Tens of millions of American adults suffer from chronic constipation, which is defined as a reduction in bowel movement frequency, releasing less than 3 stools per week, or the release of painful, hard to pass, dry, and lumpy stool. That means when you’re in a room of 100 people, up to 10 of those people may be sufferers of chronic constipation. If you go to a doctor with the condition, chances are they won’t be able to tell you why you have it. They may call it “idiopathic” constipation, which means there is no known cause or they may just give you the infamous IBS-C diagnosis and send you on your way with a bottle of Miralax and the prescription for a $200 laxative. But I believe there is a cause and a reason for everything, it’s just a matter of doing the hard work to dig and find out what that reason may be. There could be many, many reasons for your constipation stemming from gut dysbiosis, structural impairments, underactive thyroid function, poor diet and lifestyle, dehydration, anxiety, depression, you name it. 

This article isn’t about figuring out what’s causing your constipation (I suggest you work with a functional medicine practitioner or naturopath for that), but about me sharing a tried and true list of remedies that have worked for me. Remember that I am not a healthcare practitioner that specializes or is trained in digestive health. I’m just a gal who has dealt with this annoying, painful, and upsetting problem since I was an infant. These days, I don’t have to do much to keep things moving thanks to the autoimmune protocol, but I do currently take marshmallow root every single night, enjoy cups of warm lemon water and silver needle tea on occasion because they’re just relaxing and lovely, meditate frequently, and exercise daily. These habits have been incorporated into my daily routine and they provide a sense of structure for my ever-misbehaving bowels that I didn’t have before my journey into self-education.

So in this article I invite you to read about what has worked for me because the eyes are not the windows to the soul when you suffer from chronic constipation. It’s really the state of your poop. Having an easy time going to the bathroom on the regular makes for a happy person! Just ask any person who’s ever had to go more than 3 days without a successful trip to the potty. Remember, it’s always best to check in with your functional practitioner, naturopath, or doctor about any changes to your supplement regimen or exercise routine!

Marshmallow Root

Marshmallow Root is an herb that is most easily found in capsule form in the supplement aisle of natural grocers and health food stores. It has historically been reported to soothe and alleviate conditions such as burns, bruises, aches, gastrointestinal upset, and as an expectorant to soothe mucus membranes. It seems to work by soothing the digestive tract while providing a lubrication that allows fecal matter to more easily pass through the intestines. 

DIY: I have used the brand Nature’s Way for years and take (2) capsules in the evening with tea or water right before bedtime which amounts to a 960mg dose. Ingredients include organic marshmallow root and a plain gelatin capsule. 

Warm Lemon Water

Warm lemon water is an age-old trick for kick-starting digestive juices in the morning as well as promoting bowel movement. Whether it’s the warm water doing most of the action or the acidity of the lemon juice and subsequent release of hydrocholoric acid, a mug of this first thing in the morning can certainly do no harm. You can even try adding a little salt or baking soda to the water as Ben Greenfield suggests in this post “How to Naturally Fix Constipation”.  Wellness Mama also briefly explains 5 benefits to drinking warm lemon water in the morning in this post “The Benefits of Lemon Water”. She also has a fun recipe for homemade marshmallows using marshmallow root power (see above)!

DIY: I warm 8 to 12 ounces of water in a mug in the microwave for 60 seconds and then add the juice of 1/2 a large lemon. Drink as a coffee replacement. You may also drink room temperature lemon water throughout the day for added digestive benefit. 

Slippery Elm Powder

Slippery Elm Powder certainly has a flavor and texture that necessitate an adjustment period. It has beeen used in traditional medicine for similar uses as marshmallow root: to soothe and heal irritated tissues and membranes. It is made from ground up inner bark of a variety of elm tree common to the Appalachian Mountains. The bark has the same demulcent properties as marshmallow root, which is why you commonly see slippery elm lozenges in the natural medicines aisle at health food stores. It not only soothes the mucous membranes of the throat but also the digestive tract, helping feces pass through the intestines more easily. 

DIY: Make a tea by mixing 1 to 2 teaspoons of powder with 2 tabelspoons warm water to make a paste. Slowly stir in additional warm water until you reach a drinkable thickness. It will be more like a “gruel” and less like a tea because of its thickening nature. I avoid taking it in capsule form (whereas I find success with capsulated marshmallow root) as it seems to decrease the potency and results. It’s best to just “suck it down” (hold your nose, if need be) and know that your digestive tract should be soothed soon after. If you come across the whole bark, you can also make a true liquid tea out of it by steeping the bark in just-boiled water (covered) for 20 to 25 minutes. Start with a small amount and see how your body reacts to this version, as it may be more potent than the powder. 

Silver Needle White Tea

While I could not find much science or anecdotal-based support of my use of high-quality, organic silver needles white tea for bowel distress, it is my most cherished and #1 go-to in times of need. I first found out about this tea about two years into my Paleo journey when constipation for weeks on end was the norm for me. I visited a Chinese tea shop and spoke to the owner about my GI complaints. He immediately brewed me a cup of his silver needle white tea that he imported from his wife’s family’s farm in China. It is widely known to be the highest quality white tea on the market. It has a light, earthy, and floral taste which I love! It had been 3 weeks since I had properly gone to the restroom despite using all my normal tricks, and within 30 minutes of drinking this warm cup of tea, I was very successful! After that I bought two large bags which lasted me a year. This is the only tea I drink when my tummy is a little bloated/gassy or I need a digestive boost. It contains less caffeine than green tea but is rich in antioxidants and polyphenols like green tea. You can source a good quality silver needle tea at high-end tea shops and specialty stores. You are unlikely to find it in a typical grocery store.

