Constipation. It’s a punchline of a word that can set off giggles, but when you’re experiencing it, it’s anything but funny. Uncomfortable and unpleasant, constipation gets in the way of normal life, leaving you wanting to eliminate the problem as quickly as possible.

That wish for a quick fix often leads to seeking ‘relief’ via laxatives, which come with issues of their own – think cramps, nausea, unpredictable results and panic should the drugs start to take effect when you’re far from the facilities. Safe to say, most of us have found ourselves in this predicament at one time or another, and while occasional constipation isn’t that unusual, frequent bouts are. They’re also your body’s way of letting you know it’s time to pay more attention to how you’re treating it, what you’re putting in it and what may be missing. Think of constipation as a message, and if you choose to ignore it, chronic gastrointestinal problems like diarrhea, IBS, leaky gut and inflammation are very likely to follow.

So, how to cut constipation off at the pass and minimize recurrences? Here’s my in-a-nutshell guide to flushing constipation out of your life:

Multiple backups can make you sick.

When you think of constipation, you probably think, ‘Ugh, I can’t wait to get this out of me,’ rather than, ‘this is damaging my insides.’ But, unfortunately, frequent constipation disrupts your beneficial gut bacteria, weakens immunity and undermines your health, both physical and mental. With run-of-the-mill type constipation, abdominal discomfort, bloating and hard stools are typical and unpleasant, but for those with chronic constipation, more serious problems can emerge, like painful hemorrhoids, anal fissures (which may require a surgical fix) and, as a number of studies indicate, an increased colorectal cancer risk. But what’s ‘normal’ and what’s not in terms of how often? Though everyone’s system is a little different, if you’re having fewer than 3 bowel movements a week, you’ve got some dietary recalibration work to do.

What’s messing up your pipes?

While there are many reasons constipation can be a recurring problem, one of the most common causers I see in my practice is an unbalanced microbiome, or ‘dysbiosis. That can mean too many “bad” gut bacteria in the wrong place or too many not-so-helpful bacteria overwhelming the “good”.  

Frequently, this dysbiosis takes the form of SIBO, or small intestinal bacterial overgrowth. (Generally speaking, you want most of your gut bacteria working for you in the colon, not further up in the small intestine.) If it’s not SIBO, it may be its fungal cousin SIFO, or small intestinal fungal overgrowth. Either type can leave you feeling lousy and constipated. But, the bigger problem with this kind of dysbiosis is that it interferes with your body’s ability to extract and use the nutrients from food, setting you up for increased gut permeability or ‘leaky gut.’ And where leaky gut goes, constipation, IBS symptoms, brain fog, skin eruptions, mood issues and auto-immune problems follow. (Kind of the definition of a vicious cycle!)

The tricky part here getting the proper diagnosis as these symptoms are tough to tease out. So, you’ll likely need to push your doc to do some detective work to rule these two out. With SIBO, in-office breath and stool tests can offer some good diagnostic clues.  With SIFO, a history of multiple courses of antibiotics can offer up big clues, as well as symptoms of fungal rashes on the skin (typically, skin-meets-skin areas like under-the-armpits or the breasts) or recurrent vaginal yeast infections or thrush on the tongue (look for a white coating).

Once your SIBO/SIFO status has been determined, then it’s time to shift the focus to amping up the dietary and lifestyle habits that will keep your pipes clear.  

Beware those run-of-the-mill pipe-cloggers.

What you eat and drink obviously has a significant impact on how well your digestion works, and how well it’s processing what you put in it. While easily digested foods like soups, salads, smoothies and non-starchy veggies like leafy greens will pass through the system relatively quickly, a chicken parmesan with a side of vino may clog your pipes for days – so always make an effort to keep your diet as clean as possible to keep constipation at bay. In practice, that means a lot less of these top constipators:

• Alcohol – its dehydrating properties make stools hard and tougher to move thru the digestive tract.
• Baked goods – like breads and sweet treats like cakes, cupcakes and cookies that are virtually fiber-free, and loaded with sugar.
• Dairy items – particularly cheese, milk, ice cream, whose high levels of lactose can be difficult to for the body to break down.
• Fried foods and/or processed foods – few nutrients, little or no fiber, and virtually nothing that contributes to healthy digestion.
• Red meats – which can be slow to digest and tough for the GI system to process.

Other troublemakers include stress, poor sleep, lack of exercise – any or all of which can slow digestion and elimination to a crawl. Dehydration, prescription meds, opioid painkillers and even drugstore items like laxatives (particularly if they’re over-used) and ibuprofen can also constipate. Yes, it’s a minefield out there!  

The process of elimination can help you I.D. the culprits.

