About 20% of people with untreated celiac disease have chronic constipation instead of the classic symptom of diarrhea. As the rate of diagnosis improves, constipation is becoming recognized as a common symptom of celiac disease.
Constipation is a common problem in the general population of the United States. According to the National Institutes of Health, about 4 million people have frequent constipation. It is one of the most common digestive complaints in the United States, resulting in about 2.5 million doctor visits and 92,000 hospitalizations annually, although most people treat themselves. This high rate of constipation results in annual laxative sales of over $735 million in this country.
This article will discuss the following topics:
1. How to recognize constipation.
2. Natural remedies that have been shown to help constipation.
3. How to induce a bowel movement.
WHAT IS CONSTIPATION?
Constipation involves problems with stool formation, consistency, and evacuation. It is characterized by one or more of these features:
· Hard, dry stool or soft, putty-like stool.
· Difficult defecation.
· Infrequent defecation, less than one bowel movement per day.
· A feeling of incomplete evacuation following bowel movement.
Constipation can give rise to many different ailments including indigestion, a white coated tongue, bad breath, gas, hemorrhoids, hernia, body odor, depression, fatigue, headache, insomnia, and varicose veins.
The three main causes of constipation are abnormal bowel motility, malabsorption and dysbiosis. Each one, or all three together can cause constipation.
1. Abnormal bowel motility is altered peristalsis, where food passes through the intestine too slowly, due to ineffective muscle action of the intestines. It may take the form of spastic colon or atonic colon.
· Spastic colon is characterized by a spasms, (irregular and excessive muscle contractions of the intestinal walls), so that the muscles resist stretching and thereby decrease the diameter of the inside of the intestine. This restricts the passage of food.
Hard, dry stools are produced as the colon absorbs too much water from the slowly advancing stool. Spasms can result from magnesium deficiency, chronic stress, lack of exercise, lack of water or lack of fiber in the diet.
Spastic constipation is associated with variable degrees of abdominal pain or distress, erratic frequency of bowel action, and variation in stool consistency.
· Atonic colon is characterized by atony, (low muscle activity of the intestinal wall). Atonic means there is a lack of normal intestinal muscle tone, or strength, so that the peristaltic contractions that normally pass food through the intestine do not work effectively. This delays passage through the intestine and the bowel wall stretches to accommodate the accumulated stool.
Stools are putty-like or too soft, and even though the rectum is full, the amount of stool evacuated can be insufficient. There is usually no urge to defecate and even with effort, the result is ineffective. Over time the capacity of the colon enlarges as it gets used to more and more stool.
Atonic constipation is associated with minimal or no abdominal discomfort. Weakness in muscle can result from riboflavin (vitamin B2) and/or thiamin (vitamin B1) deficiency, lack of fiber in the diet, lack of water or lack of exercise, ignoring the urge to defecate, nerve damage due to chronic use of laxatives, or aging.
2. Malabsorption is the inadequate absorption of one or more nutrients. The resulting deficiency deprives the bowel of nutrients needed for health and function. Deficiency of thiamin or riboflavin or magnesium contributes to constipation.
Thiamin and riboflavin are vitamins that are important in maintaining muscle tone along the lining of the digestive tract and promoting the health of the mouth.
Other digestive problems of thiamin deficiency are abdominal discomfort and anorexia.
Other digestive problems due to riboflavin deficiency are sore, swollen, magenta-colored tongue with changes to the papillae (atrophied or hypertrophied), and the development of cracks and sores at corners of mouth.
Magnesium is needed for muscles to relax, thus preventing spasms in the intestines.
Vitamin A is needed for mucous production and healthy cells.
3. Dysbiosis is an imbalance between the good and bad bacteria in the intestines characterized by altered health and function of the colon. It is estimated that at any one point in time, we have 100 trillion bacteria in our intestines. 35-50% of the contents of the human colon are bacteria and between one fourth and one third of stool is composed of dead bacteria.
Good bacteria nourish the wall of the colon and produce vitamins, short chain fatty acids and proteins. They also supplement digestion, protect the body from infection and stimulate the immune system.
Bad bacteria produce toxins that cause constipation, damage the lining of the intestine, leak into the body to cause a host of health problems.
Increasing the good bacteria is possible by make the intestines a more hospitable environment by eating fruit, veggies, milk and yogurt to balance the intake of meat and refined starches.
CORRECTING CONSTIPATION NATURALLY
A digestive tract, especially one damaged by gluten, needs special attentiveness and gentle care. Intestinal tissues must be soothed, protected and nourished with healing substances. Laxatives that irritate the lining, such as bisacodyl, senna, castor oil or cascara, must not be used.
Steps for Correcting Constipation
1. Keep a diary. Note food intake and elimination for both urine and stool until you achieve healthy defecation. The idea is to be able to compare what’s going in, what’s going out, and what’s happening in your life to make coordinated healthful changes.
2. Build healthy eating habits.
· Increase whole food plant sources rich in vitamins, minerals and antioxidants, including fresh fruits and vegetables, beans and peas, whole grains like brown rice and ground corn, rice bran, seeds especially flax, and nuts.
· Limit refined starches and sugar which acidify the intestine.
· Eat 20 to 25 gm of fiber each day to tone gut muscle and regulate muscle activity and fluid absorption. The bulk and soft texture of fiber are proven to prevent both hard, dry stools and soft, pasty stools that are difficult to pass. The residue of fiber also encourages movement through the intestine to keep stool from fermenting. Fiber can be soluble and insoluble.
a. Insoluble fiber is the part of fruits, vegetables and grains that the body cannot digest thereby passing almost unchanged from the small intestine onto the large intestine.
b. Soluble fiber dissolves easily in water and takes on a soft, gellike texture in the intestines.
