Nota del Editor: Este artículo es una reimpresión. Fue publicado originalmente el 30 de agosto de 2017.
Para la mayoría de las personas, un episodio ocasional de estreñimiento es una molestia menor. Sin embargo, este no es el caso para casi el 12% al 19% de la población de EE. UU. que sufre de estreñimiento crónico.1 Esto significa que 63 millones de personas tienen dificultad para pasar heces duras, secas, grumosas, sufren de hinchazón, tienen dolor abdominal o sienten como si algo estuviera atascado en su recto o intestinos.2
Para muchos, el tema de sus movimientos intestinales es un asunto privado. Esto hace que entender y aprender sobre la mecánica real de cómo se produce y se elimina la materia fecal sea difícil, ya que muchos no lo consideran un tema del que quieran hablar, incluso con sus médicos.
El número de evacuaciones que tenga cada semana está estrechamente relacionado con los tipos de alimentos que consume, la cantidad de ejercicio que hace y su estado de hidratación. Mientras que muchas personas pueden tener una evacuación intestinal una vez al día, la cantidad normal varía entre cuatro veces por semana y varias veces al día.3 Lo que diferencia las evacuaciones infrecuentes y el estreñimiento es la consistencia de las heces, la dificultad para pasarlas y otros síntomas que pueda experimentar, como hinchazón o sensación de llenura.
Desafortunadamente, el número de personas que sufren de estreñimiento crónico está aumentando, lo que lleva a caracterizar la condición como una “epidemia silenciosa” ya que aquellos que sufren a menudo lo hacen en silencio.
Número de Personas que Sufren de Estreñimiento Crónico en Aumento
Una encuesta de 2013 realizada por la Asociación Estadounidense de Gastroenterología4 encontró que el 16% de los estadounidenses sufren de estreñimiento crónico y casi el 33.5% de las personas mayores de 60 años experimentan la condición. Esto lleva a millones de visitas al consultorio del médico o clínica, y casi 700,000 visitas a una sala de emergencias cada año.5 Aunque la condición se trata normalmente de forma ambulatoria, el número de personas ingresadas en el hospital desde 1997 se ha duplicado.
Un estudio estimó que si el 6% de los estadounidenses que sufren de estreñimiento funcional incorporaran cambios naturales en su estilo de vida para mejorar su condición, se podrían evitar $12.7 mil millones en costos médicos directos anualmente.6 Los investigadores consideraron que esta era una estimación conservadora ya que no tuvo en cuenta salarios perdidos o productividad.
Aunque la encuesta encontró un número creciente de personas que sufren de estreñimiento crónico, no fue un estudio que evaluó las causas detrás del problema. Hay varios factores controlables comunes a un estilo de vida moderno que contribuyen a un aumento del riesgo, y factores sobre los que no tienes control.
Por ejemplo, el número de personas que sufren de estreñimiento aumenta significativamente con la edad.7 Esto puede estar relacionado tanto con elecciones de estilo de vida, como la dieta y el ejercicio, como con la disfunción neurogénica relacionada con la edad.8
Hay una cantidad significativa de elecciones que haces cada día que aumentan tu riesgo de desarrollar estreñimiento crónico. Uno de ellos es el estreñimiento aprendido, ya que tu recto es flexible y puede estirarse. En un estudio con estudiantes universitarios, los investigadores encontraron que los participantes podían entrenarse fácilmente para evacuar sus intestinos cada 51 horas en lugar de cada 28, lo que llevó a los científicos a concluir que los hábitos intestinales pueden inducir al estreñimiento.9 Otros factores que influyen en tu riesgo incluyen:10,11,12,13
Dieta baja en fibra
Cambios en tu rutina
Falta de ejercicio
Avoiding a bowel movement when you have the urge
Drinking insufficient amount of fluid
Certain medications, such as opiates, antidepressants, antacids and anti-hypertensives
Uso frecuente de laxantes o enemas
Mala nutrición que lleva a deficiencia de vitaminas, incluida la deficiencia de magnesio
Suplementos de hierro
Problemas de Salud Significativos Relacionados con el Estreñimiento Crónico
Few people realize that chronic constipation, and the daily agony that accompanies the condition, may be dangerous or even deadly. The American College of Gastroenterology believes a diagnosis of chronic constipation warrants further medical workup, as patients may have a higher likelihood of colon cancer, even if they don’t present with colon cancer symptoms, such as GI bleeding, anemia or weight loss.14
When the scientists started the study, they didn’t expect too many surprises. Yet, after analyzing the results they found medical conditions they didn’t anticipate would be associated with chronic constipation, including ischemic colitis, diverticulitis and other gastrointestinal cancers.
