When bowel movements occur less often than usual and with difficulty, this is referred to as constipation. The result is often a BM that is small, hard, and difficult to pass, resulting in abdominal cramping, rectal discomfort, and occasionally bleeding. When constipation is chronic or recurring, a search for a cause is generally advised.

Constipation Overview

Nearly everyone experiences constipation at one time or another, and, at any given time, constipation is experienced by over four million people in the US, creating five hundred million dollars in sales of laxatives.

There are a variety of causes of constipation, including pregnancy and medication. Many medications are known to cause constipation including narcotics, antidepressants, antihypertensives, diuretics, muscle relaxers, and antacids containing aluminum and calcium. Constipation is more common in the elderly.

The most common cause of constipation is a diet lacking in fiber, a common problem in our high-fat American diet, rich in prepared food and low in fruits and vegetables. Fiber adds bulk to the stool, which allows for its passage through the GI tract. In addition to improving bowel function, fiber has also been associated with a decreased risk of heart disease, gallbladder disease, obesity, and certain cancers. It is also known to lower cholesterol.

There are two main types of fiber, soluble and insoluble. This refers to the degree to which the fiber is digestible and absorbable. There are numerous sources of fiber, with some sources containing more fiber than others. Good sources of fiber include fruits, vegetables, whole grains, whole wheat, unrefined and unpolished rice, wheat bran, oat bran, whole wheat pastas, pectin, psyllium, kelp, agar, and legumes.

Different types of fiber have different properties. For example, guar gums found in legumes have better cholesterol-lowering properties than fiber from wheat bran. For this reason, it is important to get a variety of different types of fiber to achieve the different benefits. Your physician can give you more specific advice based on your particular situation.

The best source of fiber would be dietary, with supplementation as needed. When laxatives are used, they should be used only on a temporary basis. Fiber supplements should be taken to achieve a fiber intake that can not be accomplished through dietary means. If fiber supplements are used, small amount should be used at first so as to minimize the amount of gas produced as a result. Starting doses should be one to two grams before meals, increasing gradually to five grams before meals. This should be in addition to changing to high fiber foods as mentioned above. Studies on cancer prevention suggest twenty-five grams per day as the recommended dose, with thirty-five grams per day the dose recommended to lower blood pressure and cholesterol.


There are a number of natural and herbal preparations with laxative effects.

  1. Cascara Sagrada and Cassia Senna:
  2. Prunes and Prune Juice.
  3. Aloe Vera Juice: One-half cup morning and evening.


Eliminate known causes: drugs, antacids, chronic laxative use.

  1. Increase dietary fiber, especially fruits and vegetables.
  2. Drink six-to-eight glasses of water a day.
  3. Encourage regular bowel function, at regular times, even when the urge is missing or weak. When the urge is stronger, elimination should not be resisted.
  4. Regular exercise. Physical activity is known to promote bowel function.
  5. Avoid fried foods, dairy products, and all processed refined foods, salt, alcohol, and sugar as they contain very little fiber. Try to eat smaller portions at meals.

For more information on fiber, refer to our sections on “Dietary Fiber” and “Health and Wellness through Nutrition.”

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