Treating Constipation without Destroying Your Gut

May 29, 2012 in Categories: , by

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Perhaps you are wondering how on earth I am going to address this topic delicately.  The answer is:  I can’t.  It’s an impossible task and I’m just plain old going to be frank, cross over into TMI territory, and talk about poop.  Although, I will spare you the drawing of a constipated stick figure. Perhaps you are wondering exactly why this is even a worthy topic for my blog.  Well, constipation is a relatively common complaint during the adjustment period when people first transition to a paleo diet (as is diarrhea, but that’s a topic for another day).  And even the best of us can suffer constipation on occasion as a result of stress, eating foods we shouldn’t, and traveling.  But perhaps more relevant, you may be interested in how to treat constipation if you have some type of gut pathology than lends itself to constipation or if you suffered nerve damage caused by years of chronic constipation like I have.

Before discovering paleo, I had chronic constipation for about as long as I can remember.  I was officially diagnosed with Irritable Bowel Syndrome in my early twenties and prescribed daily doses of stool softeners and laxatives.  As a result of 12 years of irregular bowel movements, constipation and laxative use, I have nerve damage that may never fully heal.  Transitioning to a paleo diet allowed me to stop taking these medications; however, I do need to be constantly vigilant.  And, because I have a (thankfully, fairly minor) case of Small Intestinal Bacterial Overgrowth, the two chief symptoms that I get when I consume sugary or starchy foods is bloating and constipation.  The first time after transitioning to a paleo diet that I was faced with the need to take something to help me poop, I did a little research into what was safe to take.  I was shocked to find out that most of the commonly used laxatives and stool softeners available are gut irritants and can directly damage the lining of the gut (in fact, for many of them that is actually how they work!).  Since my diet and lifestyle choices now prioritize gut health, I needed to know what is safe to take for constipation!

I will spare you the long exhaustive list of what not to take (except perhaps to make sure to tell you that I include natural, senna-based laxatives, including teas, in the gut irritant list as well as fiber supplements of any kind).  Here are the ONLY treatments that I recommend:

  1. Use a squatty potty every day.  The better angle for pooping decreases straining, and makes pooping easier and more comfortable.
  2. Milk of Magnesia (or another high dose magnesium supplement like Natural Calm), taken at bedtime in conjunction with LOTS of water.
  3. Glycerin Suppositories
  4.  In extreme cases, you may wish to try a Saline Enema in addition to milk of magnesia.

But there are a few other tricks that are helpful as a preventative and also for minor constipation.  This may seem obvious, but make sure that your diet includes plenty of plant matter and make sure that you are drinking sufficient water (this is the most common cause of constipation in individuals following a paleo diet who do not have a history of digestive problems).  It’s also very important to make sure that you have a source of probiotics in your diet, whether it’s from fermented foods or a supplement.  Taking 1-2 Tbsp of Lemon Juice or Raw Apple Cider Vinegar 10-15 minutes before each meal can help with the secretion of digestive enzymes and decrease transit time.  Avoiding starches and sugary foods that feed bacteria and contribute to hunger hormone disregulation can be very helpful for some people (especially those who suspect they have Small Intestinal Bacterial Overgrowth).  Sauerkraut can be very helpful in regulating stomach acidity as well as providing probiotics.  Ginger is a miracle.  It helps regulate stomach acidity, stimulates peristalsis, and decreases transit time.  I drink several cups of ginger tea daily (my favorite brand is Yogi), and when I need a little extra, I like to eat alot of homemade honey-candied ginger (especially because the honey doesn’t aggravate my SIBO due to its monosaccharide content).  Exercise can be very helpful, especially something like going for a nice long walk.  Doing alot of spinal twist yoga poses can help too.  For a simple one, lie on your back with your legs bent and your arms out in a T position.  Drop your legs to the left, leaving your shoulders on the floor, and look to the right.  Hold for a good five minutes and then do the other side.

These paleo-friendly strategies work well if you are proactive and take some action after skipping just a couple of days of bowel movements (my rule of thumb is if I skip two days, but I have to be very careful, so depending on who you are, you may consider anywhere from 2 to 4 days as your metric).  Here is the important caveat though:  whether you are dealing with constipation as part of a greater pathology or the occasional reaction to traveling, food, or stress, you need to know when the gentle paleo-friendly strategies are not working.  There comes a point where problems caused by severe constipation are far worse than the gut irritation caused by taking a laxative.  Constipation can even be life threatening.  Please, do not hesitate to see a doctor if your attempts to get your bowels moving again are not working.  And don’t do what I did in grad school and wait two full weeks and then have to spend a night in the ER (where the very helpful resident diagnosed me as “full of shit”, his exact words).  I am still paying for the nerve damage that caused now.


