How to Manage Constipation

Updated: Sep 25, 2020

It is estimated that 16% of Americans suffer from chronic constipation (1). The frequency doubles once a person reaches sixty years of age, to 33% of adults having constipation.

Definition of Chronic Constipation

Constipation is defined as bowel movements that are difficult or infrequent, hardness of stool, or a feeling of incomplete evacuation. Currently, there is a standard of two or more of the following symptoms that an individual experiences for 3 or more months without the use of laxatives:

  • straining with defecation more than 25% of the time

  • lumpy or hard stools more than 25% of the time

  • incomplete elimination more than 25% of the time

  • two or less bowel movements per week

Healthy bowel movements should be daily. It is important that if you are only having a bowel movement every couple days, you should meet with a health professional to discuss interventions to help promote daily, regular bowel movements.

What Triggers Constipation?

Constipation can be triggered by a variety of factors, including:

  • Stress

  • Medications

  • Low-Fiber Diet

  • Depression

  • Poor Digestion

  • Hormone Imbalances

  • and more...

There are health conditions also associated with constipation, including irritable bowel syndrome, crohn’s, colon cancer, diverticulitis, and ulcerative colitis.

Other reasons for constipation can include slow colon transit or dehydration. If muscles in the GI tract are tightened it can prevent the natural movement and contraction that allows for excretion of waste. If the body is not properly hydrated, the colon cannot pull enough water into the GI tract to allow for transit to occur.

Since there are many different factors and symptoms of constipation, the medical community has defined as two types of constipation: primary and secondary.

  • Primary constipation can be caused by slowed transit time or an obstruction in the GI tract. Primary constipation typically causes symptoms of pain and/or straining during defecation.

  • Secondary constipation is due to diet, hydration, medications, lack of exercise, laxative abuse, or other causes.

Additional Symptoms

Many of my clients who are suffering from constipation also experience symptoms of

  • Bloating

  • Pain

  • Nausea

  • Fatigue

  • Fullness

  • Anxiety

  • Acid Reflux

While we can treat these symptoms, the most important focus is still on naturally promoting daily, healthy bowel movements so that the root cause of these symptoms can be eliminated.

What Can You Do

Most clinicians agree that the first place to start is adequate fiber in the diet, adequate fluid intake, and exercise. If you have already tried these interventions and you still suffer from constipation, there is another underlying condition triggering your constipation. 

Now we say increase fiber, but what does that look like and how can you do it without worsening symptoms? In a randomized study, more than 60% of patients reported adverse effects, primarily constipation or diarrhea, after treatment with bran or psyllium fiber. There are gentle alternatives to fiber supplements including: aloe, okra, and marshmallow. Increasing fiber naturally in the diet is also important.

Fiber can be found in all plant foods, including: vegetables, fruits, grains, legumes, nuts, and seeds. See list below on high fiber foods.

For hydration, you should try to drink at least half your body weight in ounces of water. What does that look like? If you weighed 200 pounds you will want to try and drink 100 ounces of water daily. Foods that contain a good amount of water include fresh fruits and vegetables, as well as soups or smoothies.

Elimination Diet is another option for finding what triggers your constipation. Working with a dietitian is the best way to implement a successful elimination diet. Two of the most common foods linked to constipation include gluten and dairy.

Activity helps to promote natural movement of the GI tract. Walking brisk, or at a reasonable pace for any physical limitations is a good place to start. You can also start a routine of massaging your belly to stimulate movement.

Supplements for Constipation

  • Magnesium Citrate or Oxide –250mg to 400mg, preferably at bedtime

  • Slippery Elm capsules or powder

  • Aloe Vera Juice –1 to 2 tablespoons with water or juice, 1 to 2 times daily

  • Ground Flax Seeds or Psyllium Fiber –1 to 2 teaspoons daily

  • Senna tea or tablets, preferably at bedtime

Constipation Elixir

12 oz water or prune juice with 1 serving of Metafiber (Metagenics). you can make into a smoothie with ¼ cup berries and 1 teaspoon of flax oil.


Eating 2-3 prunes, either stewed or soaked in water for about 10 minutes before eating. This is not a quick fix, but if you continue to follow for a couple days you should start to see the beneficial effect.

Other foods that provide soluble fiber include:

  • Pear

  • Apple

  • Apricot

  • Walnut

  • Almond

  • Carrot

  • Beet

  • Okra

  • Sesame seed oil

  • Spinach

  • Banana

  • Cauliflower

  • Cabbage

  • Papaya

  • Peas

  • Coconut

  • Sweet potato

  • Asparagus

  • Fig

  • Oat bran

Important Note

It is important to note that fiber and supplements have the potential to make symptoms worse if too high of a dose. Start small with ½ dose and work your way up. A good rule of thumb for increasing fiber is to increase only 5 grams fiber every 2-3 days. Water intake should always be increased along with fiber and supplements.

If you have additional questions, feel free to reach out to me at

Live Healthy & Happy

Dietitian Liz


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