Written By: Dr. Diane Fulton

While constipation can be caused by many things, there are natural alternatives to relieve this uncomfortable and sometimes painful condition

Constipation is generally described as having fewer than three bowel movements per week or the passage of hard, dry stools. It affects nearly 16% of adults and 30% of those over 65.[i] The top 10 causes of constipation are:[ii]

Irritable bowel syndrome

Eating disorders

Lack of fiber

Too much dairy

Antacid medicines with aluminum hydroxide or calcium

Other medications such as antidepressants and blood pressure drugs

Overuse of laxatives and pain-relieving opioids

Illnesses such as Type 2 diabetes, Parkinson's Disease, Multiple Scelrosis, Hypothyroidism or Gastrointestinal Diseases

Stress

Pregnancy

The medical community agrees that the first treatments for alleviating constipation should be lifestyle changes -- plenty of water, exercise and fiber.[iii],[iv] Certain fiber-rich foods -- flaxseed, kiwi, psyllium and figs -- as well as probiotics and prebiotics have been found to be among the best natural laxatives.

1. Stay Hydrated

Water is essential to your body's natural functions. Dehydration can cause chronic constipation because if you don't have enough water in your body, the large intestine soaks up water from your food waste, which gives you hard stools that are difficult to pass.[v] In general, drink eight cups of water per day, but increase liquids during exercise and hot weather since you can easily get dehydrated.[vi]

2. Be Active

People who exercise regularly generally don't typically develop constipation. Exercise helps constipation by decreasing the time it takes food to move through the large intestine and lowers the amount of water your body absorbs from the stool, which affects the hardness of your stools.

Aerobic exercise accelerates your breathing and heart rate, which stimulates the natural squeezing of your intestinal muscles. So add a regular walking plan to help your digestive system function at its best and then consider aerobic exercises like running, jogging, swimming or bicycling and weight training to keep your muscles strong.[vii]

A total of nine randomized controlled trials involving 680 participants engaging inqigong, walking and physical movement exercises were reviewed and the results showed significant benefits of exercise for improving constipation symptoms.[viii] Increasing exercise to improve constipation may be more effective in older people, who tend to be more sedentary, than in younger people.[ix]

3. Eat High Fiber Foods

Nearly 95% of adults in America eat a low fiber diet.[x] One of the best and easiest ways to increase fiber is to be sure to have lots of whole fruits and vegetables in your diet. Typically, adults need between 20 and 25 grams of fiber a day depending on their age for their health.[xi]

Legumes such as chickpeas, lentils and beans are fiber-rich vegetables that help prevent constipation.[xii] Leafy greens like spinach, kale and cabbage are fiber-dense foods that also add magnesium, which keeps water in your stool, softening it and enabling quick movement through your system.[xiii] Fruit fiber found in berries, mango,[xiv] mulberry,[xv] peaches, apricots, prunes and raisins[xvi] increases your regularity and prevents constipation.[xvii]

4. Flaxseed

Flaxseed is a strong fiber that's a highly effective natural laxative. In a study of 53 constipated Type 2 diabetes patients who received 10 grams of flaxseed pre-mixed in cookies twice per day or placebo cookies for 12 weeks, the group eating flaxseed had improved constipation symptoms, weight and glycemic and lipid levels compared to the control group.[xviii]

In another study using either 10 grams of flaxseed or psyllium or a placebo in cookies, 77 constipated patients with Type 2 diabetes ate the cookies two times a day for 12 weeks. Both fiber groups --flaxseed and psyllium -- performed better than the placebo but flaxseed was superior in improving constipation, weight and glycemic and lipid control than the psyllium.[xix]

Randomly assigning 90 constipated subjects to either 50 grams per day of flaxseed flour with meals or 15 milliliters per day of a lactulose solution every morning for four weeks, the bowel habits in both groups significantly improved, but the flaxseed was more effective than the lactulose at improving bowel frequency, bowel movements and life quality for those with chronic functional constipation.[xx]

5. Kiwi Fruit

Recruiting 33 constipated patients and 20 healthy volunteers for a four-week treatment of kiwi fruit twice daily, kiwi fiber was found to effectively relieve chronic constipation, improve bowel habits and decrease the number of days laxatives were used.[xxi] A total of 32 participants were enrolled in a 16-week study with subjects receiving either three kiwifruits or 14.75 grams of Metamucil (five grams of dietary fiber) per day for four weeks followed by a four-week washout (baseline) between treatments.