[…] Treating Constipation without Destroying Your Gut » The … – Before discovering paleo, I had chronic constipation for about as long as I … I have nerve damage that may never fully heal. Transitioning to a paleo diet allowed me to stop taking these medications; however, I do need … It is helpful in getting relief from constipation without being in … […]

Magnesium is the best!!! I take small quantities throughout the day to avoid the effects of *too* much magnesium (ahem), but it absolutely does work. It also calms the nerves. It can even wipe out bladder pain, for those who suffer from IC.

[…] 4. Eat plenty of fat and make sure you’re digesting it well.  What I mean is that you need to make sure you’re getting enough fat in your meals, but you also might want to supplement with digestive enzymes.  (As a side note, lemon juice and apple cider vinegar also apparently stimulate bile production and release, as noted by Sarah Ballatyne, who recommends taking 1-2 Tbsp 15-20 minutes before each meal.) […]

Would you recommend Magnesium citrate? If so, is it safe to take long term or should it be a short term solution? I was going fine on an almost paelo diet but since cutting out 2-4 oatcakes a day and upping my egg consumption have been having real problems! Been an issue for years pre diet change as well :)

The “Natural Calm” referred to in the post is magnesium citrate. I don’t know about long term vs short term use. I’m curious about that, too.

Hi! I’m excited to learn about the squatty potty. I want to get one for my 11 year old who really struggles with chronic constipation. She’s been on Mirilax for a few years now for the most part and I hate to give it to her. We tried the natural route by trying to get her to drink a lot and eat a ton of fiber but she got so backed up that it was quite traumatic for her so we went back to mirilax. Anyhow, my question is what size squatty potty we should get for her — 7 inch or 9 inch. Our toilet is about 15 inches from rim to floor and it looks like because of that we should order a 7″. But with her having shorter legs than an adult, would the 9″ one keep her in more of a squatting position than the shorter one? Please give me your thoughts. Thanks! ~Katie

I have seen the taller one recommended for younger children or shorter adults, as it does facilitate a better squatting position.

Hi Sarah! Thank you so much for this information! If you don’t mind me asking, what kind of nerve damage did you experience from the constipation? I’m asking because I have severe eczema and have been constipated for a few months now and just started Natural Calm, enemas, and yoga for digestion (which are definitely helping) over the past few days. My eczema (which is on my face, neck, chest) now has stinging nerve pains 24-7. It’s unbearable. Do you think it’s possible that nerve pains in my upper quarter could possibly be caused by the constipation? We’re your nerve pains in the skin or internal?

It’s possible one of those new parts of your routine is causing the pain. I would speak to my healthcare provider about alternatives and to investigate what’s going on with those pains. – Christina, Sarah’s assistant

Sounds like a great idea. I was under the same assumption regarding Magnisium. Have been taking daily for a couple of years now and have been regular as clock ( I have always had cronic constipation ). The only problem is you have to keep upping the dose as years go on. I WAS FEELING LIKE SUPERMAN, until the kidney problems started as a result of the Regular Magnisium. Wow believe me wish this wasen’t true, but keep looking for a differnt solution or you won’t just be constipated but also very sick on dyalisis.

I have tried most of these remedies, aside from the apple cider vinegar, and still nothing is helping my toddler go. Her naturopathic doctors recommendation is high dose magnesium & vitamin C, prune juice, raisins, white grape juice, and aloe drink. Nothing is helping. We even got her off paleo and introduced more grains & nuts to see if it helped. Any experience with persistent toddler constipation? She has had stool testing, which showed a very high level of commensal bacteria but nothing that explained this.

I would investigate food sensitivities in your child. Diagnos-Techs makes an inexpensive test that is mediated via secretory immunoglobulin A and tests for soy, dairy, gluten & egg. I can find it locally via a compounding pharmacy.

Can a child consume apple cider vinegar? My son is 7 and his gastroenterologist is wanting to hospitalize him for his constipation. I take ACV and think it could help him too.

I am just curious what you think of a natural prokinetic such as Iberogast, which is a bunch of herbs that help with transit time. I have IBS-C and I believe my SIBO has come back and this has been helping. I am a little concerned about long term use, but I have not read anything bad about it. I had tried triphala previously and it only worked for about a week, so I discontinued. I have not built up a tolerance with Iberogast yet and I have been taking it for about 6 months now. I also take Calm, the magnesium powder, an that helps also. Thanks!

Great article, very good info to chew on ;)
I’ve had digestive issues for years, too. This is very awkward and embarrassing, but I use maximum strength stimulant laxatives. I hate the bloated feeilng, but I know this isn’t the best thing for me. I see that you recommend milk of mag? Is that a better long-term solution than what I’m taking right now?
Thanks so much for your help!

I take Natural Calm every night before bed, helps me sleep and in the morning no problem “going”. Before i introduced Natural Calm, I had damaged myself, and was starting to despair ever being pain-free down there again..can’t say enough good things about Natural Calm. :)

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