Constipation is a topic that many people are too embarrassed to discuss with their doctors. But there’s no need to suffer in silence.

It’s widely known that infrequent and/or painful bowel movements often have relatively simple explanations—you’re not getting enough water…you’re skimping on fiber…and/or you’re too sedentary. If you drink more fluids, add fiber to your diet and get some exercise, you’re usually good to go, right? Unfortunately, that is not the case for everyone.

What you may not know: For approximately 15% of Americans, constipation is a chronic problem. This can occur if you’re taking a certain medication, such as an antacid, antidepressant or narcotic painkiller…or have a medical problem, such as low thyroid (hypothyroidism), Parkinson’s disease or multiple sclerosis, that can cause constipation.

Is a pharmaceutical laxative (pill or liquid) the next best bet? Not always. These products can cause side effects, such as bloating, cramping or gas, and may even interfere with the absorption of some medications and nutrients.

A better way: Most people can beat constipation without using a pharmaceutical. Here’s how…


If you are troubled by constipation, make sure you give the strategies below a try…

Drink up! A healthy bowel movement is about 75% water. Constipation can occur when the stool water content falls below 70%—this can cause the stool to become too hard for the body to evacuate easily.

To avoid constipation, most people need 2 to 2.5 quarts of fluids a day. You don’t need that much if you eat a lot of vegetables, fruit and other plant foods—they have a high water content that counts toward the daily total. But: If you exercise or sweat a lot, you will need more than the recommended 2 to 2.5 quarts of fluids a day.

My advice: Drink a big glass of water (or a mug of herbal tea) all at once, several times a day. Like many naturopaths, I advise against drinking fluids with meals to avoid diluting digestive juices.

• Get your roughage. Plant fibers take up space in the large intestine and cause the intestinal walls to stretch—the process that triggers intestinal peristalsis (contractions) and bowel movements.

Important: All plant fibers are good for constipation, but the water-soluble type—found, for example, in vegetables, fruits (raspberries, figs, dates and passion fruit are especially beneficial), flaxseed and beans—is particularly good because it absorbs water and can double or even quadruple in size in the intestine, which helps move things along.

My advice: Be sure to get enough fiber each day. For people over age 50, that’s about 30 g daily for men and 21 g daily for women. Those who are constipated may need even more fiber.

Avoid constipating foods and beverages. These include bananas, blueberries, fresh apricots, white rice and red wine. Generally, you would need to have these foods/drinks on a regular basis to have a problem, but sometimes having the food/drink just once causes an issue.

Walk the right amount. Walking is very effective for constipation because it stimulates nerves that trigger peristaltic activity.

My advice: To work for constipation, you need to walk for at least 40 minutes a day. If it’s more convenient, you can break it up into two, 20-minute sessions.

Note: Other types of exercise can also help constipation, but walking is the easiest and most convenient for most people.


If the advice above does not give you relief within 15 days, then it’s time to step up your game. The following tips can help—you can try all of them… 

• Heat the liver. According to the principles of Eastern medicine, a loss of heat from the liver—often triggered by fatigue or stress—causes blood capillaries to shrink…reduces circulation…and lowers production of bile, which you need for healthy digestion.

What to do: Place an old-fashioned rubber hot-water bottle over the liver—halfway down the right side of the abdomen, on the ribs under the right breast. The heat will increase circulation and cause the liver to expand, which has a stimulating effect on bowel movements.

Keep the bottle in place for about 15 to 30 minutes. Repeat the treatment up to three times a day, preferably after meals. People who do this for a month in addition to the steps above often find that constipation is no longer a problem. Or you can use the hot-water bottle indefinitely if you feel that it is continuing to help.

Self-massage. To stimulate the peristaltic muscles that push stools out of the intestine, it helps to stretch, knead and compress the intestines with self-massage.

What to do: Using your fist or fingertips, firmly rub your abdomen (the area surrounding the navel) in a clockwise direction. This mimics the clockwise direction of intestinal peristalsis and stimulates different parts of the intestine. Once a day, rub the area for five to 10 minutes, at least two hours after a meal. You will most likely start to notice an improvement in bowel movements within three or four days.

• Improve your bacterial balance. There’s an ideal ratio of bacteria in the gut—about 85% of the organisms should be “good” bacteria involved in fermentation (the dividing of food particles)…and the rest of the organisms should be “bad” bacteria that cause putrefaction (the decomposition of the particles). People who eat a lot of animal foods tend to have an excess of the second type and not enough of the first.

To restore a healthier balance, cut back on animal foods and eat more high-fiber plant foods such as fruits, vegetables and whole grains. These foods have probiotic effects—they increase levels of the fermenting organisms.

Another option: A daily probiotic supplement that provides high doses (numbering in the billions) of beneficial bacteria, such as bifidus and/or acidophilus strains. Follow label instructions.*

Strengthen the “push” muscles. Because of their sedentary lifestyles, many Americans don’t have the strength in the abdominal and/or intestinal muscles to readily generate the pressure needed for a bowel movement. This exercise can help.

What to do: Sit on the floor with your knees bent. Recline backward and rest your weight on your forearms. Extend one leg straight out in front of you…slowly bend it to bring it back to the starting position…then do the same with the other leg. Alternating legs, extend-and-bend each leg five times, then rest and repeat the cycle two more times. Do this daily. As you get stronger, increase the number of leg extensions to 10 or 20. You can extend-and-bend both legs at the same time, but it’s more challenging.

A better position. Our early ancestors squatted on their heels to evacuate. This position strongly facilitates evacuation of the bowels because it relaxes the muscles of the anal sphincter, encouraging it to open, and puts the colon in a vertical position. To achieve these benefits on a toilet, raise your feet four to eight inches with a stool.


Depending on what’s being eaten, it can take about 30 to 40 hours for food to be transformed into stools and evacuated from the body. But sometimes the body doesn’t work as intended. 

Doctors define constipation as having fewer than three bowel movements a week…straining or having hard stools more than 25% of the time…and/or feeling that your bowel movements are often “incomplete.”

*Although probiotics are generally considered safe, anyone with a weakened immune system, including those who take corticosteroids, as well as pregnant women, should check with their doctors before taking them.

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