Are You Crankypated? - Help For Constipation

I don’t know about you but my day can not really begin until I have had a poop.  Not just any poop but a #4 poop on the #2 chart.  If you don’t know what I am talking about stay tuned.  In this article we will look at what constipation is, why it can happen, how we can tell if we are constipated (it isn’t just about hard to pass stool) and then of course what you can do about it.

What is Constipation?

Many think that constipation is when you don’t poop or you poop but it is hard to pass.  Constipation is not just about infrequent bowel movements but rather the inadequate emptying of the bowels and the undesirable symptoms that manifest as a result. Ideally we are pooping at least once a day but if you poop well every other day and feel great and feel empty then that is not necessarily a bad thing. What does pooping well mean?  As we said earlier, a good poop should feel complete and satisfying and should be a #4 on what I call the #2 chart.  The Bristol Stool Chart is a graphic you can use to evaluate your poop.

#3 is pretty good but here is the crazy thing…you can be a #7 and still be constipated.  Many people think that they can’t possibly be constipated if they have loose stools but often times diarrhea can be a result of a really big ‘log jam’ as Dr Will Bulsiewicz, author of Fiber Fuelled says.

What Are The Symptoms of Constipation

Gas and bloating are the two most common symptoms of constipation. Constipation causes gas and gas causes constipation.  This was shown in research – methane gas slows bowel motility and peristalsis and transit time.

Some of the other symptoms are as follows;

Not pooping

Incomplete emptying

Abdominal pain (lower left quadrant is most common spot

Belly button pain (usually gas pain)

Fatigue

Brain fog

Crankypated

Food sensitivities

Diarrhea

Feeling full quickly

Nausea, queasiness

Loss of appetite

Heart burn

If you are not emptying completely, the colon will send a message to the body that there is ‘no room down here’ so the stomach stops emptying and instead of sending things down it will send things back up which leads to nausea, queasiness, loss of appetite, heart burn, and feeling full very quickly.

What Are The Causes of Constipation

There are so many contributors to constipation that are often missed when exploring why you aren’t pooping well.  A very commonly overlooked contributing factor is medications and supplements. The medications most likely to contribute to constipation are narcotic pain meds, tramadol, antihistamines, anti-spasm, antidepressants, antipsychotic, and blood pressure meds. Some supplements that are linked to constipation are calcium, aluminum, and progesterone.

Another commonly overlooked link to constipation is the thyroid.  Individuals who have been diagnosed with hypothyroidism will often experience constipation.  Most of these people are women and most of these women actually have the autoimmune condition called Hashimoto’s that presents the same as hypothyroidism.  Of note here, many of the symptoms of hypothyroidism and hashimoto’s are also similar to perimenopause symptoms.  It is important to work with a care provider who understands the nuances and will test for it.  A full thyroid panel should include TSH, T3, T4, reverse T3, TPO and antibody) and TGA (an antibody).

Other diseases and conditions that are linked with constipation are diabetes, parkinsons, MS and disordered eating.

A common reason why some disease states contribute to constipation is because of slow motility. When things aren’t moving through you, you get gas and bloating and when you have gas and bloating things don’t move through you. You need to get things moving and the root is often poor gut health and/or pelvic floor dysfunction like pelvic dyssynergia or rectocele.

A fun way to test your transit time (how long it takes for food to move through you) is with the blue poo test.I first learned about the blue poo test from @dr.rachelfobert when I interviewed her on my Podcast. I of course had to try it. The blue poop challenge was developed by a group of researchers at Zoe ( a healthcare science company) with an aim to provide people with important information about their gut health. To take part in the blue poop challenge, you simply need to eat two muffins dyed blue for breakfast and then wait to see how long it takes to see blue (or bluey green) poop in the toilet. (the muffin recipe can vary but the most important thing is to use the correct amount of royal blue food coloring.)

ZOE studied 863 people who took the challenge and found that the average time between eating the muffins and pooping blue was 28.7 hours. The researchers then compared each person’s transit time with the microorganisms in their poop. In their published study, the researchers found that shorter gut transit times were associated with better overall health, a healthier gut, healthier responses to food, and less abdominal fat. A shorter gut transit time — the time between eating the muffins and seeing blue poop — could indicate better gut health. Longer transit time could indicate an unhealthy balance of gut bacteria, which may indicate that changes in diet and lifestyle may be beneficial to a person’s gut health.

