If you’re 60 or older, chances are one in three that you have occasional or chronic constipation. For people under age 60, the odds are one in six, and women of all ages are 50% more likely to have constipation than men. 

But not all constipation is created equal. It occurs for several reasons, and different causes call for different treatments. Use the wrong treatment, and your problem may only get worse. Naturopathic physician Joshua Levitt, ND, explains what you need to know…

Chronic Constipation

An aging colon is a major culprit when it comes to chronic constipation. Reduced muscle function in the large intestine makes defecation more difficult. The smooth muscles in the wall of the colon become weaker, impairing peristalsis, the automatic muscular contractions that propel stool through the bowel. 

Other causes: You may not be getting as much exercise as you used to. Less physical activity results in less intestinal motility—the movement of the stool. Or your diet may be low in fiber. You need roughage from fruits, vegetables, beans, grains, nuts and seeds to add bulk to your stool. 

Growing problem: Chronic constipation is a side effect of certain medications. Worst offenders: Pain relievers such as opioids and nonsteroidal anti-­inflammatory drugs (NSAIDs)…antidepressants…and proton pump inhibitors for heartburn.

Note: There also are a number of diseases that cause constipation, including Parkinson’s and hypothyroidism. If you have disease-caused chronic constipation, see your doctor.

The Right Laxative For Chronic Constipation

It’s important to understand your unique type so that you can choose the laxative that will work best for you. At the most basic level, there are two types of chronic constipation… 

Spastic. This is characterized by pellets or thin ribbons of stool that require you to strain to pass them. This happens because of a tense bowel—the smooth muscles of the colon are overly tight.

Atonic. This is characterized by large, hardened stools that accumulate in the bowel. It happens in people who have been constipated for a while—they have trouble squeezing out the stool due to an atonic, or flaccid, bowel.

What to do…

For spastic constipation: There are osmotic or softening laxatives, some with magnesium, such as Phillips Milk of Magnesia, and some using other compounds, such as polyethylene glycol (MiraLAX).* So-called “stool softeners” usually are osmotic laxatives, such as docusate (Colace, Surfak). They work by drawing water into the bowel, softening stool. 

But my favorite osmotic laxative—because it’s the most effective due to higher absorbability and better muscle relaxation—is magnesium citrate, a ­nutritional supplement taken as a powder, pill, capsule or liquid. To find your tolerance level, start with a dose of 300 milligrams (mg) of magnesium citrate, taken with dinner, to hopefully produce a morning bowel movement. Because magnesium requires digestive acid and digestive enzymes for absorption, it’s best taken with a meal. Take the 300-mg dose for three days. If it doesn’t produce results, increase the dose to 450 mg. Continue to increase the dose by 150 mg every third day until you produce a laxative effect. If you get to the point of ­watery diarrhea, cut back to the previous dose. Magnesium citrate can be taken on an ongoing basis as long as it’s 150 mg below your tolerance level. I suggest Magnesium Citrate by Vital Nutrients or Natural Calm by Natural Vitality. 

Another option for spastic constipation is enteric-coated peppermint oil. Peppermint is an antispasmodic, making it ideal for spastic constipation.

My advice: I favor ­Mentharil from Integrative Therapeutics. Take one capsule (0.2 milliliters of enteric-coated peppermint oil) at bedtime. If that doesn’t work, take two the next night. If that doesn’t work, take three the next night. If it still isn’t working, it’s not the right laxative for you. Note: For mild constipation, a cup of peppermint tea is a great option. 

For atonic constipation: While there are many fiber-rich (bulking) laxatives—wheat dextrin (Benefiber), methylcellulose (Citrucel), calcium polycarbophil (FiberCon) and ­psyllium (Metamucil)—the most effective “­laxative” is simply high-fiber food. 

Try a daily breakfast of one-half cup of oatmeal, a tablespoon of ground flaxseed, a handful of slivered almonds or walnuts and a sprinkling of berries. Throughout the rest of the day, eat five servings of fruits and vegetables and plenty of beans, legumes, whole grains and/or nuts and seeds. 

Alternative: Add ground flaxseed to a smoothie.The optimal dose is two ­tablespoons—but don’t start at that level because it can produce increased gas. Instead, start with one-half tablespoon for three days, increasing it to one tablespoon on day four…to one-and-a-half tablespoons on day seven…and to two tablespoons on day 10.

Stimulant laxatives. Popular stimulant laxatives include bisacodyl (Dulcolax) and sennosides, the active ingredient in the herb senna (Senokot, Ex-Lax). These over-the-counter products work by stimulating the bowel to contract and expel stool—but I suggest trying a gentler, natural alternative with fewer side effects first. Drink one-half cup of senna tea daily. Try Traditional Medicinals Smooth Move senna tea. 

For Occasional Constipation

If you want quick relief from a bout of constipation that is not chronic, try this protocol, which helps prevent rectal tears caused by passing stool that has accumulated in the colon over several days.

Day 1:
1: Drink one cup of prune juice, and eat three to four prunes. Prunes contain naturally occurring sorbitol, which works like an osmotic laxative. 

2: Take magnesium citrate—from 300 mg to 500 mg.

Day 2:
If bowels have not moved…

Continue the steps above and…

3: Drink one cup of senna tea. Steep two bags for five minutes.

4: Take an aloe vera extract, which “greases” the bowels, helping stool move. Try one 450-mg capsule of Super Aloe from Ortho Molecular Products.

Caution: If there is an abrupt change in bowel movements…you’re constipated for more than a week…constipation is accompanied by severe abdominal pain…or you see blood in your stool—see your doctor. 

Keep Everything Moving

The following good habits help to prevent constipation…

Go when you need to go. Delaying defecation stretches the bowel, creating and worsening atonic constipation. When your body is telling you it’s time to go—go.

Use a toilet footstool. The optimal position for effortless defecation is squatting, not sitting. A way to mimic this pose is to use a footstool in front of your toilet, which raises your knees, creating a squatlike position that helps open the rectum. (Squatty Potty is a popular brand.)

Don’t sit around. To prevent constipation and for general health, the pelvic floor should be toned and tight. Unfortunately, sitting too long on the toilet relaxes the pelvic floor—stretching layers of muscle and tissue like a hammock. If defecation isn’t happening, come back later. If you’re finished, don’t hang around.

*Check with your doctor before taking any supplement—especially if you have a chronic medical condition or take medication.

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