There’s no better way to re-establish regularity than to start a juicing program. But it doesn’t have to be prune juice, and most people should try juicing for their constipation before they try fiber – and most people should not use laxatives at all.
What Is Constipation?
There used to be a rule in nursing textbooks, nurses paying more attention to the issue of constipation, at least in the context of hospital care, than doctors, that anyone who did not evacuate bowels at least three times a week had constipation and anyone who evacuated bowels more than three times a day had diarrhea. While that’s not a bad reference point, nowadays constipation is defined more in terms of how it makes the constipated person feel and how it affects general health.
The most widely accepted criteria for a diagnosis of constipation include three or fewer bowel movements per week or any of the following symptoms occurring on an ongoing basis, over a period of three months or more:
- Straining to evacuate the bowels
- Needing to remove fecal matter manually
- Lumpy or hard stools
- Sensation of incomplete evacuation after bowel movement
- Sensation of obstruction above the anus.
If you are 50 years or older, reporting any of these symptoms to your doctor will get you a referral for a colonoscopy. It’s true that polyps and tumors sometimes cause symptoms like these, but constipation is seldom a sign that colorectal cancer is on the way. Constipation has an astonishing number of causes.
What Causes Constipation?
Constipation can be a symptom of a variety of systemic diseases. High bloodstream calcium levels (hypercalcemia), low bloodstream potassium levels (hypokalemia), hypothyroidism, stroke, multiple sclerosis, mixed connective tissue disease, scleroderma, amyloidosis, head injuries, spinal cord injuries, and damage to the autonomic nervous system all can cause constipation. Treating these diseases will usually also help establish regularity, but all of these conditions require medical treatment.
Constipation is a side effect of numerous medications for systemic diseases. A partial list includes:
- Antacids that contain either aluminum or calcium.
- Anticholingergic medications such as benzatropine (Cogentin) used to prevent muscle spasms and writhing caused as a side effect of medications for Parkinson’s disease or schizophrenia.
- Antibiotics, killing friendly, probiotic bacteria in the colon.
- Bismuth, the active ingredient in Pepto Bismol.
- Calcium channel blockers for high blood pressure, especially the generic calcium channel blocker verapamil
- Cholestyramine for reducing cholesterol levels
- Iron supplements.
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, Ibuprofen, and tylenol
- Older antidepressants in the cyclic antidepressant and monoamine oxidase inhibitor classes (seldom prescribed in industrialized countries but still used in India and in parts of Latin America).
- Opioid drugs such as Vicodin (hydrocodone).
- Pseudoephedrine for allergies and colds.
- Thyroid hormone in inadequate doses.
Constipation can result from obstruction of the colon. This can be a neoplasm, a cancerous tumor, a volvulus, a loop in the bowel that is usually caused by adhesions of one side of the bowel wall to the other, or a stricture, an abnormal narrowing of the intestine. These are for the most part conditions that cause constipation rather than conditions that are caused by constipation. They require medical treatment.
Constipation can caused by straining. Pressure on the rectum can cause it to prolapse, or turn inside out, sometimes falling through the anus. This condition also known as rectocele likewise requires medical care.
Constipation can result from nerve damage. The pudendal nerve activates the genitalia in both sexes, and it also operates the sphincters that control release from the bladder and bowels. It can be damaged by too much straining, by diabetic neuropathy (the same as the nerves in the hands and feet), by excessive bicycle riding, and, in women, by childbirth. Most people who have had diabetes for more than 10 years have some degree of damage to the pudendal nerve.
Constipation can result from Chagas disease. This is a parasitic infection carried by the kissing bug, an insect that is native to Florida and Texas in the USA and most of Latin America. The immune system attempts to isolate the microscopic parasites in the colon by surrounding them with fibrous tissue.
Infants and small children sometimes exhibit Hirschsprung disease. This is a condition in which the nerves to the bowel are not completely formed. In Parkison’s disease, which mostly affects older adults, the pudendal nerve can suffer the same kind of damage as nerves for other muscles. Constipation is a common feature of irritable bowel syndrome, a condition that is so common that this presents it in a separate article. As we’ll discuss a little later, it’s possible to suffer self-inflicted nerve damage due to laxative abuse. But most people who have constipation have a problem with diet, not with nerve or tissue damage.
Diets that Cause Constipation
We all know that low-fiber diets without enough fruit and vegetables and whole grains tend leave people constipated. It’s not just what’s not in your diet, however, that can leave you constipated.
- Excessive consumption of caffeine, especially caffeinated soft drinks, often causes constipation.
- Excessive consumption of alcohol often causes constipation.
- Failure to drink enough water can cause constipation.