Chronic constipation is also related to at least one brain disorder: Parkinson’s disease. A number of studies have demonstrated a link between your gut health and your psychological health. A link between an unbalanced microbiome (one symptom of which is constipation) and Parkinson’s disease may be related to proteins from the gut that accumulate in the brain.
In one study, 21 days after specific proteins were injected into the stomach and intestines of mice they were found to have migrated as far as the vagus nerve.15
Constipation may also increase your risk of kidney diseases.16 Researchers reviewed medical records of over 3.5 million U.S. veterans and followed their care for seven years. At the start of the study each participant had normal kidney function. Although a causative relationship could not be proven with the method used in the study, those with constipation had a 13% increased risk of kidney disease and 9% increased risk of kidney failure.
Researchers have also found suffering from constipation may increase your risk of anal fissures, stool incontinence, hemorrhoids and urological disorders.17 The seriousness of the symptoms may vary, depending upon the severity of your constipation. An association has also been found between people suffering rectal prolapse, a condition where part of the large intestines slips out of the anus, and constipation.
Another factor connected with constipation is back pain.18 In some cases, back pain may result in the use of pain medications like opiates that slow your intestinal tract and lead to constipation. In other cases, back pain is the result of your constipation. For instance, irritable bowel syndrome or a fecal impaction may lead to back pain.
Steer Clear of Laxatives
Constipation is a symptom of other conditions and not a disease or illness process itself. Thus, treating just the symptom may mean you’re overlooking another more serious problem. Many people turn to over-the-counter laxatives to immediately relieve the discomfort, but this may have additional consequences that hinder your recovery.
Laxatives come in a variety of forms including pills, capsules, liquid, suppositories and enemas. Although tempting, if you choose to use a laxative, do it with extreme caution. The active ingredient in many enemas draw water from your body into your large intestines, softening the stool. When too much is used it can increase your risk of dehydration, and by altering your electrolyte balance, you risk kidney or heart damage and death.
Stimulant laxatives work by increasing the muscular action in your intestines. This includes senna or cassia laxatives, often marketed as being “natural.” Over time, these types of laxatives damage the function of your intestinal walls and decrease the ability of your muscles to contract on their own.
If you must use something to immediately relieve constipation, consider trying a glycerin suppository that doesn’t contain any stimulants. The suppository often produces results within two hours and works by drawing water into your large intestines directly where your hard stool is located, softening it enough to evacuate your bowels.
Magnesium May Help Constipation and Protect Against Disease
One of the most popular short-term natural supplements that is effective against constipation is magnesium. Magnesium is an essential mineral and a cofactor used in multiple enzymes.19 A deficiency is associated with poor absorption of vitamin D and an increased risk of heart disease, stroke, osteoporosis and diabetes. Supplementation is being used to treat migraine headaches, hypertension and asthma.
Magnesium is important to mitochondrial health, and in the production of energy in every cell in your body. It is estimated that 50 years ago people routinely received nearly 500 milligrams (mg) of magnesium every day from their food. Today, with soil depletion and poor nutritional habits, many may only receive from 100 mg to 300 mg per day. Although organic, unprocessed foods are your best bet; the amount you receive will depend upon the soil the plants were grown in.
The recommended dietary allowance (RDA) for magnesium is between 310 and 420 mg per day, dependent upon your age and sex.20 However, these amounts are based on reducing your potential for deficiency and don’t necessarily address the amount you need to maintain optimal health.
