What is the most common digestive complaint in the United States? Constipation. We probably don’t need to explain the symptoms, but forgive us for stating the obvious. Stools become hard, dry, and sometimes painful to pass. Although frequency usually declines, irregularity is not the defining characteristic. Not everyone has a daily bowel movement.
Constipation is more common in seniors and affects women three times more often more than it does men. If constipation persists more than three months, it’s considered chronic. The causes of constipation include the following:
• insufficient fiber and fluids (by far the most common cause)
• irritable bowel syndrome
• overuse of laxatives
• hypothyroidism
• nerve damage
• rare congenital conditions
• dietary supplements (iron and calcium)
• medications, such as: - bismuth (e.g., Pepto-Bismol) - opioid pain relievers (e.g., Vicodin and Oxycontin) - nonsteroidal anti-inflammatory medications (e.g., ibuprofen and naproxen) - antacids containing calcium and aluminum - antihistamines - calcium-channel blockers (used to lower blood pressure)
With advancing age, intestinal motility slows, allowing more time for water to be absorbed into the circulation, which leads to harder stools. Constipation and alternating constipation and diarrhea occur in irritable bowel syndrome, a condition of altered motility of the large intestine. Constipation is a common sign of hypothyroidism. Less often, the large intestine becomes obstructed. Damage to local nerves is another cause. Rare congenital conditions can also come with the absence of bowel movements.
In addition to making you uncomfortable, constipation has other negative consequences. Passage of hard stools may tear the anus, resulting in a vicious cycle where reluctance to re-experience the pain worsens constipation. Children going through toilet training are particularly vulnerable to that scenario. Repeatedly straining to defecate can lead to hemorrhoids, varicose veins in the legs, and diverticulosis (a condition wherein small pouches protrude from the wall of the large intestine). In women, constipation contributes to pelvic floor prolapse (the descent of pelvic organs). In short, it’s important to correct the condition.
RECIPES TO TREAT CONSTIPATION
Psyllium Seed Husk Elixir
½ cup (120 ml) 100 percent apple juice 1½ cups (355 ml) water, divided 1 to 2 teaspoons (6 to 12 g) psyllium husks
PREPARATION AND USE:
Mix the apple juice and ½ cup (60 ml) of the water in a glass. Stir in the psyllium and drink the remaining water. Take two to three times a day.
YIELD: 1 Serving
How it works:
Apple juice has a laxative effect. Both black and blond psyllium husks act as bulk-forming laxatives, which means their fiber holds water in the intestine, making the stool softer and easier to pass. Studies show that psyllium can be more effective than over-thecounter stool softeners, such as Colace (docusate sodium). Note: Be sure to chase a glass of a psyllium beverage with an additional tall glass of water. Fiber doesn’t help unless you consume water with it. In fact, insufficient water used with such products as Metamucil (whose active ingredient is psyllium husks) can make constipation worse.
A “Regular” Smoothie
This is easy—and effective! The flaxseeds and psyllium are a strong regulating combo. Instead of using an ice cube, try freezing the fruit in advance for a full, smooth texture. ½ banana 1½ teaspoons (11 g) flaxseed meal 1 teaspoon (6 g) psyllium husks ¾ cup (109 g) strawberries or (190 g) raspberries ½ cup (120 ml) almond milk
PREPARATION AND USE:
Place all the ingredients in a blender and blend well. Grind in an ice cube for a frothy finish.
YIELD: 1 Serving
How it works:
The fiber in psyllium and fruit help soften the stool. Flaxseed meal adds omega-3 fatty acids, which provide antioxidant and anti-inflammatory action. Flaxseeds also ought to act as a bulk-forming laxative, but research confirmation is lacking.
