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.

@ kachalmers2 post and as an amendment:
Careful with the term ‘fiber’ as a fix for constipation, it CONSTIPATES, too since there a two very different forms of fiber, the one constipates, bulks and works well for diarrhoea (soluble fiber) the other one moves = against constipation (insoluble fiber). (Healthy people simply throw in both without much thought. People with other medical conditions like gastroparesis have a hard time since being allowed eating low fiber only…there is no one shoe fits all.)
If you gave your child a ‘ton of fiber’, I am sure you considered the different types, but for other readers I might please point out:. Every ‘fiber’food is made up of both types, but the % IS VERY DIFFERENT.
e.g. psyllium husk is a typical more soluble type of fiber…it bulks, but does not move, never ever take this as a cure for constipation as it is advertised to be oh so healthy and good. Yes it is, but not when you are constipated already.
Flaxseed is pretty much both, 14%soluble, 12%insoluble fiber.
e.g. Avocado on the other hand has ca 63%insoluble, 37% soluble fiber = eat it when constipated!
You eat wheat bran, but not oat bran when constipated. etc.
Well you can eat oat bran, but it is not a constipation fix, hence do not eat alone as a fiber fix and rely on it as ‘have eaten fiber, why am I still constipated’.
An apple…the skin is insoluble fiber, the fruit itself is soluble.
A good mix is important and when dealing with constipation you need to make sure to not only offer high percentage soluble fiber like a package psyllium husks from the shelf as it will backfire for sure.
DRINKING a lot of water is also important and so hard to get your child doing, I know.

When dealing with constipation you need more the ‘roughage’, the dark greens, nuts, wholemeal, seeds, skins, you need to do a good search about each food fiber % soluble vs insoluble and this is nowadays via internet really possible and accessible easily.
That’s just what I want to make sure people are aware when talking of and taking fiber for constipation.

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.

My doctor told me that Magnesium is effective because it is an irritant. I understand that it acts to increase osmosis, as does Miralax,, but I do not know the precise mechanism. I am also concerned about causing a mineral imbalance. Now the kidney question!!??!

Miralax,and now Linzess, have been prescribed for me, to increase the osmosis of water into my intestines.

I have a question for Sarah, since she is an expert on cellular function , especially the tight junction in the small intestine.
Would using Linzess, which is a peptide agonist of the guanylate cyclase 2C, allow leakage FROM the intestine as well as facilitating osmosis of water INTO the small intestine?

I had a once or twice a year problem with constipation but it would be quite severe. The doctor put me on Miralax and it worked great. I was on it for 4-5 years. I asked the doctor about the labels saying that it was only supposed to be taken for two weeks and he said not to worry. I decided to get off of it and now I was stuck with a daily constipation problem. So It appears that Miralax has made it worse and a permanent problem. I am not using magnesium daily.

Magnesium is not an irritant. Magnesium works against constipation because it’s a natural muscle relaxant.
And women need more magnesium than men because it’s connected to hormonal balance as well.

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.

Hi there.
My toddler is very similar. Since 3 months old she suddenly didn’t go. Seems she was breastfeeding it wasn’ta concern n she would go once every 2 weeks. Like a mass evacuation. Once onto food (I waited till teeth) she would go oncea day maybe when she ate a lot and I introduced food one by one and looked for reactions. I never introduced grains dairy or legumes as I was told this would help. Now at 17 months she has only just tripled her birth weight (but isnt delayed in terms of milestones). My chiro/ped seems to think it must be normal for her to go only every 2 to 3 days. Im now seeing a chinese herbal medicine guy who believes she has spleen issues and now damp heat (due to rashes and boils) and being paleo she was on a high fat diet and too high can cause damp heat. so im hoping to resolve with herbs and chinese medicine diet. So ive included white rice.
I have no idea how this gut issue happened. I birthed her drug free n she has never had antibiotics or vaccines. I give her broth almost daily. I just want to get to the bottom of this So if uve made any natural progress

Hi Hannah! Please go to Spunky Coconut and see how she dealt with her daughter Ashley’s constipation. It may be helpful to you. Good luck.

For my constipated toddler decreasing dairy was huge and he has some psyllium husk powder in his juice in the morning. Not sure how psyllium husk affects the gut but it has helped him.