Some researchers believe you may need between 600 and 900 mg per day. Dr. Carolyn Dean, author of “The Magnesium Miracle,” recommends that you use your body as a marker for your ideal personal dose.
Begin by taking 200 mg of oral magnesium citrate each day and gradually increase the amount until you develop slightly loose stools. Magnesium citrate has a mild laxative effect — whatever your body doesn’t absorb will affect your intestines as it is flushed out through your stool, which helps you identify your personal cutoff point. There is ample evidence demonstrating the effectiveness of using magnesium to naturally improve constipation.21,22,23
Magnesium comes in several forms including chelate, threonate, citrate and sulfate. Citrate is the form that has the most effect on your intestinal tract and helps produce loose stools. However, if you are taking magnesium supplements for other health reasons, my personal preference is magnesium threonate as it appears to more effectively penetrate your cell membranes and boost your mitochondrial health, thus boosting your energy level.
Try Squatting to Enhance Elimination
Sitting on your toilet may be comfortable, but placement of your knees and upper legs at 90 degrees to your abdomen actually pinches off your anal canal and makes having a bowel movement more difficult. On the other hand, when you squat, your knees are brought closer to your abdomen, which changes the relationship of your rectum and sphincter, positioning your organs and muscles in a way that relaxes your rectum. This maximizes the efficiency of your evacuation.
In this position, muscles around your rectum and pubic bones relax. This encourages complete emptying of your rectum and cecum without straining. It also reduces the potential for stagnation of stool in your lower intestines and subsequent accumulation of toxins that impact the growth of your gut microbiome. In many non-Westernized cultures people routinely squat to evacuate their bowels and don’t sit on a toilet.
It is interesting to note that in cultures where people squat daily, people don’t have the high prevalence of bowel diseases experienced in countries where toilets are commonplace. Squatting without support is challenging when you haven’t grown up squatting on a daily basis. A simple and inexpensive method of achieving good body position is to use a small foot stool. This places your organs and muscles in a more natural position and enables easier evacuation.
Fiber, Movement and Other Natural Ways of Reducing Constipation
I list several ways of reducing your risk of constipation below. But, I strongly recommend you incorporate fermented foods to help “reseed” your gut with good bacteria that will help you regain and maintain bowel regularity. The video above includes a short demonstration of how to make your own fermented foods at home. If you don’t eat fermented food, which is your best and least expensive source of probiotics, then I recommend you take a quality probiotic supplement.
In some circumstances these lifestyle choices are not enough to eliminate your constipation. As chronic constipation is one of the hallmark symptoms of hypothyroidism, it is important to discuss your situation with your physician. In many cases though, simple changes to your diet and daily lifestyle will reduce your risk of constipation and improve your gut health, such as:
Swap out processed foods for whole, high-fiber foods, such as leafy green vegetables, squash and broccoli. These foods feed your gut microbiome, reduce your vulnerability to infection and promote softer stools that keep your intestinal walls intact.24
The American Heart Association recommends eating 30 grams of fiber each day,25 but the average American eats approximately 15 grams each day, which contributes to the growing rate of constipation.26
Remove gluten, artificial sweetener and sugar from your diet as they all damage your intestinal tract.
Regular exercise can also help reduce constipation.27 The physical movement helps increase the motility in your digestive tract and can stimulate the urge to have a bowel movement.
When you feel the urge to have a bowel movement, don’t wait. The longer the stool sits in your colon, the more water is removed and the more difficult it is to pass.
Consider using a foot stool to get into a squatting position to have a bowel movement. This will strengthen the muscles around your rectum and encourages a complete emptying of your bowel without straining.
Stay well hydrated with clean, pure water.
Avoid pharmaceutical drugs that change the speed of your bowel function or cause GI disruptions, such as opiate pain medications, antidepressants, antibiotics, antacids and laxatives.
Address your emotional challenges and life changes using tools, such as Emotional Freedom Techniques (EFT).