Constipation Update 
By Walter Sorochan Emeritus Professor San Diego State University

Posted April 18, 2016; updated October 17, 2021. Disclaimer  The statements have not been evaluated by the FDA or Health Canada. The information provided on this site is not intended to diagnose, treat, cure or prevent any condition or disease. Statements are not meant to replace the recommendations of a qualified physician. Due to varying conditions from person to person some of the information described on this site may not be appropriate for some people. 

 We do not totally understand constipation but we can feel it when we have it!  


Vested Interests

This researcher has no vested interests, except search for the truth, simplify complex medical-health issues and bring all information to one place.

All information is documented.

This article provides an update on a sensitive personal matter --- constipation. Please be aware that there is a lot of conflicting information found on the internet and this article attempts to search for the truth.

At some time in our lives, we have all experienced constipation. But most persons do not talk about constipation because they are embarrassed by it or they are not aware that they are constipated.  Up to now, many medical doctors have prescribed laxatives and not been very successful in helping those constipated.  But new research may be changing all of this.

Constipation means different things to different people – even doctors. Doctors usually define constipation as hard pellet-like stools and fewer than three bowel movements per week. Severe constipation is defined as less than one bowel movement per week. However, these medical definitions are simply ignoring how the digestive system works! Such definitions make for constipation and do not fix constipation. 

On the other hand, common folk usually think of constipation as:

  • infrequent stools,
  • difficulty or straining at stools,
  • feeling of being unable to completely empty during a bowel movement,
  • the sensation of wanting to go but not being able to.

None of these definitions are helpful, as there are different interpretations of constipation and regularity.

When we are constipated, we are usually experiencing one of the two different types of constipation:

1. Organic constipation happens when the body undergoes some sort of physical change, like an obstruction or deformation in the colon. This form of constipation requires your doctor’s immediate attention. For that reason, this article does not address this type of constipation.

2. Functional constipation occurs when we are: Not eating a well-balanced diet; Not drinking the right fluids in appropriate quantities; Experiencing continual high stress; Choosing to live an improper lifestyle for our body’s well-being. All of these will inhibit movement of our food waste through the digestive tract.

To understand bowel movement and constipation you really need to view and understand the anatomy of the colon [ below for your convenience ]:

The colon receives the contents from the small intestine.  As the contents travel down the healthy colon, the colon absorbs liquid [water] back into the blood stream, and the left overs form waste feces that travel toward the rectum.


The above diagram illustrates a healthy colon on the left and a toxic colon on the right.  As illustrated in the diagram above, solid feces waste can often get stuck in the descending colon [right colon], delaying transit time and defecation.  Eventually the waste feces get to the rectum.  The rectum acts as a storage bin for the feces.  Usually, under normal circumstances, the nervous system of the rectum will sense when the rectum bin is full and activate a soft bowel movement.  But if the feces is compacted and has been sitting in the descending colon and rectum for considerable time, then the bowel movement is usually hard and difficult .... and the person will be constipated .... that is, unable to pass the feces.  That fecal matter is going to start to rot .... it will ferment, fester and stagnate — becoming food for the bad microscopic bacteria. When those bacteria feast on the leftovers inside your gut, they produce gas. Gas and backed up waste cause bloating, cramps and transforms your gut into a trash bin. Those same bacteria also produce waste products that damage the lining of your colon, the nerves responsible for pumping food out; and can cause all kinds of digestive disorders and illnesses.  The colon’s job is to absorb water from fecal material, and send it back into the body. If the colon moves slowly, then the stool will be hard and dry [constipation]. If the colon is moving rapidly, then the stool will be wet and loose [a normal bowel movement].   This is the simple understanding of constipation in the colon. Dallas: Bowel movement expalined 2014 

Since the majority of doctors don’t think constipation is a serious problem, they also don’t believe that it can lead to autointoxication. Most doctors will wait until your health declines or you develop a disease before they perform tests to see the root cause of your issue. At this point, it can be difficult to connect the newly developed disease to the toxic colon. Mauro: constipation causes 2013  Huizinga: Activity in gut 2014

Two recent researches are beginning to shed some light on our understanding of constipation: one is leaky gut and the other is how we digest food and defecate.

How you poop: New research from Canada, which claims to have uncovered the "secret:"  Dallas: Bowel movement explained 2014

New Research: The Canadian research team has found out how the digestive system absorbs nutrients and moves the mix of nutrients and enzymes down the digestive tract rhythmically and facilitate a bowel movement.

Video Huizinga, How we poop,   length 1:03 mns.

