Constipation is a pervasive struggle and one that can be challenging to resolve because of its complexity.

This guide is intended to help you take impactful action for relief.

There are five main parts to this guide:

1. A verbal and visual definition of constipation
2. Foods to eat for constipation relief
3. Anatomical and physiological considerations
4. The most common causes of chronic constipation
5. How to identify the root cause of your constipation

This guide will help you take action on the things that are within your control and direct you toward additional help when it is beyond your control. 

What is constipation?

Before we can talk about how to resolve constipation, we first need to define constipation.

Constipation is defined as having two or more of the following symptoms with at least 25% of bowel movements:

• Straining 
• Lumpy or hard stools 
• Sensation of incomplete evacuation
• Sensation of anorectal obstruction/blockage
• Manual maneuvers to facilitate
• Fewer than 3 defecations per week

Another way of identifying constipation is via the Bristol Stool Chart. A visual aid that classifies poop into seven categories based on appearance. It tells us about transit time – how fast or slow the food you’ve eaten moves from mouth to anus. 

Passing a bowel movement that matches Type 1 or 2 on the chart below indicates constipation. It’s normal for there to be occasional episodes of constipation. However, if it is a common experience for you, it should not be ignored and warrants further investigation.

Foods to eat for constipation relief:

Before we jump into this topic, I want to clarify that diet isn’t the only factor to consider in resolving constipation. However, it is a critical piece of the puzzle, and it’s the first place to start. 

Vitamin C rich fruits and vegetables

Vitamin C is crucial to digestion and has the added benefit of boosting your immune system. Unabsorbed vitamin C acts as an osmotic, drawing water into your intestines and softening your stool. The adult body’s requirement for vitamin C is about 65-90 mg. Reaching the saturation point at which vitamin C can have an osmotic effect isn’t difficult if you are eating various vitamin C rich fruits and vegetables.

Here are some of the best sources:

• Guava: a single fruit contains 126 mg of vitamin C
• Sweet yellow bell peppers: 1 cup contains 150 mg of vitamin C
• Kiwi: 1 fruit contains 70 mg of vitamin C
• Kale: 1 cup chopped contains 80 mg of vitamin C
• Lemon: 1 fruit contains 83 mg of vitamin C
• Strawberries: 1 cup contains 89 mg vitamin C
• Broccoli: 1 cup cooked contains 100 mg vitamin C
• Kakadu plums: this Australian superfood contains 481 mg of vitamin C per little plum – this is the highest known concentration of vitamin C in an edible plant
• Acerola cherries: 820 mg per half cup

Some individuals with chronic constipation may need to use 1,000 mg of supplemental vitamin C twice per day to get things moving. I recommend using food as your primary vitamin C source and temporarily adding supplemental vitamin C if that’s not quite cutting it. 

Magnesium-rich foods

Magnesium is a mineral that also acts as an osmotic and can signal peristalsis – the contraction of muscles that moves stool through your digestive tract. 

It’s one of the most common nutrient deficiencies in adults due to modern industrial agriculture practices that deplete our soil. Your daily requirement is 400 mg.

The best food sources of magnesium include:

• Black Beans: 120 mg per 1 cup, cooked
• Spinach: 150 mg per cup
• Beet greens: 100 mg per cup
• Peas: 70 mg per cup
• Tofu: 53 mg per 3.5 oz
• Pumpkin seeds: 150 mg per oz
• Dark chocolate: 64 mg per oz

Magnesium is the active ingredient in laxatives like milk of magnesia. You can skip all the additives in those products by just using supplemental magnesium citrate. Start with food first and consider supplemental magnesium as a secondary option. 

Whole food sources of fiber

I specify food sources of fiber rather than supplemental fiber found in fiber powders, bars, cereals, and shakes because these processed forms can frequently worsen constipation. Whole food sources of fiber come with just the right balance of water-soluble and insoluble fibers essential for easing constipation. 

You’ll notice many of the foods listed above also contain a fair amount of fiber – this is the brilliance of mother nature. All whole foods come packaged with a combination of nutrients that promote health in a variety of ways. Supplements and processed foods cannot do this. 

Aim for a minimum of 25-30 grams of fiber from whole foods daily. If you currently are eating very little fiber, you will want to slowly work your way up to that goal to avoid unpleasant symptoms. Be sure to drink plenty of water as you increase your fiber intake.

Best sources of fiber from whole foods:

• Beans, legumes, peas: 8-12 grams per cup
• Fruits: about 5 grams per tennis ball sized serving 
• Vegetables: 4-6 grams per cup
• Potatoes (with skin) & other root vegetables: about 4 grams per 1 cup serving 
• Whole grains: about 3 to 6 grams per half-cup
• Chia seeds: 5 grams per 1 tablespoon

Healthy fats

Fortunately, the low-fat craze of the ’90s is long over, and most people are aware of how essential fats are to health. 

Healthy fats like olive oil, olives, avocado, oily fish (wild-caught salmon, mackerel, herring), nuts and seeds, etc., stimulate the gallbladder to release bile, which stimulates intestinal motility leading to a bowel movement. 

The critical thing here is to avoid unhealthy fats like vegetable oil, corn oil, soy oil, canola oil, cottonseed oil, trans fats, and other highly processed oils that increase inflammation.

Probiotics

Probiotic-rich foods contain an unfathomable number of living microorganisms that have beneficial effects on our health. The benefits range from improved digestive symptoms to a stronger immune system! 

Most studies have focused on the beneficial impact of Bifidobacterium and Lactobacillus species in improving the frequency of bowel movements and softening stools to make them easier to pass (1). Still, there are likely many more species present in the fermented foods we eat that provide benefit. 