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. :)

My doctor told me that Magnesium is effective because it is an irritant. I understand that it acts to increase osmosis, as does Miralax,, but I do not know the precise mechanism. I am also concerned about causing a mineral imbalance. Now the kidney question!!??!

Miralax,and now Linzess, have been prescribed for me, to increase the osmosis of water into my intestines.

I have a question for Sarah, since she is an expert on cellular function , especially the tight junction in the small intestine.
Would using Linzess, which is a peptide agonist of the guanylate cyclase 2C, allow leakage FROM the intestine as well as facilitating osmosis of water INTO the small intestine?

Hi everyone, I need some helps and it is quite urgent because my little daughter is facing constipation right now. She complaining to me that sometimes her stomach is quite pain and not feeling well all the time. She never poo for more than 4 days. I need some suggestion on those remedy that able to cure and prevent the issues. Thanks

I think you could try giving them some prunes or trying out those traditional remedies. Because I have been using on my child, it works perfectly well. Less chemical!!

I think you could trying out those traditional remedies. Because I have been using on my child, it works perfectly well. Less chemical!!

I think you could trying out those homel remedies like giving thme more fibres, vege . Because I have been using on my child, it works perfectly well. Less chemical!!

Prunes definitely can help in preventing constipation for children… i’ve tried it and it works ! bcos it provide high fibre intake for ur LO so it can smoothen ur Lo bowel movement!

I have suffered constipation since I was a teen and am now in my 30’s. I thought it was just normal and I would have to live with it. My doctors said more fibre, water, prunes, etc. Nothing worked I knew there had to be something else. Last year I began getting anxiety and panic attacks really bad. I did not realise that it was actually linked to my chronic bowel and gut issues! After not being happy with my doctor, I went to see my natropath. She ordered a Bioscreen to see exactly what the microbiol flora make up was in my gut (traditional doctors just test to find foreign not what SHOULD be in there) I found that my gut had HUGE overgrowths of bacteria and also HUGE undergrowths. So much that even if a microbiologist (such as my husband) were to debate about what is actually the normal amounts in a gut, it was so far over and under it did not matter! Finding out what the exact bacterias are is important to go on the right prescribed pro/prebiotics. Just getting the over counter ones will not cut it if there is this problem. Plus, a Biofilm Protocol is recommended to properly “take out” the over grown resistant bugs to ensure new balance. The protocol is generally at least 3 months. Part of establishing these good environment for me was switching to Paleo as the fastest way to healthy gut balance is cutting out all sugars and what breaks down to it so no grains. Since I made the switch and started on the protocol my 18 years of constipation has been gone! I do have a bad day here or there if I cheat with my diet, but I know if I am diligent and keep with the protocol and diet I am regular. My anxiety and cognitive function as improved dramatically (as much as one can have with 3 small children!) My prolapse issues have improved so much from not having that bowel pressure affecting it and also bladder spasms I used to have disappeared. Any hoo, for those long term suffers, that might be worth looking into. It has really changed my life!!!

Hi Megan: I think the company that did your stool’s “Bioscreen” is located in Australia, right?
1) Do you know about a company in the USA that runs a similar test (identifying the good bacteria and amounts of it in your gut).?
2) Who gave you the Biofilm Protocol? Would you give me an idea of what to eat and not to eat during the Biofilm Protocol?
3) Have you been told you will have the Paleo diet for life?
Thank you!

Thank you so much for sharing your experiences. I too have IBS; my gastro doctor thought it was stress, in my head, because of my age, post-menopausal, etc. I was in so much pain and now take permanent meds for the problem. The gastro doc who misdiagosed me almost killed me. I went to his boss (head of gastro in the groups of doctors) who checked me saying the hernia operation had been done in the wrong spot. I had a severe relapse four days later which required emergency surgery done for a strangulated hernia and colon. I survived, but now suffer from constipation and must take dlb+ doses of Miralax daily. I’ve also been hospitalized twice because I too was told by an ER doc and the original gastro doc I was “full of ____!” I’m hoping tonight I don’t have to go to the ER, but nothing seems to be working. So, we’ll wait. Not glad to read about so many people with the same problem, but now realize that IBS and prolapses of the bladder and rectal wall are misdiapnosed often through lack of empathy, education, believing the patient, and ICD 9 CM coding (insurance must cover the doctor’s diagnosis and the patient’s complaints). Even my urologist doesn’t tie the IBS problems with bladder and kidney problems. Unbelievable!