Abstract:   "When nutrients enter the intestine from the stomach, the movements of the intestine caused by contractions of the intestinal musculature (“intestinal motility”) have to fulfill the function of mixing the content with digestive enzymes and optimizing absorption by exposing all content to the lining of the gut. Intestinal motility is performed by smooth muscle cells and orchestrated by intestinal pacemaker cells and by a nervous system that is unique to the intestine. Movements to promote mixing are called “segmentation”, and movements that propel content along are called “peristalsis”. Peristalsis and segmentation in the human intestine are rhythmic and are governed by pacemaker cells called “interstitial cells of Cajal” or “ICC”. With peristalsis, a network of pace­maker cells generates a wave of electrical activity that propagates into the musculature and deter­mines the rhythm and propagation of contraction, similar to the pacemaker system of the heart. A recent discovery published in Nature Communications revealed that the segmentation motor pat­tern is initiated by certain nutrients that activate a second network of pacemaker cells. This second pacemaker activity is an electrical rhythmic signal that interacts with the first pacemaker activity, modifying it in such a way that the musculature responds with a completely different motility pattern; it changes the nature of the contractions from peristalsis to non-propulsive segmentation." Huizinga: Nutritional movements 2014

The new research explains diarrhea and constipation:  Two sets of so-called digestive "pacemakers" work together to create a certain rhythm, and these pacemakers use nerves and muscles to allow two types of movement: one that allows the body to absorb nutrients and another that moves food along the digestive tract. Huizinga and colleagues noted that when people have diarrhea, this activity is too low; for those suffering from constipation, the same activity is too high.  Specifically, with diarrhea segmentation activity is too low while with constipation it is too high.  Abnormal activity can also lead to pain associated with eating.  Dallas: Bowel movement

Recent research about leaky gut is also helping us understand constipation.  Leaky gut is an imbalance between beneficial and harmful species of bacteria in your large intestine.

Leaky gut occurs when the pores of the semi-permeable inner lining of the large intestinal wall become inflamed, causing the pores to enlarge. When this happens, the enlarged pores allow substances, that are normally block out .... bacteria, fecal material and toxins, to pass into the blood; thereby causing numerous organ disorders and diseases. Leaky gut symptoms can vary widely from reflux or heartburn to bloating, gas, constipation, stomach pain and diarrhea.

Diet .... the kind of food you eat, can control the kind of bacteria in the large intestine or colon and this is the connection to constipation.  Junk foods like candy, sweets, pastry and processed foods provide food for the bad bacteria to overpopulate the colon.  When this happens, the excess of bad bacteria can cause leaky gut and other intestinal disorders, one of which is constipation.  Constipation occurs very quickly when bad bacteria multiply and overrun the good bacteria.

You may find it helpful to study the make up of fecal matter:  What Does the Shape and Color of My Poop Mean?

What can you do to fix and prevent constipation? In order to fix constipation for good, your bowels need to work and move naturally. In other words, the body needs to work on its own and without the help of any kind of laxatives, herbal or drugstore supplements.  Mauro: constipation causes 2013  Cheryl: Preventing constipation The list below has suggestions that can both fix and prevent constipation:

1.  Eat the good foods and avoid the bad foods.

2.  Avoid medications:  Certain medications and drugs such as antacids, medicines for depression, allergies, pain killers, hypertension and diuretics can cause constipation.

2.  Eat fiber foods: four kinds of fiber: grains, fruits, veggies and nuts.  Fiber speeds up the transit of waste in the colon.  But ingesting water will allow fiber to soak up water and thereby soften the stool. So the more fiber you ingest, the more water you need to drink.

3.  Drink lots of water: water lubricates the inner wall of the colon; also adds water to fiber. Many persons do not drink enough water during the day and have hard feces. Drink 1 to 2 glasses of un-chlorinated water before breakfast and more throughout the day. The more fiber you ingest, the more water you should drink.

4.  Consider ingesting enzyme supplement: Ingest amylase, lipase, protease, lactase. Deficiency in digestive enzymes can result in lack of proper nutrient absorption; and left-over undigested food that forms hard feces.

5.  Consider a good probiotic supplement:  When constipation occurs, the bad bacteria have over-run the good bacteria.  In addition to changing the foods you eat you need to cultivate billions of good bacteria for 2 to 5 days so as to restore the normal colon flora.  You may need to consider ingesting a probiotic supplement every day.

6.  Exercise:  Exercise helps move the feces.  Running, walking and jumping are good examples.  But lying in bed or watching TV is just not exercise and may be the reason many are constipated.

7. Check out possibility of leaky gut:  You may have a leaky-gut that is contributing to your constipation.  Take a simple paper test and find out.

8.  Normal bowel movement should be 1 to 3 times a day. Three times would be best as the feces stuff would have very little time to harden and ferment. Hence, the bowel movement should be soft but not of diarrheal consistency.

9.  As a rule, it is best to try going to the toilet first thing in the morning or about 30 minutes after a meal. This is because the movement [propulsion] of stools through the lower bowel is greatest in the mornings and after meals [due to the astrocolic reflex]. Go when you get the urge and do not postpone the urge!

