Why Constipation Is on the Rise
As the number of people suffering from chronic constipation rises, so does the number of emergency room visits, hospitalizations and associated health care costs.
STORY AT-A-GLANCE
Constipation is more than an aggravating condition; this silent epidemic has led to millions of doctors' visits and 700,000 emergency room visits, and costs billions of dollars in direct and indirect health care costs
Factors that influence your risk include eating a low-fiber diet, using medications that affect your bowels, dehydration, lack of exercise and frequent use of laxatives or enemas
You may reduce your risk of chronic constipation by learning to squat when you have a bowel movement, using the bathroom when you feel the urge, getting regular exercise, eating real food and fermented food
Editor's Note: This article is a reprint. It was originally published August 30, 2017.
For most people, an occasional bout of constipation is a minor aggravation. However, this is not the case for the nearly 12% to 19% of the U.S. population suffering from chronic constipation.1 This means 63 million people have difficulty passing hard, dry, lumpy stool, suffer from feeling bloated, have abdominal pain or feel as if there is something stuck in their rectum or intestines.2
For many, the topic of their bowel movements is a private matter. This makes understanding and learning about the actual mechanics of how stool is produced and eliminated difficult, as many don't find it a topic they want to discuss, even with their physicians.
The number of stools you have each week is closely linked to the types of food you eat, the amount of exercise you get and your hydration status. While many people may have a bowel movement once a day, the normal amount ranges between four times each week to several times a day.3 What differentiates infrequent stools and constipation is the consistency of the stool, the difficulty in passing it and other symptoms you may experience, such as bloating or feeling full.
Unfortunately, the number of people who suffer from chronic constipation is rising, leading to a characterization of the condition as a "silent epidemic" as those who suffer often suffer in silence.
Number of People Suffering From Chronic Constipation on the Rise
A 2013 survey by the American Gastroenterological Association4 found 16% of Americans suffer from chronic constipation and nearly 33.5% over age 60 experience the condition. This leads to millions of visits to the doctor's office or clinic, and nearly 700,000 visits to an emergency room every year.5 Although the condition is normally treated on an outpatient basis, the number of people admitted to the hospital since 1997 has doubled.
One study estimated that if the 6% of Americans suffering from functional constipation incorporated natural lifestyle changes to improve their condition, $12.7 billion in direct medical costs could be avoided annually.6 The researchers felt this was a conservative estimate as it did not account for lost wages or productivity.
While the survey found an increasing number of people suffered from chronic constipation, it was not a study that evaluated the causes behind the problem. There are several controllable factors common to a modern lifestyle that contribute to an increasing risk, and factors over which you have no control.
For instance, the number of people who suffer from constipation rises significantly with age.7 This may be related to both lifestyle choices, such as diet and exercise, and to age-related neurogenic dysfunction.8
There are a significant number of choices you make each day that increase your risk of developing chronic constipation. One is learned constipation, as your rectum is flexible and can stretch. In a study using college students, researchers found participants could easily train themselves to evacuate their bowels every 51 hours instead of every 28, leading the scientists to conclude bowel habits may induce constipation.9 Other factors that influence your risk include:10 11 12 13
Low-fiber diet
Changes in your routine
Lack of exercise
Avoiding a bowel movement when you have the urge
Drinking insufficient amount of fluid
Certain medications, such as opiates, antidepressants, antacids and anti-hypertensives
Frequent use of laxatives or enemas
Poor nutrition leading to vitamin deficiency, including magnesium deficiency
Iron supplements
Significant Health Problems Linked to Chronic Constipation
Few people realize that chronic constipation, and the daily agony that accompanies the condition, may be dangerous or even deadly. The American College of Gastroenterology believes a diagnosis of chronic constipation warrants further medical workup, as patients may have a higher likelihood of colon cancer, even if they don't present with colon cancer symptoms, such as GI bleeding, anemia or weight loss.14
When the scientists started the study, they didn't expect too many surprises. Yet, after analyzing the results they found medical conditions they didn't anticipate would be associated with chronic constipation, including ischemic colitis, diverticulitis and other gastrointestinal cancers.
Chronic constipation is also related to at least one brain disorder: Parkinson's disease. A number of studies have demonstrated a link between your gut health and your psychological health. A link between an unbalanced microbiome (one symptom of which is constipation) and Parkinson's disease may be related to proteins from the gut that accumulate in the brain.
In one study, 21 days after specific proteins were injected into the stomach and intestines of mice they were found to have migrated as far as the vagus nerve.15
Constipation may also increase your risk of kidney diseases.16 Researchers reviewed medical records of over 3.5 million U.S. veterans and followed their care for seven years. At the start of the study each participant had normal kidney function. Although a causative relationship could not be proven with the method used in the study, those with constipation had a 13% increased risk of kidney disease and 9% increased risk of kidney failure.
Researchers have also found suffering from constipation may increase your risk of anal fissures, stool incontinence, hemorrhoids and urological disorders.17 The seriousness of the symptoms may vary, depending upon the severity of your constipation. An association has also been found between people suffering rectal prolapse, a condition where part of the large intestines slips out of the anus, and constipation.
Another factor connected with constipation is back pain.18 In some cases, back pain may result in the use of pain medications like opiates that slow your intestinal tract and lead to constipation. In other cases, back pain is the result of your constipation. For instance, irritable bowel syndrome or a fecal impaction may lead to back pain.
Steer Clear of Laxatives
Constipation is a symptom of other conditions and not a disease or illness process itself. Thus, treating just the symptom may mean you're overlooking another more serious problem. Many people turn to over-the-counter laxatives to immediately relieve the discomfort, but this may have additional consequences that hinder your recovery.
