Is there a way to cure my constipation without taking laxatives or prescription medications every day? This is one of the most common questions I get asked as a gastroenterologist, and I understand why.

Constipation, usually defined as having fewer than three bowel movements per week, is the most frequent gastrointestinal complaint. And many people don’t want to take medications every day, or fear they will become dependent on laxatives (even though that’s a common misconception).

Here are some of the more so-called natural ways to improve constipation that are also backed by science.

Increase fibre intake

Most adults should get somewhere between 21 and 38 grams of fibre each day, according to the National Academy of Medicine. But few people in the United States do.

Prioritising fibre-rich foods such as fruits, vegetables, nuts, seeds, legumes and whole grain products not only increases your fibre intake but may prevent constipation by making your stool bulkier, softer and easier to pass.

Experts also recommend taking psyllium, a soluble fibre supplement, every day.

Stay hydrated

Water and other hydrating foods and liquids naturally soften your stool by keeping it from becoming hard and dry.

To stay hydrated, try keeping a large, reusable water bottle filled and nearby throughout the day. Or consume hydrating foods and drinks, such as milk, juice, tea or coffee (which may also stimulate the urge to defaecate), or fresh fruits such as melons or grapes.

Exercise regularly

Researchers have found that exercise can improve gut health in various ways, from bolstering the microbiome to reducing the risks of colorectal cancer and constipation. Even just 15 minutes of mild to moderate exercise — such as going for a walk or raking the leaves — can cause blood flow and hormone changes in the gut that can stimulate your bowels to propel contents forward.

Food as laxative

Dr Michael Camilleri, a gut motility specialist at the Mayo Clinic in the US, said certain foods such as prunes and kiwis may help with constipation.

In a small study published in 2011, for instance, researchers found that consuming 50 grams of dried prunes (the equivalent of about five or six prunes) twice a day was more effective at improving stool frequency and consistency than consuming 11 grams of psyllium twice a day. Drinking prune juice has also been shown to be beneficial.

A 2021 clinical trial also found that eating two kiwis per day was as powerful as prunes at increasing stool frequency and reducing straining — and had the added benefit of helping with bloating.

The sugar, fibre and other nutrients in kiwis can produce a laxative effect by increasing the water content and volume of your stool, Dr Camilleri said. “That makes the consistency of the bowel movements softer, and makes it easier to expel.”

Squatty potty

Dr Darren Brenner, a gastroenterologist at Northwestern Medicine in the US, said using a toilet stool to position your knees above your waist can be a low-cost, low-risk fix for constipation. “You can use anything — a step stool, an old phone book — you just want to raise your knees above your hips,”
Dr Brenner said.

Work pelvic floor

More than 20 per cent of people with chronic constipation have a dysfunction of the pelvic floor muscles — called pelvic floor dyssynergia — that causes them to contract in ways that block the expulsion of stool.

Dr Brenner said that if bowel-cleansing methods such as enemas don’t help, or if you find even soft stool difficult to pass, you need to talk to a physician about this condition.

Several small but solid studies have found that a special kind of physical therapy with biofeedback, which involves working with a physical therapist to coordinate your muscles during defaecation, can help about 80 per cent of people with pelvic floor dysfunction.

Vibrate the colon

A new prescription electronic capsule, called Vibrant, is now available for certain people with chronic constipation. After the capsule is swallowed, it promotes a bowel movement by stimulating the colon with gentle, timed vibrations — “similar to the vibrating device you get at a restaurant,” according to the description on its website.

In one clinical trial of more than 300 patients with chronic constipation, those who took Vibrant five times a week had more frequent bowel movements, better quality of life and reduced straining compared with those who took a placebo.

Bottom line

No matter what the hype says, the jury is still out on many purported “natural” remedies.

“People always ask about things like probiotics or faecal transplant,” Dr Brenner said. “These may be plausible treatments in the future, but the data isn’t robust enough right now to recommend them as treatment for constipation.”

If you suddenly start having constipation, discuss it with your physician as it may warrant further investigation with a colonoscopy.

And, sometimes, “natural” or lifestyle interventions won’t cut it for severe cases. Just as you need to take medications for other health problems, such as high blood pressure or diabetes, you might need medication to control chronic constipation.

NYTNS