We’re talking constipation.

Constipation is a common problem, especially when hormone levels are ebbing and flowing. So, be it after ovulation, while taking extra progesterone during IUI/IVF cycles, during pregnancy when progesterone is elevated, or during menopause, POD, or while nursing, it’s common in many stages of a woman's life — and is something I see a lot of. So I thought it was time for a blog post! That, and if I'm honest, TCM practitioners love talking about poo.

But, as much as I love a good poop talk, I know only all too well what a pain it is to actually deal with constipation. So here is the scoop on why it happens and what you can do about it.

Why it happens.

Hormonal changes slow down the movements of your intestines. The technical term is transit time — see aren't we having fun already?! So, instead of your intestines churning and chugging away and the poo that is in transit through the intestine moving along at the normal rate, the poo slows down to a glacial pace and ends up hanging out in the intestine longer than it should.

The large intestine's job is primarily to consolidate the slurry of liquid that has been digested and had the nutrients absorbed from it and turn it from a sloppy slurry into poo as we know it. It does this by serving as the place along the digestive journey where water is absorbed and what is left gets firm and — well — turd like! 

If the transit time slows down and if the poo hangs out in this area too long, then too much water gets absorbed. And instead of a nice healthy easy to pass turd it turns into hard-to-pass bouldery rubble. 

Fun note: Prostaglandin, which is released at the start of a period or in labor, does the opposite! It SPEEDS UP the transit time, which is is why loose stools and diarrhea are more common during these times.

The Bristol Stool Scale

Have you ever heard of the Bristol Stool Scale? Prepare to be amazed!

Type 4 is ideal, Types 3, 2, and 1 are common with constipation and high levels of progesterone. So, what's a gal to do if you’re into Type 1 - 3 and feeling backed up? I recommend a stepwise approach, starting with the most natural options and working your way to the big guns.

Things to try.

Step 1

Make sure you’re actually drinking enough water. You should divide your weight in half and drink that same number of ounces of water per day (up to 100 oz max if you’re a woman and 130 for men). Increase your fiber intake too. It's good to start with food, but you can use a supplement if you need to! Psyllium, flax fiber or a fiber power or chewable supplement are all options.

Most Americans eat around 10 - 15g of fiber day, but women need 25g. if you are a chronically constipated woman, you should aim for 30g, and men need 38g! There are two forms of fiber - soluble (nature's osmotic laxative … keeps/pulls water into the stools) and insoluble (which bulks up the stools). Aim for some of both.

Example. An apple's flesh is soluble/osmotic, the peel is insoluble/bulking. If you pay attention to food, you'll realize, you need to be mindful to consistently get 30g of fiber per day. It's worth the effort. I make a small smoothie each morning to start the day with fiber. I put an apple or pear, some frozen raspberries, a couple tablespoons of peanut butter, chia seeds or flax seeds, a splash of kefir and some probiotics in the mixer. It'll get me about 16g of my daily fiber so it's not so much work the rest of the day. Here's a nice list of foods with fiber.

Get a little exercise if it feels right and you have the energy. If you’re tired, listen to your body and just do light exercise like walking and yoga.  

Another huge thing everyone (constipated or not) can do to help with bowel movements is to invest in a tiny step stool or a Squatty Potty. When you bring your feet up 6 or so inches from the floor it actually straightens out your colon so that the poop has a straight shot to get out. Much less resistance than the kinked position that "normal" toilet sitting creates.

Step 2

If this isn't enough, add some things to directly stimulate your intestine in a gentle way. A cup of hot water with fresh lemon juice squeezed in it. Taking Triphala (an Ayurvedic formula you can purchase in pill form) which has three food therapy type fruits in it that help stimulate healthy elimination. Or even try drinking a small cup of coffee to encourage intestinal movement.

Senna is a stimulant laxative that is intensely cramping in some bodies (and pregnancy category C). But in lower doses and for those with truly slow intestinal churning it can be totally comfortable for some people too. If you try it I recommend starting with a low dose at bedtime. Buying a tea that contains senna and steeping it for a shorter than recommended duration is a good way to start low and move up slowly). Try other things and talk with your doctor before trying senna once you’re pregnant.