To take full advantage of these microbes’ power, consider adding a daily source of living unpasteurized probiotic-rich foods to your diet. Here are a few ideas to get you started:

• Kimchi
• Refrigerator pickles
• Sauerkraut
• Water kefir
• Kombucha
• Yogurt 

A note of caution for those individuals dealing with histamine intolerance – fermented foods are a high histamine food source and will worsen symptoms. Best to avoid them until you’ve resolved the source of your histamine intolerance.

Anatomical and physiological considerations

Let’s move on from diet to anatomical reasons for constipation. Beginning with the longest cranial nerve in your body, the vagus nerve. 

The gut-brain connection via the vagus nerve

The vagus nerve is responsible for activating the parasympathetic nervous system, responsible for rest and digest. When the vagus nerve is not firing correctly, the brain cannot send the appropriate signals for digestion, a condition known as poor vagal tone. Poor vagal tone is a significant cause of slowed motility leading to constipation. 

To improve vagal tone add one or two of the following to your daily routine:

• Sing loudly: this will activate the muscles at the back of your throat, stimulating the vagus nerve. 
• Gargle: do this hard enough that your eyes start to tear, which will activate the vagus nerve.
• Do yoga: in addition to stimulating the vagus nerve, yoga decreases stress and builds muscle. Bonus if your instructor leads the class through chanting Om, as chanting can also stimulate the vagus nerve.
• 4-7-8 breathing: inhale fully for 4 seconds, hold for 7 seconds, and exhale slowly for 8 seconds. This breathing technique is also a powerful tool you can use to fall back asleep.

Pelvic floor dysfunction

Pelvic floor dysfunction (PFD) refers to the impaired relaxation and coordination of the pelvic floor and abdominal muscles during pooping. Ruling out pelvic floor dysfunction requires a visit to a medical professional trained in its assessment and treatment. Biofeedback is to be very effective at helping treat PFD.

Sleep duration

People who sleep more or less than the recommended 7-9 hours per night report significantly more constipation than normal sleepers, based on data from 14,590 adults (2). This highlights one of many important reasons to get enough sleep. 

The most common causes of chronic constipation

If addressing nutrition, sleep, and vagal tone doesn’t result in improvements to your constipation, you may want to consider the following possibilities.

Constipating Medications

Medications are one of the most common and obvious reasons for chronic constipation. The frequency of use plays the most significant role in how constipating they are likely to be.

• Ibuprofen, naproxen and other non-steroidal anti-inflammatory drugs
• Benadryl, Zyrtec, Allegra and other antihistamines
• Iron supplements
• Blood pressure medications
• Opioid pain relievers
• Tricyclic antidepessants
• Urinary incontinence medications

Gut Infections

Gut infections can occur anywhere from the stomach to the large intestine. The most common gut infections that can lead to constipation are caused by:

• Parasites: Blastocystis hominis, Giardia lamblia
• Bacteria: Helicobacter pylori, Citrobacter, Clostridium difficile, Klebsiella pneumonia
• Yeast: Candida albicans

These gut infections are commonly acquired from:

• travel abroad
• food poisoning
• exposure to contaminated water
• or in the case of Candida albicans after a course of antibiotics 

Antibiotics and dysbiosis

Antibiotics wipe out native species of beneficial bacteria that would otherwise hold organisms like Candida in check. After a course of antibiotics, opportunistic yeast, bacteria, and pathogens can proliferate, further altering the gut microbiome’s commensal balance. These microbiota shifts can cause yeast infections, bloating, abdominal pain, constipation, and diarrhea (3).

Although people more commonly associate a gut infection with diarrhea, constipation is also quite common and tends to be more challenging to reverse. This is because pathogenic bacteria release neurotoxins that damage the nerves that signal peristalsis (4). Peristalsis is the contraction of the muscles that move food through the gastrointestinal tract. 

A weakened immune system from chronic Lyme disease or toxic mold exposure may also make a person more susceptible to gut infections. 

Intestinal methanogen overgrowth (IMO)

Intestinal methanogen overgrowth is an overgrowth of methane-producing archaea in the small or large intestine. The methane they produce slows transit time, resulting in constipation. It is common for people with IMO to experience unexplained weight gain, abdominal bloating, excessive burping, and even increased food sensitivities. 

Food sensitivities

Food sensitivities often occur as a result of the conditions discussed in the two points above, and they can also be a cause of constipation. 

Regardless of whether they are the root cause of your constipation, they will need to be addressed to resolve symptoms fully. That might look like:

1. Identifying food sensitivities using a quality food sensitivity test, such as Mediator Release Testing or an IgG panel
2. Removing reactive foods for some time while utilizing a gut healing protocol so that you’ll eventually eat these foods again without symptoms. 

Take note: for some, the removal of dairy products can bring quick relief of constipation. 

How to identify the root cause of your constipation

Testing provides a clear roadmap to healing by identifying the root cause of your constipation. Guessing doesn’t work and usually results in a lot of wasted time and effort. 

I use the following tests to help clients get clear on what’s causing their symptoms:

• Stool tests that identify gut infections and provide detailed microbiome analysis
• Breath testing for SIBO and IMO
• Mediator Release Testing or IgG panels for food sensitivities

If you are struggling with constipation (as you probably are if you read the whole way through this), use this guide as a tool to make adjustments to nutrition and lifestyle that are within your control. If those changes do not resolve your constipation, reach out for support and testing to get to the root cause. 

If you would like more information on using probiotic supplements to support digestion, including for constipation relief, click the link below to get my free probiotic guide.