If You Don’t Poop at Least Once Each Day, You’re Constipated.

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Despite what your doctor, other healthcare practitioner, or well meaning person in your life may say, it is not healthy to have a bowel movement less than one time each day. Notice I’m not saying that it’s not “normal” to have a BM every 2, 3 or more days; I’m saying it’s not healthy. Let me explain…

Why are regular bowel movements important?

Your body has four ways to get rid of something that it doesn’t need: poop, pee, sweat and breath. These four elimination pathways give your body all the means necessary to remove toxins from the body. More specifically, bowel movements are the pathway by which your body eliminates:

  • Undigested food material, including fiber and any other nutrient to which you have an intolerance
  • Sloughed off intestinal cells (the cells of your intestine wall live a total of about 7 days)
  • Remnants of dead bacteria that lived in the digestive tract
  • Fat soluble toxins (After the liver transforms them into harmless substances, it puts them into the bile and releases the bile into the intestines. These useless substances include bilirubin, broken down hormones like estrogen and the by-products of medication metabolism. It’s also important to note that poop is really the only way that your body can get rid of things that are fat-soluble because every other pathway is composed primarily of water and, therefore, can only carry out water-soluble substances.)

When you don’t poop, this waste material sits in your colon. Take a second to think about that. What would your house be like if you only took out the garbage once in a while? Or how gross would your toilet bowl get if you cleaned it every so often? Or would you even consider not brushing your teeth everyday? Ick!

The story is actually worse than just being dirty. When the waste sits in your colon, it can affect the microbiota living there and/or be absorbed back into the body, and this can have all sorts of negative consequences. For example, the liver gets rid of excess estrogen by packaging about 20% of the estrogen conjugates in bile (the rest is sent to the kidneys to be urinated out). Once the bile has been excreted into the intestine, the part that contains toxins is intended to be carried out with the stool. However, some bacteria can unconjugate the estrogen, which allows the hormone to be absorbed back into the body. The longer the conjugated estrogen sits in the colon, the more time the bacteria has to do its work and the more gets reabsorbed. For post-menopausal women, this extra estrogen might be a good thing as they are no longer making as much estrogen. But for pre-menopausal women, those who are susceptible to estrogen-receptor positive cancers, and those who get a lot of xenoestrogens from their environment (which is most of us for the record), this extra estrogen may contribute to estrogen dominance and the problems associated with it.

And the above is just one example! Research has linked infrequent bowel movements and long-term constipation to many conditions such as urinary tract infections (UTI), urinary and fecal incontinence, diverticulitis, rectal prolapse, hemorrhoids, anal fissures and colorectal cancer. Some studies have even shown that chronic constipation increases the risk of Parkinson’s Disease and death in the elderly. As well, chronic constipation in children has been linked to stunted growth and bed-wetting. Finally, and perhaps of more immediate importance, irregular and infrequent bowel movements reduces quality of life, physically and mentally. I mean, for real, doesn’t a good poop make you feel clean and light?! Oooorrrr is that just me? 😉

(As a side note, keep the point about toxin elimination in mind if you are planning any sort of detox regimen. You need to be pooping properly before detoxing! Otherwise, the main elimination pathway for detoxification won’t be working effectively and you won’t rid your body of the toxins.)

How is constipation defined?

A person is considered constipated based on the frequency, consistency and/or effort to eliminate feces from the body. More specifically, constipation can be diagnosed when two or more of the following Rome III Diagnostic Criteria are met:

  • Straining to eliminate the excrement at least 25% of the time (1 out of 4 BMs),
  • Feeling like there is still feces left after a bowel movement (i.e., incomplete evacuation) at least 25% of the time,
  • Feeling of anorectal obstruction or blockage for at least 25% of BMs,
  • Requirement of manual intervention, including use of hands or pelvic floor support, to facilitate at least 25% of defecations
  • Having a bowel movement less than three times per week*, and/or
  • Lumpy or hard stools like that of type 1 or type 2 on the Bristol Stool Scale (also known as the Meyers Scale)  at least 25% of the time

Bristol Stool Scale

* Note: Although the criteria officially says a frequency of 3 or more times per week is sufficient, I whole-heartedly disagree with this! We need to poop every single day in order to eliminate toxins from our bodies. If you need convincing that this is true, go back to the section above and read why bowel movements are important. Also, if you have a dog (or know a dog), what would you think if the dog didn’t poop for 2 – 3 days? Surely, our need to poop is as important as a dog’s!