It’s simple: Eat crap, feel like crap – and get constipated. To start de-constipating, dump processed, slow-to-eliminate Frankenfoods and fill up on real, unprocessed, whole foods. Go for farmers’ market or organic leafy greens, colorful veggies, grass-fed meats, pastured poultry, wild (pole-caught) fish, nuts, nut butters, good fats and low-sugar fruits. Go easy on grains, dairy and quick-digesting carbs which can be major pipe-cloggers for some folks. Remember, digestion begins in the mouth, so what you put in it will have a huge impact on digestion’s final product and how long it sticks around.

Let’s say though, you’re doing the dietary thing right, but still having trouble identifying what’s stopping you up. If that’s the case, then it’s time to try an elimination diet. An elimination diet involves a two-week program of cutting out foods like sugar, gluten, dairy, soy, caffeine, and ‘FODMAPs’ – a group of foods that may cause gut issues for some. After the initial two-week period, you can slowly reintroduce foods one at a time to see which ones trigger problems and which don’t. For some people, it may be as simple as eliminating dairy to alleviate their constipation issues, while others may need to avoid multiple food groups to find relief.

Give your gut bacteria a daily feast.

You know what your gut bacteria love to feast on? Prebiotic, plant fiber-rich foods like leafy greens, cruciferous vegetables, low-sugar berries, nuts, and legumes. These foods provide many of the essential nutrients that help make your good gut bacteria thrive – which in turn keeps digestion on an even keel. For an extra boost, add a high-quality probiotic supplement to introduce additional beneficial bacteria into the mix. Getting your fill of prebiotics and probiotics will help keep digestion on track and waste will be eliminated easily and more regularly, no strain, no pain.

Seek out constipation-combatting supplements.

If you’ve taken a few laxatives in your time, you already know they’re rough on your system and can be quite unpredictable. The good news is theres little need to put yourself through all that when there are plenty of kinder, gentler, more natural ways to ease constipation without going near an OTC ‘remedy.’ Try these healthy helpers the next time you feel things starting to get sludgy:

1. Magnesium – In the citrate or oxide form, magnesium works by softening hard stools and relaxing the bowels to help get things moving again. Follow label dosing instructions, slowly increasing the dose until the desired effect is achieved.
2. Aloe vera— Add aloe vera juice to a smoothie or drink it straight up to take advantage of it’s stool softening effect. One or two daily tablespoons should do the trick.
3. Triphala – Though you may not be familiar with it, those in Ayruvedic circles have been using this well-tolerated fruit-based powder to ease constipation for thousands of years. You can find it in most health food stores in powdered, liquid or pill form.

Balance your fluids – and drink up.

OK, life gets busy, so you probably don’t spend your days thinking much about your fluid intake. But if constipation is an issue for you, you might want to keep a closer eye on it – and that goes double for those who rarely feel thirsty. Fluid intake matters, and drinking plenty of water keeps stools softer and easier to pass.  

Be especially aware of your fluid balance if you sweat a lot, work outdoors, live in a hot climate or often fly cross-country or internationally. Hydrate with water, seltzer and herbal teas. Steer clear of dehydrating caffeinated drinks, cocktails and beer, or sports drinks like Gatorade which are full of artificial ingredients and sugar.

Embrace the constipation fighters.

To keep constipation at bay 24/7, try a few of these easy, everyday habits to keep help digestion and elimination on track:

EAT:

1. Improve digestion by adding 1 tablespoon apple cider vinegar and/or bitters to a glass of water, before and after meals.
2. Chew fennel seeds or infuse them into a tea for sipping.
3. Add flaxseeds and chia seeds as toppings for soups, salads, breakfast bowls and as a smoothie ingredient.
4. Dig into more healthy fats, like olive oil, avocados, nuts and seeds.
5. Think prebiotic foods at every meal – and don’t chop off those fibrous stalks and stems – eat them!

DO:

1. Move daily, not only to stay fit but also to stimulate the rhythmic contraction and relaxation of the digestive pipes that pushes waste products through the system. (Peristalsis is the technical name.)
2. Add yoga twists and poses, gentle abdominal massage (use clockwise strokes while lying down) to your daily routine.
3. Add a few acupuncture sessions to stimulate the meridians that can help promote healthy digestion.
4. Train (or re-train) yourself to poop on a schedule, roughly at the same time each day.
5. Optimize your elimination ergonomics, by elevating your feet with small wooden stool, over-turned bucket or Squatty Potty while on the toilet.
6. Meditate daily to relieve stress, too much of which can trigger and/or exacerbate constipation issues.
7. Do get things moving by taking magnesium citrate before bed to aid elimination in the morning.
8. Drink enough (caffeine-free) fluids to ensure your urine is straw-colored (bright yellow indicates you’re not drinking enough, while no color means you’re overdoing it).
9. Don’t ‘hold it in’ or ignore the urge, as doing so disrupts regularity.
10. Avoid over-the-counter meds, antacids, or supplements with a lot of iron which contribute to constipation problems.