Everybody poops. Yet most people are not willing to ask questions about it to their healthcare provider. However, if you walk down the laxative/ hemorrhoid aisle at the store, you see hundreds of products and a couple of customers all the time. You will see the young man walking through the aisle like he’s lost or buying condoms for the first time. Some guy who wants to tell you all about his colonoscopy rationalizing his presence in the store. And perhaps a couple of middle aged women discussing the virtues of probiotics. For the most part, it’s a strange fraternity of hemorrhoid sufferers, GI patients, and those who have no clue about what’s going on with their bodies.
“How many years have you been dealing with this issue?” is one of the questions I ask in every patient interview. Years? Yes, years. We all have a sense of independence that keeps us out of doctors’ offices. Yet that same sense leaves us often suffering needlessly. That is especially true when we believe the symptom or condition is embarrassing or a relative inconvenience versus a true medical condition. The secret is, medical providers are not snickering about you behind your back. It is safe to say that most practitioners have pretty much seen it all so don’t be nervous, scared, or embarrassed; get those funny questions resolved. This is especially true when it comes to bowel movements.
Many people do not know or think they are constipated. If you have used or considered laxatives or stool softeners (drug or herbal), have hemorrhoids, or do not have a healthy voluminous bowel movement every day, consider yourself constipated. Think about who has nearly perfect digestive systems – babies and dogs. And how often do they normally have a bowel movement? Nearly every time they eat! So we know that if our digestive system is working well, we should be similar. It should take about one day for a bite of food to travel through the digestive system. So, the bowel movement you just had should be the meal you had yesterday at about the same time.
Regular bowel movements and a healthy digestive system are critical as they are the foundation of our immune system. Most people do not realize that most of the immune system is developed and “lives” in the gut and a slow bowel may also indicate a sluggish immune system. Interestingly, some physicians believe that inflammation is really repair deficit and the immune system is in charge of reducing inflammation. Now we know that systemic inflammation is involved in a plethora of chronic conditions and disease states including, but not limited to arthritis, diabetes, lung conditions, weight gain, cancer, cognitive conditions, and chronic pain. Healthy people have healthy stools.
1. Hydration: One of the main causes of constipation is dehydration. Interestingly, that does not always mean just drinking more. Demineralized water has a diuretic effect as does coffee and tea. Reverse osmosis or distilled water contain no minerals. The answer is pure, clean water with important minerals added to it which improves both the hydration of water into the cells. High quality charcoal filters work well too. Regarding volume, there are several “rules of thumb,” but what I have consistently found to be helpful is setting a goal of 16 ounces first thing in the morning, 48 more ounces by 1:00pm followed by an additional 32 ounces throughout the rest of the day. This applies to anyone who is 150 pounds and has two functioning kidneys.
2. Dietary fiber: Fiber is critical for constipation, but it must be approached gradually. Fiber ultimately must be increased to about 35 grams per day to ensure long-term success and relief, but excessive fiber can cause pain and even potentially make it worse which many people don’t know understand. I recommend add one “extra” fibrous serving (ideally of a food) per day for a week and then add in a second additional fiber serving in the second week and so on. Fiber containing foods include legumes (black beans, pinto beans, lima beans, lentils), nuts and seeds (almonds, pistachios, and pecans), vegetables (broccoli, peas, Brussels sprouts), and select fruits (raspberries, pears).