I should mention here that the Rome III criteria says the above conditions confirm a diagnosis of constipation, if the additional criteria for Irritable Bowel Syndrome (IBS) is not also met. If a person meets the above criteria and has abdominal pain or discomfort at least three times per week, then the person will be diagnosed with IBS-C (IBS, constipation predominant) rather than plain ol’ constipation.

What causes constipation?

As with all non-specific symptoms and conditions, there are many potential causes. The following are all the ones that I know of (I acknowledge that there might be others!):

  • Insufficient amounts of insoluble fiber or water… insoluble fiber speeds up transit time through the intestine and holds onto water so the feces are soft and squeeze-out-able.
  • Food sensitivity / intolerance… often dairy is a culprit, but it can be others.
  • Overgrowth of bacteria or yeast in the small intestine (especially if eating more fiber increases the problem or if a recent history of taking opiates)
  • Inadequate digestion due to:
    • Insufficient bile output by the gallbladder… so you aren’t digesting fat properly and more makes it to the colon.
    • Insufficient production of stomach acid… so you aren’t breaking down the protein enough for absorption and, therefore, a larger volume is making it to your colon.
  • Magnesium deficiency
  • Medication use including opioids, anti-depressants, antacids and too many laxatives
  • Supplementation with large amounts of iron or calcium
  • Hypothyroidism
  • Pelvic floor dysfunction, caused by diabetic neuropathy, pregnancy, childbirth, ignoring the urge to defecate, or other conditions
  • Premenstrual Syndrome (PMS) due to a reduction in the hormone-like prostaglandins that trigger smooth muscle contraction (many women experience a drop in prostaglandins prior to their period which slows the movement of the GI tract before the prostaglandins increase again to cause contraction of the uterine wall)
  • Lack of exercise or mobility… I don’t know why, but movement helps us poop.
  • Excessive intake of red meat, wheat and/or alcohol
  • Stress
  • Neuromuscular disorders such as ALS, multiple sclerosis, muscular dystrophy, cerebral palsy and paraplegia

What can you do to relieve constipation?

As with all conditions and symptoms, if you are constipated, I encourage you to identify and resolve the true cause of the problem. Otherwise, you will only relieve the issue temporarily (if at all).

If you aren’t quite ready to enlist the help of a healthcare provider, you can do some things for yourself besides taking a laxative to become regular:

