Constipation Q and A

What is a normal bowel movement?

Colour: Medium to dark brown. Bile produced by the liver and secreted by the gallbladder has a yellowish green colour that gets converted into the characteristic stool brown colour by bacteria in the gut on the way through. If stool is light or clay coloured, sometimes there is inadequate bile production or flow. If stool is yellowy it may mean that stool is passing through the digestive tract too quickly for bacteria to break the bile down and turn it brown.

Diameter: Normal stool diameter is approximately 1-2". Very narrow stool can signify inflammation in the bowels that should be addressed.

Consistency: Stool should be firm but not hard nor loose and there shouldn't be any undigested food in it. Undigested food can be from a lack of digestive enzymes, low stomach acid, or overly rapid transit time i.e. stool is passing through too quickly to be properly digested.

How often should I go?

At least once per day every day, any less than that is constipation. People in great health will sometimes have a bowel movement 2-3 times per day. Every time you eat, your entire intestinal tract will contract and release, a process referred to as peristalsis. Peristalsis moves everything in the intestinal tract along which should prompt a bowel movement.

What if there is blood when I have a bowel movement?

Constipation can often cause harder stools that are more difficult to pass. This can lead to tearing and blood. If the blood is bright red and just a bit on the toilet paper when you wipe it's probably nothing to worry about, but if it's more than that, if it persists or if it's dark in colour you should mention it to your medical doctor.

What about mucous?

Mucous is a sign of inflammation. Bowels can be inflammed by food intolerances or sensitivities, mechanical irritation or infection. In any case, chronic inflammation of the bowel is not a good thing so if you see mucous regularly, best to see your naturopathic doctor for assistance.

Should it float or sink?

The constituents of the bowel movement will determine whether it floats or sinks, it is not a reflection of whether the bowels are healthy or not.

What causes constipation?

There are a number of factors that can cause constipation:

1. Food sensitivities/intolerances - most people have food intolerances that they aren't aware of but that do cause problems like skin rashes like acne, eczema and psoriasis, irritable bowel syndrome symptoms like constipation, diarrhea, bloating, gas, mucous in the stool, rectal itching, rectal leaking, headaches, fatigue, joint pain, sinus congestion or recurring sinusitis, vaginal irritation not related to yeast, environmental allergies, asthma, arthritis and autoimmune disorders like Hashimoto's thyroiditis or lupus.


2. Dehydration - water helps keep stool softer and easier to pass. Inadequate water intake will mean harder stool that's more difficult to pass. Getting at least 6-8 glasses of water per day is a pretty easy way to fix constipation problems.


3. Dysbiosis - dysbiosis is overgrowth of unwanted organisms in the digestive tract and not enough good bacteria to keep the bowels healthy. Some people try to restore probiotics through eating yogourt, however dairy is a very common food sensitivity and there's no way of knowing how many good bacteria you are getting per serving of yogourt. I recommend use of a good quality probiotic where you know what strains of good bacteria you are getting and in exactly what quantity.


4. Inadequate bile production or flow - the liver produces bile and the gallbladder secretes it when prompted to do so by stomach acid emptying from the stomach. Bile is a bit of an irritant to the gut which prompts contractions to move it along and get it out.


5. Other irritants - coffee and tea can act as irritants to the bowel. For some people this helps keep their bowels more regular, although this is not a healthy way of maintaining regularity. Irritation from coffee and tea can also cause inflammation in the digestive tract that inhibits proper bowel movement.


6. Low stomach acid - stomach acid is the trigger for bile release from the gallbladder and bile stimulates bowels to move. Heartburn, fullness after eating a small amount, burping, belching, upper abdominal bloating and difficulty digesting protein rich foods like eggs, can all be signs of low stomach acid.


7. Inadequate magnesium intake - magnesium helps hold more water in the stool keeping it softer and easier to pass. It also helps with muscle relaxation which may allow bowels to relax and let stool through easier.


8. Wheat bran - wheat bran is touted as being helpful for constipation and many find it does help. However because it acts to relieve constipation by irritating the bowels, regular scraping of the bowels with wheat bran is not recommended and can cause more long term damage.