Everything You Wanted To Ask About Constipation But Were Afraid To Ask!

By: Holly L. Thacker, MD • Posted on March 22, 2023

Ugh, constipation is such a pain in the you know what! It is a common condition amongst many young and old, but fluids, fiber and fun exercise can help a sluggish bowel.

What causes constipation?

Chronic constipation affects at least 20% of the population and females are affected more often than males. Constipation is more likely to occur during times of change like potty training, premenstrual time, pregnancy and post menopause. In addition, females tend to have a slower colon transit time. Lack of physical activity can also contribute to a slower colon and some females may engage in less vigorous work or recreation activity compared to males.

Treatment and relief for constipation

For several reasons it is important to ingest fiber-rich foods, including fruits, veggies and beans as well as foods high in prebiotics (avocado, oats, garlic, onions, asparagus, mangos, chicory root, Jerusalem artichokes, apples and berries).

The colon is an organ that holds stool and absorbs water so staying hydrated is important. Fiber both holds in some water in the stool preventing hard stools and conversely absorbs water preventing loose stools.

Probiotics help with healthy bacteria in the gut and include fermented foods like yogurt, kefir, buttermilk, tempeh, sauerkraut, pickles natto, apple cider vinegar and some soft cheeses like gouda, mozzarella, cheddar and cottage cheese. Cheese is nutrition rich in calcium and may help reduce osteoporosis and heart disease. Some folks avoid cheese if they are constipated, but this is not necessary if you focus on cheeses with healthy probiotic bacteria.

Foods to help with constipation

If you do experience constipation, try focusing on high fiber foods and foods that have some natural laxative effects. These foods include:

Apples - one small apple has over 3 grams of fiber and contains pectin known for its natural laxative effect.
Prunes are classically recommended as they are high in fiber and contain sorbitol which the body doesn’t digest well drawing in water into the intestines. Prunes are sweet and can be a favorite with children. Figs and fig paste and jams can increase stool transit time.
Kiwi is a power fruit high in fiber and appears to speed up bowel transit.
Pears are also rich in fiber packing a high 6 grams of fiber and also contain sorbitol and fructose which is not well absorbed by the gut. Pears can be eaten by themselves, added to smoothies and placed sliced on salads or sandwiches.
Rhubarb is high in insoluble fiber and also contains sennoside A which is a laxative. Sennosides are found in laxatives that contain senna (which I do NOT recommend any regular use as long term can damage the autonomic nerves that supply the gut.) Sennoside A works but decreases a protein that controls water transport in the intestine. Rhubarb is frequently mixed with strawberries and put in baked goods like a pie but can be added to yogurt or oatmeal.
Flax seeds are rich in fiber and omega 3 and contain both soluble and insoluble fiber and can thus help both with constipation AND diarrhea.
Beans also contain both soluble and insoluble fiber The soluble fiber absorbs water and insoluble fiber passes through adding bulk to the stool. Black beans contain more than 7 grams per ½ cup while navy beans pack over 9 grams of fiber.
Chia seeds are the queen of fiber packing in the most fiber clocking in at 11 grams per one ounce. Adding these omega 3 rich seeds to sm
oothies, yogurt and baked products can be a winner with children.
Lentils are packed with 8 grams of fiber per ½ cup but also increase the production of butyric acid, a type of short chained fatty acid that increases the transit time of the gut. Adding lentils to soups and salads alike help fortify nutrition and bowel habits.
Avocados are not just for millennials on their toast! One cup of sliced avocados contain a whopping 10 grams of fiber and heart healthy fats which aid in satiety and help with weight loss. Try using as a substitute for mayonnaise or add to baked goods, smoothies or in the popular dip guacamole.
Oat bran is the fiber rich outside of the oat grain. Oat bran contains more fiber than plain rolled oats. Oat bran can be used in making bread and granola.
High fiber cereals such as Fiber 1 contain 8 grams of fiber per cup.
Fiber supplements such as Metamucil fiber thins contain psyllium with 5 grams of fiber, Citrucel® contains methylcellulose.

How to prevent constipation

When fluids, fiber and fun exercise is not enough.

Avoid constipating foods and substances such as alcohol, fried foods, fast foods, gluten rich foods, excessive dairy and cows milk (although if lactose intolerant-lactose containing foods can actually cause diarrhea), bananas and in some persimmons. When one has diarrhea foods such as tea, toast, apple sauce and bananas are recommended.
Visit your physician to see if a medical condition such as low thyroid or bowel disorders needs to be investigated. Some causes of constipation include medications such as opiates, some antidepressants and some overactive bladder medicines, celiac disease, diabetes, Parkinson’s disease, pregnancy, high calcium states, Irritable Bowel Syndrome and changes in environment like travel.

Causes of constipation in children can include withholding during potty training, Hirschsprung’s disease, celiac disease and cerebral palsy. Over 90% of constipation in children is “functional” which is constipation without an underlying medical disease. If constipation continues in children, dilated colon and encopresis (fecal soiling of loose stool around the hard stool) can occur.

Causes of constipation in the elderly include immobility, malnutrition, lack of abdominal wall strength, weak pelvic floor, chronic medical conditions, and some medications. Constipation may be due to slow transit, normal transit constipation, or defecatory conditions which include structural problems such as rectocele (bulging of the rectum into the vagina).
Discuss using magnesium supplements with your health care team as long as you do not have kidney impairment. Milk of magnesium, magnesium tablet supplements or magnesium chewies can be used.
Fiber gummies may be popular with toddlers and children who are picky eaters.
Consider a trial of MiraLAX® (polyethylene glycol) which can be added to apple juice, prune juice or water and may need to be used consistently. After a week or so of use without results, you will need to contact your physician and any adult who has to use for more than 2 weeks needs to have a screening colonoscopy, unless done already.
Stool softeners such as Colace®/docusate can be considered.
Mineral oil is a lubricant laxative and coats the bowels. It is usually taken before bedtime as it takes 8 hours to work and should only be used in those with intact swallowing and no neurologic impairment. Most physicians do NOT recommend for children under age 6.
Re-evaluating bowel habits setting a regular time, sitting on the toilet after some food or warm beverage may help some. Drinking coffee which contains caffeine stimulates gastrin release from the stomach which prompts a bowel movement in many. Sometimes a glycerin suppository may be advised and occasionally saline enemas and dis-impaction may have to be employed under a healthcare clinician supervision.
Aloe Vera juice has antioxidant and antibacterial effects. Aloe Vera should be avoided in pregnancy and during lactation (like so many things). It is the outer pulp of the aloe leaves that contain the anthraquinones known as aloin that are the laxative part. Do NOT ingest aloe gel, do not ingest or use if allergic and even though aloe Vera juice can be obtained in health stores and online, it is best to consult with your physician when using.

Be Strong. Be Healthy. And Be in Charge!

-Holly L. Thacker MD

About Holly L. Thacker, MD, FACP

Holly L. Thacker, MD, FACP is nationally known for her leadership in women’s health. She is the founder of the Cleveland Clinic Specialized Women’s Health Fellowship and is currently the Professor and Director of the Center for Specialized Women’s Health at Cleveland Clinic and Lerner College of Medicine at Case Western Reserve University. Dr. Thacker is also the Executive Director of Speaking of Women’s Health and the author of The Cleveland Clinic Guide to Menopause. Her special interests and areas of research including menopause and related medical problems including osteoporosis, hormone therapy, breast cancer risk assessment, menstrual disorders, female sexual dysfunction and interdisciplinary women’s health.

women's health, constipation, fiber, probiotics, prebiotics, water, exercise, diet, gut, colon, bowels

Columns