  1. Be sure to get enough fiber and water. This is the starting point because you absolutely have to consume enough fiber and water to poop properly.
  2. Identify if you have a food sensitivity. If you aren’t up for doing a full elimination diet, I strongly suggest eliminating dairy for at least three weeks and seeing if your constipation resolves, as dairy is the most common food sensitivity related to this symptom. You can also reduce your intake of red meat, wheat and/or alcohol to see if that helps.
  3. Build a habit around pooping at the same time every day. According to Chinese medicine, the colon comes into power from 5 – 7 am and, as such, this is the best time of day to have a bowel movement. So get up in the morning, drink a big glass of water, maybe get some exercise in (see #5 below) and don’t eat until your bowels have been cleared so the blood doesn’t get diverted to digestion. It is worth noting here that it may take time for your body to get into a new habit… this is called bowel retraining, and can be frustrating in the beginning, but will pay-off in the long run.
  4. Change your position on the toilet. I’m sure by now you’ve heard of the Squatty Potty, which is intended to create the best angle in your hips for pooping. Cheaper (and perhaps just as effective) options are to elevate your feet just slightly by putting them on your bathroom scale (this is sometimes enough of an angle change for me) or leaning forward, which also shortens the angle between your torso and your thighs.
  5. Get moving! Exercise and movement in general are good for us in all sorts of ways, including helping the smooth muscles of the intestine to work efficiently and effectively.
  6. Increase your intake of flaxseed oil and/or flaxseed meal (i.e., ground flaxseeds). Although the exact mechanism is not understood, it is believed that the oil fractions from the flaxseeds help move the bowels, since the oil and the meal seem to work equally well (although the flaxseed meal will also help you meet the necessary quota for fiber). For the oil, take 1 – 2 tablespoons and for the meal take 2 – 3 tablespoons per day, in separate doses (i.e., 1 tablespoon in the morning and 1 tablespoon in the afternoon, if using flaxseed oil).
  7. Eat some prunes. If you’re anything like me, you probably think that prunes are nasty. At least I used to think that before I tried one, and it turns out they taste like dried fruit! (Shocking, right?!) While prunes are high in fiber, you don’t need a bunch of them to have an effect. Even one prune can make a difference, which likely means the effect is caused by the prune’s natural sorbitol content.
  8. Consider a probiotic that has bacterial strains proven to help constipation, IBS-C and/or slow intestinal transit time. These include Bio-Kult, Garden of Life Raw Probiotics Colon Care, and Jarrow Ideal Bowel Support 299v.
  9. If you have to go to the bathroom, then go! All of us have to poop. It is totally natural. So, while you may feel hesitancy about having a bowel movement in a public place, not allowing yourself to go when you need to will teach your colon and anus that it’s not safe to poop and this can lead to pelvic floor dysfunction and constipation. (There are other causes of pelvic floor dysfunction as well, and fixing it may require physical therapy.)
  10. Be sure you are getting enough magnesium. This mineral helps the smooth muscles (of which your intestine is one) relax. Imagine if your bicep was constantly tense; you wouldn’t be able to move your arm at all.  Same thing happens if the muscles of your intestines are constantly tense. So eat foods that are rich in magnesium, and if you don’t think you can get enough, try a supplement like this powder form (which I mentioned that I take most days) or this capsule form.
  11. Increase your vitamin C intake to create an osmotic effect in the intestine. To do this, you will need a supplement to help and this is a good one that also includes magnesium. Beware that too much vitamin C or magnesium can lead to diarrhea, so be careful as you increase the dosage.

Note: If you would like to support my business and order any of the above supplements from me, follow these instructions: Nutrition QED – Supplement Ordering Instructions – NP Script.

If none of the above works and you are still struggling with constipation, get with your healthcare provider or contact me to get to the bottom (so to speak) of the trouble. Pooping regular is super important to keep your system clean and healthy… and to keep you happier!

 

Sources:
— Abbott RD, Petrovitch H, White LR, et al. Frequency of bowel movements and the future risk of Parkinson’s disease. Neurology. 2001;57(3):456-62.
— Allen S. Gastrointestinal Health from a Functional Medicine Perspective. Webinar held on February 11, 2015.
— Chao HC, Chen SY, Chen CC, et al. The impact of constipation on growth in children. Pediatric research. 2008;64(3):308-11.
— Gaby AR. Nutritional Medicine. Concord, NH: Fritz Perlberg; 2011.
— Hall J. Guyton and Hall Textbook of Medical Physiology. 12th ed. Philadelphia, PA: Saunders Elsevier; 2011.
— Hawrelak J. Probiotic Advisor.
— Koloski NA, Jones M, Wai R, et al. Impact of persistent constipation on health-related quality of life and mortality in older community-dwelling women. The American Journal of Gastroenterology. 2013;108(7):1152-8.
— Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food and the Nutrition Care Process. 13th ed. St. Louis, MO: Elsevier Saunders; 2012.
— Rome Foundation. Appendix A: Rome III diagnostic criteria for functional gastrointestinal disorders. In Rome III Disorders and Criteria. Accessed March 15, 2016.
— Skwarecki B. Gut microbes linked to estrogen breakdown in menopause. In Medscape Medical News. September 15, 2014. Accessed March 16, 2016.
— Sun SX, DiBonaventura M, Purayidathil FW, et al. Impact of chronic constipation on health-related quality of life, work productivity, and healthcare resource use: an analysis of the National Health and Wellness Survey. Digestive Diseases and Sciences. 2011;56(9):2688-95.
— Valerie Matthiesen NP, DeWolff D. Constipation and Fecal Incontinence. Accessed March 15, 2016.
— WebMD, LLC. What kind of poop do I have? In Digestive Disorders Health Center. Accessed March 15, 2016.
— Yazbeck S, Schick E, O’Regan S. Relevance of constipation to enuresis, urinary tract infection and reflux. A review. European Urology. 1986;13(5):318-21.

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