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:
- Use a squatty potty every day. The better angle for pooping decreases straining, and makes pooping easier and more comfortable.
- Milk of Magnesia (or another high dose magnesium supplement like Natural Calm), taken at bedtime in conjunction with LOTS of water.
- Glycerin Suppositories
- 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.