- Either too little or too much fiber can cause constipation.
And it’s that last point that most people get wrong when they are trying to correct their irregularity. It’s not just too little fiber that causes constipation. It can also be too much fiber that makes constipation worse.
Fiber absorbs water and makes the stool softer. Trying to stuff your colon with fiber when it’s already blocked, however, just makes you more constipated, especially if you take fiber but don’t drink enough fluids.
“Fluids” isn’t necessarily the same thing as water. Distilled water, for instance, does not contain electrolytes. Drinking distilled water can actually cause the lining of the intestine to pump electrolytes out into the contents of the intestines. These electrolytes can combine with minerals in feces to make it even harder, the water flowing on through the colon but the fecal matter staying put.
Juices provide water with small amounts of natural sugar and lots of potassium and magnesium. The colon releases water as it absorbs the natural sugars. The water softens the stool. The potassium and magnesium prevent the formation of the “cement” that can be formed from digested food that stays too long in place in the colon. Doing one or two meals as a “juice fast” stops adding more and more digested food on top of impacted stool and gives your bowels a chance to move. The most popular juice for this purpose is prune juice.
What Prune Juice Does for Your Bowels
The reason prune juice is the most popular constipation remedy is simple. It usually helps make the bowels move without cramping in just a few hours—provided the person drinking the juice is not otherwise dehydrated. Prune juice contains relatively large amounts of a naturally occurring sugar known as sorbitol. This sugar has a low glycemic index. It’s usually digested “overnight” and does not raise blood sugar levels appreciably except in insulin-dependent diabetics (who would need additional “slow” insulin or additional units of Levomir about 12 hours after drinking the prune juice). Because sorbitol is digested so slowly, it stays in the small intestine longer, drawing water from the bloodstream into the stool. The stool becomes softer and easier to expel.
Prune juice drunk in small amounts is not a “colon cleanser.” Consumption of up to 12 fluid ounces (360 ml) by an adult, 8 fluid ounces (240 ml) by an adult, or 2 to 4 fluid ounces (60 to 120 ml) by a chil only makes bowel movement easier over a period of 12 to 24 hours, and this only happens if prune juice is used by itself. Eating more of the foods that cause constipation such as dairy products, wheat products, and fat cancels out the benefits of prune juice.
Other Juices that Relieve Constipation
Pear juice is also a good source of sorbitol. It’s such a good source of sorbitol that it is not recommended for treating children’s constipation, as it may cause diarrhea and flatulence. Rowan berry juices contain even more sorbitol than prunes, as do “country wine” made with rowan berries in the UK and Vogelbier in Germany and Austria. Peach juice, apple juice, and apricot nectar also relieve constipation through their sorbitol content.
Banana and tomato juices relieve constipation in an entirely different way. These juices are good sources of natural serotonin. The same serotonin that regulates nerve transmissions in the brain also regulates nerve transmissions in the lining of the digestive tract. The more serotonin in your bowel, the more they “run.” Black (but not the brown English) walnuts contain large enough amounts of naturally occurring serotonin that they nearly always quickly relieve constipation when added in ground form to fruit smoothies. Black walnut hull, however, has an equal and opposite effect and should be avoided.
Don’t try to overcome your constipation with a great big glass of juice. And don’t use laxatives on a regular basis. It’s possible to be so constipated that laxatives don’t work.
Treating Constipation with Laxatives
Natural laxatives such as aloe bitters (not the juice), rhubarb root, frangula, buckthorn, and senna all work on the same principle. The digestion of the herb releases compounds known as aglycones that paralyze the muscles that hold feces in and that stimulate muscles that push feces out. Before these aglycones can interact with the nerves that control muscles lining the bowels, however, they have to be activated by probiotic bacteria. If you don’t have the right probiotic bacteria in your colon, even the “brown bomb” laxative frangula won’t do anything in your digestive tract.
When herbal laxatives work, they tend to work well. Many people, however, use so much senna (sold as Exlax, Senna-Gen, Senokot, and Senexon) or the synthetic equivalent (sold as Alophen, Carter’s Little Pills, Correctol, Dulcolax, Durolax,and Fleet) that the nerves lining their bowels cease to respond to all but the very highest doses. There are people who (and this is never advisable) take an entire box of Exlax or Dulcolax every day just to stave off severe constipation.
It’s easily possible to become addicted to stimulant laxatives. That’s why it’s important never to use them for more than 2 out of 4 weeks. When the stimulant laxative begins to work, then it’s a good idea to switch to prune or pear juice (or products made with rowan berries, if you happen to live in Europe) for maintenance. Fruit juices aren’t addictive and they restore the electrolytes that stimulant laxatives can deplete.