I messed up the test at first because I made the muffins in the afternoon....and couldn’t resist trying them so I ate 2 muffins at 5pm...and my poop was blue the next morning at 7:45 am. The next morning, I ate 2 more and then the following morning (24 ish hours later) I pooped blue again. So my transit time is between 14-24 hours. Not bad I guess!

When I shared this post it went viral – over 7 million views and counting at the time of writing this article! 

The most common comments were…’why not beets?’, ‘why not corn?’, ‘why not sesame seeds?’ I learned that only 14% of people get red poop and pee from beets.  The corn and seeds may interfere with the true transit time so blue dye is preferred.  People were freaking out about the blue dye and I found myself saying ‘this is just a test’ a lot.  I don’t eat foods with dyes very often and I am not suggesting this is a healthful thing to do.  It is a test that is easy to do and is kinda fun and can tell you a lot. 

Here is the recipe that I used

How Can We Overcome Constipation?

Fiber

The first thing people think about when they want to overcome constipation is fiber and while fiber is super important, it can also make things worse for some people.  It is important to get things moving first and then play around with fiber to find your magic amount.  Generally speaking, we want to aim for between 25-35g of fiber.  I highly recommend reading Fiber Fuelled.

Hydration

Hydration is essential when it comes to optimizing our poop.  I recommend 2-3 liters of water per day and it can also be beneficial to add in some electrolytes. Without optimal hydration our poop will be dry and will not move along very well. 

Exercise and Movement

Pooping well requires optimal digestion, foods, hydration and movement.  If we are sluggish and not moving, our bowels will be too.

Establish A Rhythm

Our bowels love routine.  Having a set bedtime and wake time is important and leaving time in your mornings to poop will really help.  Waking up, hitting snooze several times and then rushing to get out the door or onto your first zoom call will not foster the state we need for our bowels to eliminate.  Drinking ½ liter of water, perhaps warm water with lemon can help.  Caffeine is known to simulate a bm for many and even the process or anticipating the coffee or first meal can help.  Digestion begins in the brain with the sigh of food or drink.

Don’t Ignore The Urge

If we delay voiding after we have the urge, the poop that was ready to be eliminated will stay stuck, not allowing other waste to pass and will become dried out which will make the void harder.  When you feel the urge, find a toilet and ‘let that shit go’.

Pelvic Floor Physical Therapy

If the reason why you are constipate is because of anatomical issues or tight muscles, working with a pelvic floor physical therapist is essential. (I argue that even if you are not constipated it is essential but if you have been following me for awhile, you already know that). Releasing tension, improving a rectocele, and helping optimize potty posture are all helpful.

Squatty potty

In an ideal world all toilets would have a squatty potty (I like to call it a stool stool) to help elevate the knees above the pelvis.  This relaxes one of the pelvic floor muscles called the puborectalis which will ‘unkink the hose’ so to speak and allow for easier elimination. I have used backpacks, suitcases, stacks of towels, stacks of toilet paper rolls and upside down trash cans when I didn’t have my porta squatty with me.

Supplements

There are several herbs and supplements that can promote optimal gut health and may also help you establish a rhythm with your bowel movements. Prebiotics like acacia powder, psyllium husk, and guar gum are great – these are what feed the probiotics in the body. Probiotics are well established to help with gut health. My favorite probiotic is Poophoria and it includes Turmeric which can help support inflammation, Aloe vera which is known to support digestive health, Slippery Elm which is a prebiotic that helps increase mucous secretion to lubricate bowels and Inulin which is a prebiotic from chicory root that can help promote more frequent bowel movements and better stool consistency.

Magnesium citrate or oxide are known to help with constipation and magnesium bisglycinate can also help promote relaxation which in turn may help with digestion and elimination.

Laxatives and Stool Softeners like Colace or Senna can play a role in helping you establish a rhythm and can also help when you travel and your rhythm gets disrupted.

Optimal digestion and pooping can not be overlooked as an integral part of managing our pelvic health.  Hydration and constipation are the first things I address in my community always. Wishing you daily poophoria!