Step 3 (or during pregnancy)

Stool softeners (Docusate) which are sold under the names Colace, Correctol, Dulcolax, Phillips Liquid Gels and others, are the safest for pregnancy (Category B - no harm shown in animal studies). These are the laxatives most pregnant women use. Just know that these have to work from the top down, so if you’re really backed up, you may need to soften a lot and end up with “soft serve” stools before you break through the end part of the stools that have been drying out the longest.
 

Step 4

Osmotic Laxatives. Magnesium Citrate is the natural way to pull water back into your intestine (which is what osmotic laxatives do). Magnesium citrate is also a natural anti-spasmatic and muscle relaxer so it can be good for tension and cramps too. Miralax which is also sold under various store brands is the more pharmaceutical version. Osmotic laxatives actually pull water back into the stool so they really help things stay moving despite the slower transit time. However they are Category C - possible harm shown in animal studies to unborn fetuses, but no study showing what they do in humans. That said, many pregnant women faced with significant constipation have taken this product for years.

If it comes between not being able to go and taking magnesium citrate or miralax, many OBs, midwives and women will choose osmotic laxatives. The nice thing about these is they are powders you mix with water, so you can adjust the dose, sort of dial it up or down, based on what your BMs were the day before. Just remember, more is not better and not to exceed the maximum dose of magnesium citrate. It can slow heart rate and lead to muscle issues if you overdo it. If you are on top of things, a very low dose can help. Miralax does not pass into breastmilk, in fact it doesn't actually leave the intestines very much at all. So many take it while nursing too. Magnesium citrate — here’s some I’ve used — is more natural but it does enter breast milk. 

Also note, these work from the top down too, so you might have to over-treat to get the blockage to clear at the end!

Pregnant notes.

While many people think Senna or teas with Senna are good because they’re natural, they are actually often nerve-wracking because they are stimulant laxatives. This means they irritate the intestinal lining and stimulate churning and cramping in the intestines. This can actually be quite scary when you are in an early pregnancy situation, so I tell people to avoid these products, especially in the 1st trimester when the last thing you want to feel is cramping of any sort! On the flip side, if you’re used to them and use them already they might be fine.

When you’re desperate to go poop now, the above methods won't really get the job done. All of these methods have to work their way through from the top down. Meaning, if you have a hard rubbly blockage at the very end of your intestine or in your colon, then you have to soften everything else up that's behind it before you'll actually break through. It can take too long and end up with diarrhea from over treating the constipation. This is bad because dehydration is a serious problem in pregnancy and can trigger preterm labor. So if you get dehydrated be sure to treat it fast. The best option to go poo now is a glycerine or mineral oil suppository. Or, if you aren't squeamish about it, some people simply manually extract (aka stick their gloved finger up their bum) the hard rubble and then whatever else they try will work. 

Occasionally a significantly constipated person will start having diarrhea without having used any laxatives. This is actually their body's way of trying to get the poo out by liquifying what it can so it can squeeze past the blockage at the end of the line. Usually this is discovered through palpation in an ER or via X-ray or CT scan after a person is having abdominal pain.

Lastly, a bit more anatomy.

The reason a person gets the "gotta go" sensation is because the intestine, stretching as it fills, triggers the nerves to give the message to go to the bathroom and push and expel the poo. If you don't listen to this message and the intestine stays distended because you do not go to the bathroom, then the nerves eventually stop sending the message to push and go. This happens to people who don't like using public bathrooms, kids who don't want to go to the bathroom at school, and young children who would rather keep playing than go sit on the potty.

Making sure you listen to your body's urges is another important step in keeping constipation at bay. If the urge to push and go gets delayed too often it can actually cause nerve damage and dysfunction that can take years to treat — if treatable at all. Sitting on the toilet 15 minutes after breakfast and dinner is a good way to get in the habit of listening to your body as tthe urge usually happens in most people during these two times.

Here's a nice NIH article about laxatives in pregnancy.

I hope this info can help you stay more comfortable and informed, even in those stages of a woman's life when constipation is par for the course! And if you have chronic constipation MOST of the time, you might also want to explore IBS-C type and look into a great app called Nerva. I’ve used this myself and it’s helped a lot with discomfort and bloating.