The number of bowel movements per week was significantly greater during daily consumption of three kiwifruit compared with the baseline and the Metamucil treatments. Kiwifruit produced softer stools and less straining, abdominal pain, constipation and indigestion.[xxii]

Fifty-eight moderately constipated participants were randomized to kiwifruit extract or placebo for a three-week period with results showing significant increases in defecation frequency, improvements in fecal score and less defecation/abdominal pain in the kiwi treated group with no side effects of diarrhea, urgency or abdominal pain -- symptoms of irritable bowel syndrome.[xxiii]

In another study of 28 participants, healthy and constipated groups all used two kiwifruit-derived nutritional treatments as well as a placebo and results showed the kiwi interventions significantly increased the mean daily bowel movements compared with the placebo.[xxiv]

In a recent study comparing prunes, psyllium and kiwifruit in 78 patients with chronic constipation, psyllium and prunes were more effective than kiwifruit in terms of alleviating symptoms related to constipation, but patients were not able to tolerate them as well as kiwifruit, and kiwi was effective in over 40% of the patients.[xxv]

6. Figs

In a trial of 40 subjects with functional constipation -- less than three bowel movements a week, hard stools and difficulty passing stools -- patients received either a fig paste -- approximately three figs -- or a placebo paste for eight weeks. The fig group experienced a significant reduction in colon transit time -- from 63 to 38 hours -- and softer stools versus the placebo.[xxvi]

7. Psyllium

In research of 24 healthy and constipated patients, psyllium supplementation increased stool water and was associated with significant changes in microbiota, most notably in constipated patients.[xxvii] In a trial of 132 gastroesophageal reflux disease patients with functional constipation, psyllium alleviated constipation, which improved the reflux disease and its recurrences comparably to those given omeprazole, a common treatment drug with significant side effects.[xxviii],[xxix]

In patients with chronic idiopathic constipation, a comprehensive literature review of psyllium versus wheat bran research showed that psyllium was 3.4 times more effective than insoluble wheat bran for increasing stool output.[xxx] Psyllium husk treatment was compared to a placebo in 54 constipated women of reproductive age and psyllium effectively alleviated constipation symptoms by altering gut microbiota.[xxxi]

8. Probiotics

Probiotics add different strains of bacteria to your gut, which help make you healthier and are linked to improvements in constipation. Probiotics can be found in the food you eat like yogurt, fermented milk (kefir), sauerkraut, kombucha, tempeh and pickles or in supplements.[xxxii]

In a study of 135 constipated adult women taking 100 grams of kefir versus a control for one and two weeks, the kefir treatment was highly effective compared to the control for stool frequency, defecation condition and stool consistency in adult women with constipation for both periods of consumption.[xxxiii]

The probiotic Lactobacillus reuteri and magnesium were compared against a placebo in 60 children, who were 6 months to 6 years old, and both treatments were significantly more effective than the placebo in managing functional constipation. However, the probiotic was easier on the microbiome, or gut microbes.[xxxiv] A mixture of probiotics -- bifidobacteria and lactobacilli -- were given to constipated children ages 4 to 16 years for four weeks with very positive effects on constipation too.[xxxv]

A total of 11 clinical trials with 13 probiotic treatments including 464 subjects were meta-analyzed and showed probiotics decreased intestinal transit time, with greater effects in constipated or older adults and with certain probiotic strains compared to controls.[xxxvi] Similarly, in a meta-analysis of 14 studies representing 1,182 patients, probiotics significantly improved whole gut transit time, stool frequency and stool consistency.[xxxvii]

9. Prebiotics and Synbiotics

Prebiotics serve as food for the healthy bacteria in your gut and are found in onions, garlic, leeks, chicory root, honey, apples, asparagus, bananas and Jerusalem artichokes. Synbiotic means a combination of prebiotics and probiotics.[xxxviii],[xxxix]

In a meta-analysis of five trials involving 199 patients who were administered prebiotics and eight studies involving 825 patients administered synbiotics, prebiotics increased weekly stool frequency and improved stool consistency. Synbiotics significantly improved stool frequency, consistency and whole-gut transit time as well.

Galacto-oligosaccharides and fructo-oligosaccharides with probiotic combinations (synbiotics) had the strongest effects on symptoms related to constipation.[xl] In a study of 297 obese patients experiencing constipation during a weight loss program, those using synbiotics improved constipation, whereas those who used drug laxatives once a week had a worsening of constipation symptoms.[xli]

A synbiotic -- fermented milk with multiple probiotic strains and prebiotic fiber -- or a placebo was given for four weeks to 120 Parkinson's disease patients with constipation and the synbiotic was superior to the placebo in improving constipation.[xlii]

Choosing Natural Laxatives and Healthy Lifestyles

The first lines of defense for constipation are simple lifestyle changes -- staying hydrated, exercising and eating more fiber-rich foods. Certain natural fibers, probiotics, prebiotics and synbiotics are strong natural alternatives for those suffering from chronic constipation and stubborn symptoms.

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