DIY: Steep 1 teaspoon high-quality organic silver needle loose leaf tea in 8 ounces of 175 degree water (water that has been boiled and cooled slightly) for just 2 minutes. Remove the tea after 2 minutes and enjoy. 

Coffee

As my husband’s friend says, “coffee gets the colon rollin'”. I can’t tell you how many people in my life I’ve suggested giving up their morning coffee habit when they complain of poor sleep, waking mid-night, or overall high stress. Inevitably the answer is, “No way. How else am I going to poop in the morning?” While I don’t mind using warm lemon water or safe and natural herbs to keep things moving, the idea of using a gastric stimulant (caffeine) that is also dehydrating and sets off a hormonal cascade in our bodies just so we can do the most natural thing in the world (eliminate), peeves me just a bit. Alas, I have included it on my list because when all else fails, we need a back-up plan. Coffee of course is not autoimmune protocol compliant, but it is certainly not a poor choice. The science is mixed on whether or not coffee can be considered a health-promoting food or not, but overall many studies agree it has its benefits. I am in the camp of the like of Dave Asprey, who advocates for the use of high-quality, minimally processed, organic, and fair-trade beans. I really like his article “Why Bad Coffee Makes You Weak”. So why does coffee make some people run to the bathroom? In many people it stimulates the release of a hormone called gastrin. Gastrin is responsible for increasing GI motility as well as the release of hydrochloric acid. 

DIY: I would never make a cup-a-day a habit for those of us with a history of adrenal fatigue or chronic constipation as I feel like it can be used as a crutch or to cover up underlying issues. But if you really need to go and you tolerate coffee occasionally, it may be worth it to try an 8-ounce brew. Just make sure you know where your beans are coming from! Buy Bulletproof Coffee beans here.

Exercise

Many forms of exercise can be used to promote gut motility and create an urge to go. Anything from short 30-minute brisk walks to particular yoga positions to full on 5-mile jogs have helped your sister, neighbors, and mailman clean themselves out! It’s really not the type of exericse that matters (i.e. swimming works for me every time but may not for you) but the fact that you are moving your body from a stagnant position (i.e. sitting at a desk all day). In fact, in my job we place people who are in wheelchairs in a device called a standing frame, which allows people without lower extremity function to maintain and upright position for a duration of time. This can help my patients’ issues with constipation and even helps with kidney function and blood pressure regulation. We need that natural contraction of intestinal muscles to signal to our body it’s time to make friends with John again. A slouched seated position is the worst posture for stimulating a bowel movement! Think about how scrunched up and disengaged all those muscles are!

DIY: Make time for physical activity every single day. This can be several short-duration bouts such as 15 minute walks 3 to 4 times a day, or a dedicated hour-long walk, swim, jog, or bike ride. Obviously benefits extend beyond intestinal motility to a host of body-wide outcomes!

Meditation & Relaxation Breathing for Vagal Nerve Stimulation

You know how they say you’re so nervous, your stomach is in knots? Or you have butterflies in your tummy when you’re anxious? Or stressful situations can either make someone “go” (AND FAST) or not go at all? Stress isn’t just a mental event but a physical one that affects many functions in your body, including digestion and elimination. You’ve probably heard of the central nervous system (i.e. your brain and spinal cord) and the peripheral nervous system (i.e. the nervous system that resides in the rest of your body), but did you know you have a third nervous system called the enteric nervous system? It resides exclusively in your gut and is controlled by the vagus nerve, a long tract of uber-important nerve branches that runs from your brain, through your heart, to your digestive tract.

The vagus nerve is responsible for not only your heart rate but also peristalsis (the movement of the gastrointestinal muscles that push food/poop through to your colon and out the door). It is part of the parasympathetic nervous system (the “rest and digest” one) therefore when activated it can reduce heart rate, blood pressure, and increase digestion. But what about when it’s function is impaired? If your vagus nerve is overactive, meaning it is stimulated more than it needs to be, then you may experience frequent drops in blood pressure or heart rate, leading to fainting or even frequency of urinary incontinence. You see, you’re a little TOO at rest, in this case! If your vagus nerve is underactive, your body isn’t getting that “digest” signal as much as it needs to be. UGH! This can certainly and commonly result in constipation and when at its worse, gastroparesis, which is a painful condition of incredibly slow moving intestinal contents. Symptoms include painful bloating, weight loss, malnutrition, peptic ulcers, and heartburn. 

In more extreme cases when diagnosed by a medical practitioner, a patient with a vagal nerve disorder may undergo electrical stimulation of the nerve and treatment for gastroparesis or heart arrthymia. So what can we do about subclinical vagal nerve disruption (which can be caused by a physical stress on the body such as food allergies or leaky gut, in some emerging literature)? There are some thoughts about using meditation and relaxation exercises to stimulate the parasympathetic nervous system (which the vagus nerve is part of) and turn “off” the sympathetic nervous system (which many of us with autoimmune disease and cortisol dysregulation are constantly running “on”). I have used both hypnosis and subequently recorded hypnosis CDs, self-guided meditation, and meditative apps on my iPhone (Headspace), for the purpose of improving GI motility with success. 

DIY: What harm can a little sitting, breathing, and relaxing do? Give 10-minute daily meditation a try when you’re feeling particularly tied up in knots or make it part of your daily routine. I have been on a several day constipation binge, laid down on my bed with my meditation tapes in a quiet room for 30 minutes, and been able to go to the bathroom within an hour after that! Sometimes we really just don’t realize how anxious we are throughout the day until we lay down for some purposeful silence.