In this episode of The Dr. Rob Show, we discuss the common issue of constipation, which affects approximately 2% of the population in the U.S.  and tends to affect women and the elderly most often.

The common advice is to drink more water and consume more fiber, but this is often ineffective.  Also, mnay of the OTC options are only short-term solutions and can be harmful in the long run.

What is constipation?

Fewer than three bowel movements per week
Hard, dry and small bowel movment
Hard to pass stools
Incomplete bowel movement
Can be painful
Aggravate hemorrhoids

Constipation can Cause:

Dysbiosis with candida overgrowth leading to leaky gut,
Bloating
Weight gain
Sluggish,
Bloated
Acne

What causes constipation?

Genetics
Overburended liver
Medications
Coffee (caffiene)
Alcohol
Refined carbohydrate and sugar
Lack of fiber - 6 grams is US daily average

Medical conditions:

Hypothyroid
Adrenal insufficiency
Endometriosis
Irritable bowel syndrome
Chronic fatigue syndrome
Depression
Fibromyalgia
Stress--sympathetic overload with reduced parasympathetic

Common advice: (In most cases this does not work)

Exercise
Drink more water
Increase fiber.  In most cases this does not work and can make worse

Treatments to alleviate Constipation

Look for underlying disease or conditions
Stimulants (coffee)
Osmotics
Surfactants
Bulk agents

Stimulants: decrease the absorption of water and electrolytes from the bowel and irritates the lining.  Common medication is bisacodyl (dulcolax).  Natural herbs are Aloe and Senna. Coffee. addictive

Osmotics: increase water in the stool.  Medications are usually lactulose, it does contain lactose and polyethylene glycol (PEG) - (Miralax).  Magnesium citrate is a great osmotic but in heart failure patients and renal insufficiency patients may have a concern.  Magnesium add calcium with it and use as a 1:1 ratio to reduce gas.  Vitamin C included but monitor dose for diarrhea.

Surfactants are commonly prescribed such as ducosate.  These are stool softeners--increase the mixture of fat and stool.  Can use coconut oil or increase oils in diet.  Surfactants do not usually work alone.

Bulking Agent : This increases mass of the stool.  non-soluable fiber, psyllium, cellulose.  Not always recommended because of risk of obstruction.  Also causes bloating, gas, pain and more constipation, especially if you are not drinking a lot of water.

For medication induced constipation such as opioid pain medications: will need to use a combo of stimulating and osmotic.

Natural Treatments:

Stop coffee / alcohol
Stop Senna / Cassgarra
Increase food fiber (fruits and veggies) - pear has 7 - 9 grams
Choose a non pysllium fiber source
Magnesium citrate (use 400-800 mg at night before bed)
Cal / Mag 1:1 ratio  (use 2 to 6 cap at night before bed)
Buffered Vitamin C Powder (use 1-2 tsp at night before bed)
Probiotic (take 1-2 caps daily)
Liver support (improves phase II detoxificaiton)
Adrenals support (take 1 cap twice daily, morning and noon)