Great article, was wondering what you thought of triphala or Dr.millers holy tea for gut motility?. I have sibo and prokinetics, acidophilus, magnesium , enzymes, 5 htp, acv, and iberogast just don’t seem to really be doing enough. I follow a scd/low fodmap diet and do eat jasmine rice (apparently o.k.according to mark pimentel)…thoughts?

How about psyllium seeds? I see that psyllium husks are regarded as not Paleo, (though they seem to suit me well) but that psyllium seed or seed powder is regarded as OK. I can’t do whole seeds because of diverticular disease. Seeds trigger attacks for me, and the seed powder isn’t available where I live, so for the moment I stick with the husks and use inulin as a prebiotic to take with it.

What I really don’t get is why eating Paleo causes constipation in the first place. It’s sooo frustrating to try to eat what’s healthy for my gut, only to have it make me really constipated! I just don’t get it. It’s doesn’t seem to get better with time, either. But as soon as I add back in grains, I can go again. If I take enough magnesium to get moving, it makes me really sick to my stomach. This is my biggest obstacle to trying to fix my leaky gut. I’m not sure if it’s worth the health trade off to do a glycerin suppository every day or not. I’ll give the ACV and ginger a shot, but making little changes hasn’t helped much in the past. If I eat Paleo, my gut feels better but my hormones are screwed (my period disappears and I have insomnia) and I’m constipated. If I don’t eat Paleo, my gut stays messed up. So discouraging.

A great way to deal with constipation is to prevent it from happening. I wrote a recent article on constipation and I do believe it should do wonders in preventing constipation from happening.

Your series on Paleo and AIP have been very helpful so thank you for that. You’re one of the best bloggers on curing the gut, probably because you’ve experienced these issues first hand. I’m very grateful. Sorry for this long post – my question is: While it’s known that lectins and other inflammatory foods cause constipation for some people, how exactly do they do this? I know that maldigested carbohydrate largely escapes digestion and feeds bacteria, causing gas especially in the case of SIBO. Is it the gas itself that causes constipation? This is what I’ve experienced since going Paleo / AIP. The less gas, the less constipation.

The only study I know of that directly links constipation and gas is Mark Pimental’s studies on methane, but I believe he only found a correlation, i.e. no proof that gas itself caused the constipation. He believes that methane acts like a neurotransmitter. I’ve experienced 2 types of constipation: the “traditional” type from too much meat / not enough veges or water where the stool is in the lower colon and takes ages to evacuate (but when it does it’s complete) and the second type, what I call the inflammatory type: where the stool is incomplete, very broken / mushy and usually there’s a lot of gas as well. This was what I used to have when eating refined starches, wheat, fructose, FODMAPs etc. Evacuation took hours.

Is it the gas from carbohydrate malabsorption causing the constipation? I’d appreciate it very much if you could shed some light on this.

Thanks for the article and the comments, all helpful. I haven’t been on paleo but 2 was started getting constipated. Took 2 magnesium tablets, added a little salt in my water and it helped within 30min. However, my question is if you are constipated does it keep you from losing weight and how long does it typically take you to lose weight with the PaLeo eating? I want a life style change but I am also wanting to see the weight come off so any information is helpful. Thank you

Oh no! What kind of nerve damage? Have you found a way to fix it? I am sure I have the same…. i’ve gone years with barely being able to go and having to use mag citrate miralax and enemas. What have you done to fix your constipation issues? AIP diet has not helped me too much with the constipation although it has helped a little.

Medically speaking, constipation usually is defined as fewer than three bowel movements per week. Severe constipation is defined as less than one bowel movement per week. There is no medical reason to have a bowel movement every day.

I used to have constipation issues, but i started taking a supplement that keeps me regular. I have a bowel movement EVERY DAY since I started taking the Lady Soma Fiber Cleanse. I take them for about 2-3 weeks out of the month. I do not always need it every day, but it has totally regulated my system.

Yes, if you use Senna Leaves too much, they will make your constipation worse. they are meant to be used in the short term. For me, I use the Dr Max Powers 15 Days Cleanse. I DO NOT TAKE IT FOR 15 DAYS!!! I only take two pills the day i have constipation, and maybe the next day. NO MORE. And then I dont take it for a month, as you dont want you body getting used to it. A bottle lasts me about a year, and for the last year I have barely had any problems.

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