There are also chemical laxatives that don’t have to be activated by probiotic bacteria. One of the best known of these is polyethylene glycol. Sold under the trade name Miralax, this is the laxative most Americans and Canadians get—in one gallon/4 liter jugs, sometimes two jugs holding 8 liters/2 gallons—to prepare for colonoscopy.
Propylene glycol holds water in the bowel. It sloshes against hardened stool and eases bowel movement. Many people find it works excessively well and “live” on the toilet for a day or two while taking the preparation. It can also cause nausea and cramping. You can’t become addicted to propylene glycol but for most people addiction is not a welcome possibility.
Mineral oil is also considered to be a gentle laxative. It coats the stool and helps it slide through the colon and rectum. People who have to stay in bed and people who have bowel obstructions, however, should not use it, and it interferes with the absorption of digoxin (Lanoxin) and vitamin D.
Stool softeners containing docusate (such as Colace or Dok) don’t stimulate defecation. They just make it easier to pass a bowel movement without straining. There is also a product which is essentially an antidepressant for the lower digestive tract called tegaserod or Zelnorm. It alters the way the digestive tract uses serotonin. And there are two prescription medications that reverse the effects of opioid drugs such as hydrocodone (Vicodin), alvimopan (Entereg) and methylnaltrexone (Relistor). These medications also help people who are especially sensitive to dairy, wheat, and beef.
What about probiotics, fiber, and magnesium? Probiotics, fiber, and magnesium are so useful in treating constipation that we’ve present separate sections on how to use them with juicing.
3 Steps In Getting Regular by Juicing
We know this is a lot of information about how juicing can help alleviate constipation, so here are 3 essentials.
1. Give your bowel a break. Do a “juice fast” for at least one meal, drinking a glass of prune or pear juice instead of eating solid food, especially dairy, wheat, and beef.
2. Use prune and pear juices to achieve regularity, and tomato and banana juices to maintain regularity.
3. Don’t use laxatives unless absolutely necessary and never for more than two weeks at a time. Incorporate probiotics, fiber, magnesium, and digestive enzymes into your daily health routine to stay regular over the long run.
Frequently Asked Questions About Juicing and Constipation
Q. Why should I care about constipation if my personal hygiene routine is not unpleasant?
A. Many people carry about as much as 10 kilos (about 20 pounds) of impacted stool. Your weight problem may actually be a constipation problem. The pressure on the lining of your intestines stimulates your pancreas to release insulin. This causes blood sugar fluctuations and also primes your belly fat to store every calorie in excess of your body’s energy needs.
Q. Is it best to drink juice that contains a lot of pulp?
A. At first it’s best to rely on the ability of juice to soften stool rather than to add fiber. If you have both a juice extractor and a macerating juicer, use the juice extractor rather than the macerating juicer to avoid getting too much fiber in your juice. After you have become regular, then it’s fine to drink “high-fiber” green juices.
Q. Should I use juice as my only beverage when I’m treating constipation?
A. No, it’s important to drink water. If you live in a hot climate you may need up to a liter of water per hour to replace fluids lost in respiration and perspiration, taken with small (1/4 cup or 60 ml) amounts of fruit to replace electrolytes.
Q. Is there any reliable sign that constipation is caused by intestinal blockage or inflammation?
A. Ischemic colitis is most likely to cause symptoms in the upper left quadrant of the abdomen, although the pain may be felt closer to the navel. Polyps and tumors can occur anywhere in the bowel. Fresh red blood on toilet tissue is an indication of anal fissures that are usually caused by straining at stool, but dark brown blood is a sign you need to see the doctor.
Q. Why do dairy products, beef, and wheat products cause constipation?
A. These foods contain mu-opioids that interact with some of the same sites in the brain as opioid drugs such as morphine and hydrocodone. They dull the nerves that propel stool through the bowel. Dairy products made with sheep’s or goat’s milk usually don’t have this effect, and neither do oats or rye. It’s the blood in beef that contains the mu-opioids; kosher or hallal beef do not usually aggravate bowel problems.
Q. My doctor says I have to take Miralax. It tastes awful. Can I mix it with juice?
A. Miralax can be mixed with juice or tea to make it more palatable without losing its laxative effect.
Q. Is lime juice helpful for constipation?
A. No, but in many Latin American cultures lime juice is added to juices for flavor. The lime juice also reduces the activity of E. coli bacteria. Citrus juices in general (orange, lemon, lime, grapefruit, and so on) should be avoided until you get constipation under control because they slow the rate at which the stomach empties—you can wind up with bloat as well as constipation if you drink large amounts of citrus too soon.