Every year Canadians spend almost a billion dollars on laxatives and yet constipation is still on the rise. Conventional medicine gives little attention to what usually proves to be a chronic functional condition–constipation that is not symptomatic of any underlying disease such as bowel cancer.

The Physician’s Manual for Patients offers the misleading assurance that "daily bowel movements are not essential to health." Herbalists such as myself strongly disagree. We feel that not one but two or three bowel movements a day is ideal for health maintenance. Instead of automatically suggesting you pop a pill or herb to make the problem go away, we consider constipation a symptom of deeper lifestyle problems. We try to identify underlying causes and make changes that will get your bowels moving and improve your overall health in the bargain.

Virtually everyone, even those with cast-iron stomachs, suffer bouts of constipation from time to time as a reaction to stress, erratic meals, illness or jet lag. In addition to pain or discomfort, constipation often produces a bloated feeling, as the bowels have become distended with gas and liquid, not to mention the surplus of stool. Stools can be hard, causing straining and hemorrhoids. The extended transit time of elimination can contribute to colitis and inflammatory bowel syndrome.

Lifestyle Changes

Chronic constipation is a symptom deserving of more than just another round of laxatives. Identify and treat the major lifestyle causes and most cases will disappear. Your entire body-not just your bowels-will thank you for it.

Fibre: the key to treating and preventing constipation is eating a high fibre diet and drinking plenty of water. We need at least 30 grams of fibre a day, yet the average North American diet provides only about 10 grams.

The British Medical Journal recently stated that "fibre increases stool bulk, holds water and acts as a substrate [catalyst] for colonic microflora," all of which "decreases transit time, reduces intracolonic pressure and produces a softer stool." You need both soluble and insoluble fibre in the diet. For a laxative effect, insoluble fibre found in wheat bran, whole grains, beans and raw fruits and vegetables (brussels sprouts, cauliflower, corn, apples, berries, figs, pears) is what the doctor ordered. One cup (250 ml) of kidney beans provides almost six grams of total fibre. One cup of oat bran offers four grams.

Food allergies and sensitivities: pasteurized cow’s milk is the most common culprit here, especially in children.

Water: drink six to eight glasses a day. Insufficient fluid intake can contribute to the hard stools that cause so much misery.

Exercise: exercise stimulates the peristaltic action of the colon (the wavelike contractions and dilations that expel waste matter) and decreases emotional stress, itself a cause of constipation.

Feelings: emotional upset and anxiety can go straight to the "stomach" and provoke ulcers, diarrhea and constipation. In some serious cases, peristalsis becomes extremely weak and the colon, severely dysfunctional.

Posture: another type of stress, the misalignment of the spine, can also contribute to constipation. Lumbar spinal adjustments by a chiropractor may be helpful, as may other forms of bodywork.

Medications and other chemicals: hundreds of common medications can be constipating. The worst offenders are opiates and derivatives of nightshades (atropine, scopolamine). Bismuth and iron salts as well as exposure to certain toxic metals (arsenic, lead, mercury) in air, water or food can also promote constipation.

Coffee: because they stimulate nerves that increase intestinal contractions, coffee and other sources of caffeine are strong laxatives. But when used addictively, these beverages and drugs prevent the bowel from following its natural rhythms. Not a good thing.

Helpful Supplements

Perhaps you’ve attended to the basic causes of constipation and still have a problem; or your bowel movements are fine but you want to go a step further to promote your gastrointestinal health; or you’re just looking for a harmless quick fix for that isolated case of pre-exam constipation. The following gentle, natural remedies are effective.

Acidophilus supplements feed the growth of "friendly bacteria," which decreases transit time by maintaining more moisture in the digestive tract.

Insufficient levels of digestive enzymes-hydrochloric acid, pancreatic enzymes and bile salts-can cause constipation. Digestive enzyme supplements are the solution when eating cooked food. Enzymes are still intact in unheated fruits and vegetables.

The dietary mineral magnesium is "hydrophilic," meaning it draws water into the bowels. This makes magnesium a natural stool softener. Chlorophyll is an excellent source of magnesium, be it in liquid tablet or green drink form.

If you’re still not having regular bowel movements, try herbal laxatives. Basically there are two types. Lubricating bulk laxatives that include demulcent (soothing) herbs such as psyllium and flax seed. These comparatively nutritious herbs work like a sponge. By swelling up with absorbed fluid, they act as an "intestinal broom."

The second type is purgatives, including aloe, senna, rhubarb, leptandra, buckthorn and cascara. These often contain bitter principles in the form of anthroquinones, which work by stimulating the peristaltic action of the intestinal lining either directly or by promoting the secretion of bile through the liver and gall bladder. Use these strong herbs only for short periods of time (for example, to do a cleanse) and in combination with gentle, aromatic herbs such as anise, caraway or fennel.

It is important to realize that there is always a cause behind an effect. Constipation is an effect. Taking a laxative does not touch the cause. In most cases, simple lifestyle changes do work. When they don’t, it’s generally best to try the gentlest agents, such as acidophilus, digestive enzymes and magnesium, before bringing out the heavy herbal artillery.