Brocco-licious
Broccoli is rich in fiber and magnesium, both of which help regularity. Simmer it to keep its bright green appeal. ¼ cup (16 g) hulled pumpkin seeds or (28 g) slivered almonds 1 pound (455 g) fresh broccoli 1 tablespoon (15 ml) olive oil ½ to 1 teaspoon (0.5 to 1.1 g) red pepper flakes ¼ teaspoon sea salt ¹∕8 teaspoon freshly ground black pepper ½ cup (120 ml) water
PREPARATION AND USE:
Lightly oil a skillet using canola or olive oil cooking spray. Place over high heat, add the pumpkin seeds, and brown lightly, about a minute or two. Immediately transfer the seeds to a bowl. Remove the larger, tougher stems of the broccoli, break the florets into bite-size pieces, and slice the remaining stems. Add the olive oil to the pan and lower the heat to medium. Add the broccoli, red pepper flakes to taste, salt, and black pepper. Pour the water on top. Cook for 3 to 5 minutes until barely tender and still bright green. Remove immediately from the heat. Drain any remaining water. Sprinkle the pumpkin seeds on top and serve.
YIELD: 4 To 6 Servings
How it works:
Magnesium salts (magnesium citrate, sulfate, and hydroxide) taken as supplements draw water into the intestine and stimulate motility, thereby creating a laxative effect. Magnesium is well absorbed from such vegetables as broccoli; from seeds (including pumpkin seeds) and nuts—especially almonds; and from legumes, whole grains, squash, and leafy greens. All these foods also provide fiber.
When Simple Doesn’t work
Laxatives take up a lot of drugstor e shelf space. Some are relatively benign; others are better avoided altogether. Choose wisely.
• Fiber supplements (bran and psyllium) are safe. Just be sure you take them with plenty of water.
• Stool softeners such as docusate (Colace and Sur fak) are also safe bets. The same is generally true for lubricant laxatives, such as mineral oil, though longterm use may decrease absorption of fat-soluble vitamins (A, D, E, and K).
• Osmotic agents work by drawing water into the lar ge intestine. These include magnesium salts (milk of magnesia), polyethylene glycol (MiraLa x), sorbitol, and lactulose. They’re generally safe. Ditto glycerin (glycerol) suppositories. Overuse of osmotic agents, however, can lead to loss of minerals. Milk of mag - nesia contains magnesium hydroxide, which holds water in the intestines and hastens intestinal motility. Side effects include diarrhea.
• Reserve stimulant laxatives for times when less harsh methods fail. These increase contractions in the large bowel. They can cause cramping and diarrhea, which depletes the body of water and electrolytes (especially potassium). Although you many have heard that frequent use can lead to dependence and damage to the large intestines, scientific study does not support such associations.
• Avoid stimulant laxatives if you’re pregnant or nursing. If increasing fiber, water, and physical activity fail to correct constipation, some doctors recommend bulk-forming laxatives, stool softeners, lubricant laxativ es (mineral oil), and sometimes osmotic laxatives. Ask your doctor befor e trying any over-thecounter medication or dietary supplement.
• Some herbal laxatives stimulate the bowel. Used at r ecommended doses for short periods of time (a week or less), they’r e generally safe for healthy, nonpregnant adults. Examples include senna (sold over the counter as Sennakot and other brands), cascara sagrada, and buckthorn. Aloe juice t hat contains latex from just under the leaf ’s skin acts as a stimulant laxative, too. However, ingesting high amounts of aloe latex (1 gram per day for severa l days) has been linked to kidney damage, kidney failur e, and death. Also, the latex con - tains anthroquinones, which may cause cancer.
• A traditional remedy is a tablespoon (15 ml) of castor oil. If you only use th is remedy occasionally, it’s generally safe. Otherwise, it carries the same risk as other stimulant laxatives.
• Do not try enemas at home unless dir ected to do so by your doctor. They do cause a bowel movement, but carry the risk of bowel per foration and derangements of electrolytes.
When to Call the Doctor
• You’ve noticed a significant, unexplained change in bowel habits.
• Constipation is associated with significant discomfort, painful hemorrhoids, or anal fissures.
• You feel that bowel movements don’t completely evacuate your rectum.
• You have chronic problems with constipation.
• You’re pregnant. Call before you resort to over-the-counter laxatives.
• You’re concerned about your child’s bowel movements.
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