Laxatives come in a variety of forms including pills, capsules, liquid, suppositories and enemas. Although tempting, if you choose to use a laxative, do it with extreme caution. The active ingredient in many enemas draw water from your body into your large intestines, softening the stool. When too much is used it can increase your risk of dehydration, and by altering your electrolyte balance, you risk kidney or heart damage and death.
Stimulant laxatives work by increasing the muscular action in your intestines. This includes senna or cassia laxatives, often marketed as being "natural." Over time, these types of laxatives damage the function of your intestinal walls and decrease the ability of your muscles to contract on their own.
If you must use something to immediately relieve constipation, consider trying a glycerin suppository that doesn't contain any stimulants. The suppository often produces results within two hours and works by drawing water into your large intestines directly where your hard stool is located, softening it enough to evacuate your bowels.
Magnesium May Help Constipation and Protect Against Disease
One of the most popular short-term natural supplements that is effective against constipation is magnesium. Magnesium is an essential mineral and a cofactor used in multiple enzymes.19 A deficiency is associated with poor absorption of vitamin D and an increased risk of heart disease, stroke, osteoporosis and diabetes. Supplementation is being used to treat migraine headaches, hypertension and asthma.
Magnesium is important to mitochondrial health, and in the production of energy in every cell in your body. It is estimated that 50 years ago people routinely received nearly 500 milligrams (mg) of magnesium every day from their food. Today, with soil depletion and poor nutritional habits, many may only receive from 100 mg to 300 mg per day. Although organic, unprocessed foods are your best bet; the amount you receive will depend upon the soil the plants were grown in.
The recommended dietary allowance (RDA) for magnesium is between 310 and 420 mg per day, dependent upon your age and sex.20 However, these amounts are based on reducing your potential for deficiency and don't necessarily address the amount you need to maintain optimal health.
Some researchers believe you may need between 600 and 900 mg per day. Dr. Carolyn Dean, author of "The Magnesium Miracle," recommends that you use your body as a marker for your ideal personal dose.
Begin by taking 200 mg of oral magnesium citrate each day and gradually increase the amount until you develop slightly loose stools. Magnesium citrate has a mild laxative effect — whatever your body doesn't absorb will affect your intestines as it is flushed out through your stool, which helps you identify your personal cutoff point. There is ample evidence demonstrating the effectiveness of using magnesium to naturally improve constipation.21 22 23
Magnesium comes in several forms including chelate, threonate, citrate and sulfate. Citrate is the form that has the most effect on your intestinal tract and helps produce loose stools. However, if you are taking magnesium supplements for other health reasons, my personal preference is magnesium threonate as it appears to more effectively penetrate your cell membranes and boost your mitochondrial health, thus boosting your energy level.
Try Squatting to Enhance Elimination
Sitting on your toilet may be comfortable, but placement of your knees and upper legs at 90 degrees to your abdomen actually pinches off your anal canal and makes having a bowel movement more difficult. On the other hand, when you squat, your knees are brought closer to your abdomen, which changes the relationship of your rectum and sphincter, positioning your organs and muscles in a way that relaxes your rectum. This maximizes the efficiency of your evacuation.
In this position, muscles around your rectum and pubic bones relax. This encourages complete emptying of your rectum and cecum without straining. It also reduces the potential for stagnation of stool in your lower intestines and subsequent accumulation of toxins that impact the growth of your gut microbiome. In many non-Westernized cultures people routinely squat to evacuate their bowels and don't sit on a toilet.
It is interesting to note that in cultures where people squat daily, people don't have the high prevalence of bowel diseases experienced in countries where toilets are commonplace. Squatting without support is challenging when you haven't grown up squatting on a daily basis. A simple and inexpensive method of achieving good body position is to use a small foot stool. This places your organs and muscles in a more natural position and enables easier evacuation.
Fiber, Movement and Other Natural Ways of Reducing Constipation
I list several ways of reducing your risk of constipation below. But, I strongly recommend you incorporate fermented foods to help "reseed" your gut with good bacteria that will help you regain and maintain bowel regularity. The video above includes a short demonstration of how to make your own fermented foods at home. If you don't eat fermented food, which is your best and least expensive source of probiotics, then I recommend you take a quality probiotic supplement.
In some circumstances these lifestyle choices are not enough to eliminate your constipation. As chronic constipation is one of the hallmark symptoms of hypothyroidism, it is important to discuss your situation with your physician. In many cases though, simple changes to your diet and daily lifestyle will reduce your risk of constipation and improve your gut health, such as:
Swap out processed foods for whole, high-fiber foods, such as leafy green vegetables, squash and broccoli. These foods feed your gut microbiome, reduce your vulnerability to infection and promote softer stools that keep your intestinal walls intact.24
The American Heart Association recommends eating 30 grams of fiber each day,25 but the average American eats approximately 15 grams each day, which contributes to the growing rate of constipation.26
Remove gluten, artificial sweetener and sugar from your diet as they all damage your intestinal tract.
Regular exercise can also help reduce constipation.27 The physical movement helps increase the motility in your digestive tract and can stimulate the urge to have a bowel movement.
When you feel the urge to have a bowel movement, don't wait. The longer the stool sits in your colon, the more water is removed and the more difficult it is to pass.
Consider using a foot stool to get into a squatting position to have a bowel movement. This will strengthen the muscles around your rectum and encourages a complete emptying of your bowel without straining.
Stay well hydrated with clean, pure water.
Avoid pharmaceutical drugs that change the speed of your bowel function or cause GI disruptions, such as opiate pain medications, antidepressants, antibiotics, antacids and laxatives.
Address your emotional challenges and life changes using tools, such as Emotional Freedom Techniques (EFT).
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