10.  Positioning on the toilet is also important, especially for elderly people with constipation. Western-style toilets actually make things more difficult - squatting is probably the best position in which to pass stools. Putting a small footstool under your feet is a simple way to change your toilet position to aid the passage of stools. Relax, lean forward and rest your elbows on your thighs. You should not strain nor hold your breath to pass stools. Patient: constipation

11.  Flax seeds:  Grind flax seeds; these contain high amounts of omega-3 fatty acids and lots of fiber. Flaxseed oil contains no fiber. After processing the seeds, only the oil is left. However, the oil is very useful as an intestinal lubricant. Consuming this type of oil is different from taking mineral oil, as mineral oil depletes fat soluble vitamins A,D, E, and K. Flaxseed oil does not, it can help you prevent or get rid of your constipation.

12. Prunes:  California Dried Plums contain about 3 grams of fiber per serving [4-5 California Dried Plums]. But scientists are not sure what makes prunes a laxative. Prunes are dried plums, so when ingested, prunes absorb a lot of water. Need to drink more water than usual when you ingest prunes.

13. Senna:  These sennosides encourage smooth muscle contractions in the colon, and use their laxative effect to aid in bowel regulation. Senna also softens stool by stimulating fluid secretion in the colon, which eases waste passage out of the rectum. [ Senna contains hydroxyanthracene glycoside compounds, or sennosides.]

14. Laxatives: Commercial supplements may help but should not be used for a long time or as a substitute for natural ones as listed above.  When needed, many doctors prescribe Per-Colace [docusate sodium] that is both a laxative and a stool softener.  Docusate sodium, the active ingredient in Colace, works by allowing water and fats to get into the stool. This helps soften the stool and makes passing stool more comfortable. You should not use laxative products such as Colace for longer than one week, unless your doctor tells you to do so. Use with your doctor's guidance. 

Alert:  You should not need to apply all the suggestions, all at once, in the above list.  Be discrete and selective with your medical-health professional. Your constipation symptoms will dictate what to do.

The colon’s job is to absorb water from fecal material, and send it back into the body. If the colon moves slowly, then the stool will be hard and dry. If the colon is moving rapidly, then the stool will be wet and loose.

Complications with bowel movement and urination: Internet search had real difficulty finding articles or 'internet hits'   for "constipation blocking urination in men".   Such a link should be most evident from a view of the male anatomy below.  When fece- matter in the rectum is hard, it can press against the prostate gland or urethra, causing disruption of urination.  This is illustrated as a possibility in the yellow rectangle.  A similar condition can occur in females.

Substantiation: Below is an example of three such guarded comments:

rectum prostate pressure

"There is a close relationship between the muscles and nerves that control bladder functions and those that control bowel movements. In addition, the bladder and the colon are close together in the body. Large amounts of stool in the colon can put pressure on the bladder which can cause the bladder to not fill as much as it should, or cause the bladder to contract when the bladder is not supposed to contract. This large amount of stool can also cause the bladder to not empty well. All of these problems can lead to daytime wetting, nighttime wetting, urinary tract infections, and in some cases esicoureteral reflux."  Arnhym: Proximity anatomy rectum & prostate gland

""Some people with constipation often have to strain to have a bowel movement. Hard stools in the rectum may push against the bladder and urethra, causing the urethra to be pinched, especially if a rectocele is present." NIH: Urine retention 2014

"Anyone can experience urinary retention, but it is most common in men in their fifties and sixties because of prostate enlargement. A woman may experience urinary retention if her bladder sags or moves out of the normal position, a condition called cystocele. The bladder can also sag or be pulled out of position by a sagging of the lower part of the colon, a condition called rectocele. Some people have urinary retention from rectoceles. People of all ages and both sexes can have nerve disease or nerve damage that interferes with bladder function." Cunha: Urinary retention 2014

As the reader can surmise, medical doctors are hesitant to linking the constipated rectum to pushing against the prostate gland and/or urethra, blocking the urethra and causing urination problems!


Good Leaky Gut Food List:    Axe: Leaky gut diet

Dr. Axe provides a list of foods on the leaky gut diet. These foods are similar to foods recommended by others. These foods support healing because these are easy to digest and can help repair the lining of the intestines:

Bone broth Bone broth (made from scratch) provides important amino acids and minerals including proline, glycine and potassium that can help heal leaky gut and improve mineral deficiencies.

Raw cultured dairyProbiotic rich foods like kefir, amasai and yogurt can help heal the gut by destroying bad bacteria like candida.

Fermented vegetables – Try to add fermented foods such as coconut kefir, kvass, sauerkraut or kimchi.  These fermented foods contain probiotics essential in helping repair a leaky gut that work by balancing the pH in the stomach and small intestines.

Steamed vegetables – Non-starchy vegetables that are cooked or steamed are easy to digest and are an essential part of the leaky gut diet.

