, I doubt that person would agree. It's definitely correct to have 1-2 easy to pass sausage like BMs a day. (You do not need to have a BM after every meal) Constipation is a common US problem.
Around 16 out of 100 adults have it, and over 60 years old, it goes up to 33 out of 100. That's one out of every three people! There are 2 million doctor visits a year and Americans spend $725 millon on laxatives each year. Constipation happens in kids too. 1 out of every 20 visits to the pediatrician is due to constipation.
Dr. Morstein has treated many constipated children. Nearly everyone feels pretty bad getting "backed up". People feel full, heavy, bloated/distended, get headaches, bad breath, have flatulence and are not happy. When it becomes chronic it can really negatively affect one's quality of life. Chronic constipation can lead to hemorrhoids, and more serious problems such as appendicitis, diverticulitis, fecal impaction, leaking stool, anal fissures, and rectal prolapses. So, it's a good thing to fix as much as possible.
In the famous Bristol Stool Chart above Type 1 and 2 show a constipated stool. The Type 4 easy to pass sausage stool is the classic good looking BM, but "rabbit pellets" and/or clumped stool is typical when passing a constipated category poop. Constipation is also associated with having to strain hard to pass the stool.
Here is a list of some of the more common reasons people develop constipation:
Poor diet low in fiber: insoluble fiber is used to bulk the stool and make it easier to pass. Although whole grains have fiber in them, even on low carb diets, such as Keto, you can still get good fiber intake. Below I'll discuss good fiber foods.
Dehydration: a classic drink in the morning to help with bowel movements is to wake and drink a liter of room temperature or warm lemon water. Yes, a liter! Think about it--if you went to bed at 10, you probably stopped drinking around 7 pm, and then you woke at 6 am, so you've not had anything to drink for 11 hours. Adding a good quantity of water into the intestines, and lemon stimulates liver release of bile, which signals the colon to empty our, is a great method for helping to initiate a morning BM.
Lack of movement: exercise moves the whole body including the blood in the gut and that helps have BMs.
Ignoring the urge to defecate: easy to do with business meetings, travel, running around a lot, shopping. It's not an uncommon feeling to be uncomfortable passing a stool in a public restroom.
Traveling/change in routine: when you are eating different food and not drinking as much
Medications: opioids are classic medications causing constipation
Low digestive enzymes: particularly HCL/pepsin in the stomach, and protease and amylase from the pancreas. (If one cannot digest fats, due to low bile or lipase, there is going to be diarrhea).
Low thyroid functioning: when your thyroid is low functioning, cells in your body slow down, and constipation is a potential symptom.
Food sensitivities: can be, as my grandmother used to say, "binding."
Change in the gut microbiome: intestinal fungal overgrowth, for example, is typically constipating; low beneficial bacteria can be problematic, as well.
Medical conditions: SIBO, diabetic autonomic neuropathy, ehlos danler's, spinal cord injury, MS, Parkinson's, etc.
Certain supplements or teas: that contain activated charcoal, carob, or calcium, etc.
Emotional trauma
Vaccine reaction: in infants or adults
Conventional care of constipation relies on OTC softeners, laxatives or medications.
A stool softener is a non-addictive capsule that brings water into the stool. Taken at night, it helps keep stool in the colon wetter, and easier to pass. Combining this with a good water intake in the morning can be a very helpful treatment.
Many people take a OTC laxatives for constipation including Miralax, Dulcolax,or Magnesium. Dulcolax contains Senna, a cathartic laxative. The other two bring water into the colon due to an osmotic gradient change.
There are also drugs that force the gut to move forward for patients who have chronic constipation: Trulance, Zelnorm, Amitiza, Linzess, though these can be very hard for patients to find the happy medium of not being constipated but also not getting diarrhea. Motegrity is the best one, but most expensive and usually only covered by insurance if a patient fails one of the other ones.
Dr. Morstein does order Motegrity from Canada for many patients as it's inexpensive if patients have to pay out of pocket.
Low Dose Erthromycin or Low Dose Natlrexone are gotten from compounded pharmacies, and have a little ability to help empty the stomach start small gut movement.
Naturopathic medicine prefers to dive deep into etiology, finding out what could be causing it. Dealing with constipation is a complex protocol investigating and setting up treatment for any of the above that is pertinent to a patient.
Analyses can include:
Dr. Morstein will request a patient fills out her infamous diet diaries,
Doing tests that seem to be related to one's constipation problem; Food sensitivity, stool analysis, SIBO test, are very commonly done, and a gastric emptying test with gastroenterologist can occur as well.
Doing hormone analyses
Looking at teas, supplements, medications
Discussing anything from the list above of etiologies that resonates with the patient.
Treatment of constipation can include:
Help work on diet to increase fiber intake. Remove constipating foods. High fiber foods include beans/peas/legumes, whole grains, vegetables and fruits, nuts and seeds, avocados, dried fruit like prunes, eggplant skins, squash.
Fiber supplements such as fiber powders, Kiss My Keto Fish Friends gummy bears. Any fiber is good but psyllium husks, ground flax seed, chia seeds, guar gum, acacia, etc are also fine.
Drink half your body weight in water a day so if you weigh 150 lbs you'd drink 75 ounces. Drink a liter ideally with some lemon juice in it upon waking up in the morning.
Get treated for SIBO, intestinal dysbiosis, and remove food sensitivities.
Get treated for a condition where a medication that constipates is being taken by a patient.
Take Flax seed oil 1-2 TBSP a day
Do homeopathy, counseling, EMDR, NET for emotional traumas that initiated the constipation.
Ensure you are exercising regularly, including sit-ups which specifically affect the blood flow in the abdomen.
Ensure your spinal vertebrae are in ergonomic order.
Constipation is common and typically reasons can be identified and treated. If this is a problem of you or a loved one, please alert the person to Dr. Morstein's comprehensive analysis and treatment.