Q: I read your emails and info on your website regularly but haven’t found info on relief from constipation. I’m 57 years old and have pretty consistent constipation. Are colon cleansers a good product to try? Any help you can give will be appreciated.

Thank you and please continue your excellent website information.

A: Constipation can cause every variety of stomach and digestive pain, not to mention hemorrhoids and varicose veins (from straining), so it’s best not to ignore it, as many people do. To relieve constipation it’s necessary to explore possible underlying causes as well as solutions and remedies.

The three basics for relieving chronic constipation are:
1) plenty of water
2) plenty of fiber (fruits, vegetables, whole grains)
3) exercise

Please take the exercise recommendation seriously—moving the body every day is essential to regular, comfortable bowel movements. Every inch of the human body is made to move, including the colon. Long hours in front of the computer or on the couch are a common cause of constipation.

Causes of Constipation

Processed foods contribute to constipation because all or most of the fiber has been removed. Remember how we made paste in kindergarten? We mixed white flour with water. By the time white bread, white rice, white pasta, cookies, cakes, chips and other such foods reach the colon, they’re paste. Add the problem of not enough water and it’s easy to imagine why processed foods can be difficult to eliminate.

Dozens of drugs can cause constipation. Some of the biggest offenders are allergy and asthma drugs, antidepressants, opiate pain killers such as codeine, and the calcium channel blocker drugs used to treat heart disease. In fact, one of the biggest health risks of getting hooked on pain killers is their tendency to slow and even stop the normal muscular contractions of the intestines and colon, making it impossible to have a bowel movement. If you are taking prescription drugs, ask your pharmacist if constipation is a possible side effect.

Nicotine can help stimulate bowel movements, so quitting smoking can cause constipation.

Constipation is often part of diseases such as low thyroid, multiple sclerosis, Parkinson’s, lupus and diabetes, and can be a side effect of stroke.

The single biggest cause of constipation is growing older. As we age we lose muscle mass and strength, including in the bowels. As our outsides sag and go south, so do our insides. This makes it more difficult to have a bowel movement. Again, the key to holding on to muscle mass is exercise! Getting plenty of water and fiber will help keep stools soft.

Constipation Remedies

Here are a few tried and true remedies, one of which is likely to help get you moving again.

Prunes have been keeping those over the age of fifty regular for centuries and are a sweet, healthy treat. They’re loaded with nutrients, particularly beta carotene and potassium. Three to four prunes do contain 4 teaspoons of sugar, but the fiber will help  your system process it slowly. Until you know how prunes affect you, it’s probably wise to eat two or three prunes in the evening for a morning bowel movement.

Although I’m not a big fan of using flax seeds every day, because their oils are highly unsaturated and prone to rancidity, they can work wonders for relieving chronic constipation. The best way to eat flax seeds is freshly ground (use a coffee grinder). Keep in mind that literally, the second you grind flax seeds and expose their oils to the air, they start going rancid, so don’t try to store them after grinding. They have a nutty flavor and can be sprinkled on cereal, yogurt, in a smoothie, or on a salad, for example. Use just one or two tablespoons.

The classic, and most-often used remedy for constipation is psyllium seed husk, which is inexpensive and available at your local health food store or pharmacy. Just be wary of pharmacy versions (e.g. Metamucil), as they’re often flavored with sugar or artificial sweeteners, and colored with artificial dyes. Psyllium seed husk is pure fiber of a kind that helps the bowels absorb and hold water and create a bulkier, softer stool. While psyllium is usually quite effective at relieving constipation, most people find its sticky, gelatinous texture, once it’s mixed with water, to be unpleasant.

Magnesium is often helpful for constipation: take 400 to 800 mg of magnesium before going to bed, and it will also help you relax and go to sleep. A magnesium product called CALM can be mixed with water so that you can drink it, and that seems to work even better. Milk of Magnesia is an old-timey constipation remedy made from magnesium hydroxide, but it’s not ideal because this type of magnesium blocks the absorption of iron and folic acid. Magnesium deficiency can be an underlying cause of constipation—400 mg daily is a usual supplemental dose, in the form of magnesium citrate, aspartate or oxide.

Taking too much of any of the above remedies can cause painful gas and cramping. Start small and gradually work up to the effective dose.

Colon Cleansers or Wallet Cleansers?
The so-called colon cleansers and detox formulas are very trendy these days, but most of them are simply psyllium mixed with a long list of healthy-sounding ingredients such as herbs, probiotics and aloe vera. In most cases it’s really the psyllium that’s doing the job—the rest of the ingredients are likely there in very small amounts, just for show. There’s an expression in the supplement industry—“fairy dust”—which is used to describe the common practice of sprinkling tiny amounts of ingredients, often herbs, into a product to make it seem more serious and appealing. Some colon cleansers contain flax seed, which is almost guaranteed to be rancid.

Herbs such as cascara sagrada and senna are powerful laxatives. Although occasionally useful when you know you’ll be close to a bathroom, they work at least in part by irritating the bowel, which is not a good long term strategy. There’s some evidence that long-term use of laxatives causes permanent damage to the muscles and nerves of the colon.

Unexplained constipation can be a symptom of colon cancer, so if you truly can’t track down the underlying cause of your constipation it may be wise to see a doctor, who will probably recommend a colonoscopy.

This article by Dr. John Lee, What Your Dr May Not Tell You about Colon Cancer, has a lot of great info on fiber and on preventing colon cancer.