· Drink at least eight 8-ounce glasses a day of water and juice. If this amount of fluid intake does not relieve constipation, but instead gets passed out through the urine, then you need more fiber to hold the water in the colon.
· Coffee stimulates the colon in 29% or more of people within 4 minutes of ingestion and lasts for thirty minutes, so enjoy coffee before the movement rather than indiscriminately throughout the day. Tea is constipating.
3. Establish regular times for bowel movements so that enough stool is ready to evacuate. Some people move better in the morning, others at night. Find when is best for you.
4. Do not hurry defecation, so that all stool that is ready is actually evacuated.
5. Do not eat when under the influence of strong emotions to prevent spasms and gas.
6. Build healthy exercise habits. Regular, daily exercise helps maintain bowel function.
7. Abdominal massage can be very helpful. Work from the lower right side massaging upwards to below the ribs then across to the left side and down. This follows the path of the colon.
8. Build relaxation habits. Stress is a part of life. Learn ways to better deal with it.
INDUCING NORMAL BOWEL MOVEMENTS
1. Carminatives tone muscle and improve peristalsis, and thus aid in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.
2. Laxatives are foods or medicines that loosen the bowel. Some work by stimulating peristalsis. Others pull fluid into the bowel. Still others work by increasing the bulk of the stool.
The following foods and herbs can be used to correct or prevent constipation.
1. Atonic constipation can be helped by the following foods and herbs:
Raspberry, celery and lemon are carminatives.
Horseradish is a carminative and also a digestive stimulant in small amounts.
Carrot is a carminative and also a cleansing digestive tonic.
Grape is a carminative, bile stimulating and cleansing remedy for sluggish digestion and laxative.
Rice bran acts as a laxative with 8 grams fiber in ¼ cup. Use as cereal or in cooking.
Asparagus acts as a laxative and is also a liver stimulant.
Figs are laxative and counter habitual constipation.
Pear (ripe) is an excellent laxative and cleansing tonic.
Strawberry is laxative and also a liver tonic.
Onions a n d Garlic stimulate and improve digestion and also cleanse the gastrointestinal tract to help maintain healthy gut bacteria, prevent fermentation and tone the intestine.
Pineapple juice before eating can help stimulate a sluggish digestion. It is cleansing and nutritious, rich in minerals.
Redbeets stimulate and improve digestion and are easily digested.
Cabbage stimulates and improves digestion and is also a liver decongestant.
Coffee stimulates and improves digestion and also increases gastrointestinal activity in many people.
Artichoke stimulates and improves digestion and is also a laxative, bile stimulant and liver tonic.
Lettuce stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change. It is a cleansing, mild laxative, and useful for menstrual pains.
Tomato stimulates and improves digestion, is a mild laxative and stimulates the pancreas. The juice can be used as an aperitif.
Apple (ripe) stimulates and improves digestion and is also a liver stimulant and laxative.
Sage is a carminative, digestive, astringent, bile stimulant and energy tonic that heals the mucosa. It contains powerful antioxidants and is rich in estrogen to encourage menstrual flow. Drink as tea or use in cooking.
Thyme is a soothing remedy useful for stimulating digestion of rich, fatty foods.
Pot Marigold (calendula) is useful as a bitter to stimulate bile production and improve digestion. It is especially helpful during irregular and painful menstruation associated with constipation.
Tumeric is also a liver tonic.
2. Spastic constipation can be helped by the remedies listed above and below.
Flax seed meal swells and produces bulk. It has 2 gm of fiber/ tbsp and contains 1300mg of Omega 3-oil. It is valued for its demulcent effects (softens stool and soothes damaged or inflamed mucous membranes) to calm irritable bowel. Add to cereal and use in cooking or simply mix into a glass of water and drink.
Nutmeg is a carminative useful for abdominal bloating, indigestion and colic.
Parsley is a carminative remedy for colic, gas and indigestion.
Potatoes are a carminative, antispasmodic (due to atropine like properties) and liver remedy.
Cinnamon is a carminative and is antispasmodic.
Cloves are carminative and antispasmodic.
Dandelion is a carminative, a digestive and liver tonic, bile stimulant, and mild laxative.
Olives, Olive oil (1 ounce) is laxative.
Apricots (dried) are laxative and also immune stimulant.
Almonds are laxative, restorative and intestinal antiseptic.
Pear (ripe) is laxative and also cleansing digestive tonic. The juice can be used as an aperitif.
Chamomile, lemon balm, and fennel, (as a tea), are carminatives and also help relieve nervous tension.
Mint such as peppermint, spearmint, or hyssop, (as a tea), are carminatives and also improve digestion.
Rosemary as a tea and in cooking is a carminative and also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
Primrose oil available in the form of capsules improves stool consistency.
Physilium powder swells and produces a gel, which increases the bulk and softness of the stool.
Wine before dinner (aperitifs) or cordial liquors or brandy in hot water taken after dinner (degustives) are helpful.
Author Information: Cleo Libonati, RN, BSN, Philadelphia, PA/Englewood, FL
Cleo Libonati is president/CEO and co-Founder of Gluten Free Works, Inc. www.glutenfreeworks.com. She is the author of Recognizing Celiac Disease. www.recognizingceliacdisease.com. She can be reached at firstname.lastname@example.org.