Healthy fats – Consuming healthy fats in moderation like egg yolks, salmon, avocados, ghee and coconut oil are easy on the gut and promote healing.

Fruit – Consuming 1-2 servings of fruit daily is good on a leaky gut diet.  You can steam apples and pears to make homemade apple sauce or fruit sauce. Fruit is best consumed in the morning and not later on in the day and keep fruit intake in moderation.

Bad Foods that Cause Leaky Gut:  Axe: Leaky gut diet

Foods that create intestinal inflammation and candida, thereby causing a leaky gut are:

Gluten – A gluten free diet can help improve the symptoms of leaky gut. Gluten is the sticky protein found in most grain products including wheat and is difficult to digest unless it’s been brought through a sourdough or sprouting process. On the leaky gut diet you will want to avoid all foods that contain gluten and wheat products.

Cows Dairy – The protein in cows dairy, called A1 casein, can trigger a similar reaction as gluten and therefore should be avoided. In fact, A1 casein may be 26x more inflammatory than gluten!

Sugar – Feeds yeast and bad bacteria that can damage the intestinal wall creating a leaky gut. If you are going to use a sweetener, raw local honey is your best option but even that should be consumed in moderation at 1 tbsp daily.

Unsprouted Grains – Grains and soy when unsprouted and unfermented contain phytic acid which can irritate the intestines causing leaky gut.

GMO – Genetically modified organisms contain herbicides and pesticides that damage the gut lining. Studies out of the Journal of Environmental Sciences have found that GMO foods destroy the probiotics in your gut and cause organ inflammation.

Remember, the top foods to remove .... that cause leaky gut are sugar, grains, conventional meat, processed foods, conventional dairy and GMO foods. The top toxic exposures to eliminate are tap water, pesticides, NSAIDS [ aspirin, painkillers], birth control pills and antibiotics — but remember to always consult with your physician if he or she has prescribed these for you.  Axe: Getting rid of leaky gut 


Conclusion:   What can you do to prevent constipation?

1.  eat foods that feed good bacteria in the colon, thereby restoring the good bacteria.

2.  eating fiber foods is good but fiber soaks up water and thus can make fecal matter hard. To counter this, you need to drink more water than usual and keep fecal-matter soft.  The traditional saying "drink 6 or 8 glasses of water per day " does not account for the extra fiber one may eat.  Eating more fiber by itself may not fix your constipation. Give your colon water .... Drink water!

3.  go have a bowl movement whenever you get the urge.  Do not postpone it.

4. the urge to have a bowl movement usually occurs about a half hour after eating breakfast.  This is a normal body alert and you should respect it.

5.  you should have 2 to 3 bowel movements each day; certainly not every 3 days or once a week.  More normal frequent bowel movements, like every 8 hours, keep the fecal-matter soft and easy to go. The longer the feces stays in the rectum, the more difficult the bowel movement!

5.  exercise should be considered a natural laxative; it helps move fecal matter.

6.  consider ingesting a probiotic supplement if the above suggestions do not work. Probiotics can help cultivate the colon with good bacteria over several days.

7.  if constipation persists after trying the above on your own, then seek medical help immediately.


Arnhym Anne, Laurence S. Baskin, Angelique Champeau, Hillary L. Copp, Michael J. DiSandro, "Constipation," University of California, San Francisco, Dept of Urology,  Arnhym: Proximity anatomy rectum & prostate gland

Cheryl, "Huizinga: Activity in gut 2014."  Article no longer active.

Cunha John P.,"Urinary Retention,", August 13, 2014.   Cunha: Urinary retention 2014 

Dallas Mary Elizabeth, "Researchers Uncover the Secret Behind Bowel Movements,", February 24, 2014.  Dallas: Bowel movement explained 2014

Huizinga Jan D., and others, "The origin of segmentation motor activity in the intestine," Nature Communications, 2014.  Huizinga: Activity in gut 2014

Huizinga Jan D., Ruihan Wei, Ji-Hong Chen, George Wright, Berj Bardakjian, "Generating bowel movements that facilitate nutrient absorption," The Journal of  Student Science and Technology, 2014, Vol 7, No 3.  Huizinga: Nutritional movements 2014

International Foundation for Functional Gastrointestinal Disorders [ ], "IBS with Constipation," IFFGD, February 26, 2015.   IFFGD Constipation 2015

Lametti Daniel, "Don't Just Sit There! How bathroom posture affects your health," Science, August 26 2010.   Lametti: Squatting helps 2010

Mauro Karlo, "Discover The 7 Most Common Causes of Constipation That Every Woman Should Know and Avoid," 2013.   Mauro: constipation causes 2013

Patient, "Constipation in Adults.  Patient: constipation 

Wikipedia, "Rectocele."   Wiki: Rectocele