Constipation  is usually a symptom of an underlying problem.  Constipation is difficulty passing stools, infrequent elimination, or lacking the need to have a bowel movement.

Other symptoms which tend to be associated with constipation are hemorrhoids, indigestion, loss of appetite, nausea, reflux, heartburn, hiatal hernia, bad breath, acne, headaches, high cholesterol, liver pain and weight gain.

Constipation increases the workload of the body.  Metabolic waste, excreted toxins and fermentation products accumulate in the intestines with constipation.  These byproducts of digestion and liver detoxification (toxins) are absorbed back into the blood stream, causing the liver to increase its workload.  Eventually, the extra metabolic waste in your bloodstream can cause symptoms and illness.

For example, estrogen is broken down in the liver.  Both men and women create estrogens that need to be removed.   The “detoxified” estrogen is then passed into the intestines from liver processing and through the bile.  Bacteria in the intestines can remove the estrogen from the bile, which is then absorbed through the intestinal lining.  Your liver then has to process that same estrogen again, as well as new estrogen.  This can lead to PMS, menopausal symptoms, hormone imbalance, increase risk of cancers and even prostate problems (for the men out there, of course).

This same viscous cycle also applies to pesticides, herbicides, environmental chemicals, bacterial byproducts and processed physiologic waste.

Constipation can be managed acutely with laxatives, but the cause of the constipation must be found and treated.



There are 3 classes of laxatives.

1) The least aggressive laxative is FIBER:

Fiber adds bulk to the stool.  This is useful when stools are small or hard.  Fiber can be eaten in food or supplemented.  Fiber is non-addictive and safe for most people.  People with diverticular disease have to be careful of fiber because the fiber can lodge in the pockets of the intestines.  In this case, soluble fiber such as apple or citrus pectin is safer choices.

Choices of fiber include:

  • Psyllium
  • Flax fiber
  • Fiber blends

 2 ) A stronger form of laxative is an OSTMOTIC LAXATIVE.

Osmotic laxatives “pull” water into the intestines.  Bringing more water into the stool increases volume of stool and makes it softer.


  • Magnesium Citrate helps relax bowel spasms and is an osmotic laxative.  Magnesium citrate is non addictive and gentle.  To determine the level of magnesium to take, start with 1/day with or without food.  Then daily, increase by 1.  Stop when stools are normal. For instance, 1-2 magnesium citrate 1-2X/day is a common dosage.

Do not exceed the dose of 300mg 3X/day (total 900-1000mg/day).

Magnesium citrate is an excellent choice as a laxative because magnesium is also muscle relaxing and magnesium is necessary for nerve function and bone density.  Magnesium does not cause urgency or spasms, unless you take too much.  That is why you start off slowly.  Remember using magnesium is safe, but should be used to give you the opportunity to find and resolve the cause of the constipation.

  • Calcium/Magnesium Citrate effervescent
  • OTC products like Miralax or Epsom Salts) The strongest laxative is a Stimulating (Irritating) Laxatives:


Stimulating laxatives (including Senna, ExLax® or Casgara sagrada) irritate the lining of the intestines.  This irritation in the intestines causes spasms, forcing the stool out.  These intestinal spasms create urgency.  Irritant laxatives are addictive and dangerous. Your intestine loses the ability to contract and propel stool normally when irritant laxatives are used long term.

I do not recommend irritant laxatives except in extreme cases.

Naturopaths prefer to determine the REASON for the constipation so that we can treat the cause, rather than using addictive dangerous treatments.


Intestinal Bacteria: Probiotics: “Gut Bugs”

Certain bacteria including Lactobacillus and Bifidobacteria live in the intestines, and they should be there.  These good bacterial create up to 1/4 of the entire stool volume.  If the volume of stool is low, it may be a lack of these healthy intestinal bacteria.

If this population of healthy bacteria gets out of balance and dies off, other organisms will colonize the intestines.  These organisms include: Candida albacans, other fungus and harmful bacteria.  Fungus and harmful bacteria secrete toxins, which slow gut movement and cause a tremendous number of symptoms.

Food sources of Probiotics include: live (refrigerated) miso, live culture yogurt, live (refrigerated) sauerkraut, live kim chee, and kefir.  All of these foods should not be boiled, because it kills the bacteria.

Probiotic supplements are pills or powders that deliver healthy friendly bacteria to the intestines.  Not all Probiotics are created equal.  Some must be kept cold so the living bacteria don’t die.  Other Probiotics are suspended in a “bacterial food”, so they can survive at room temperature.

Some companies use bacteria that are isolated from soil.  I do not recommend soil based organisms, because they don’t inhabit the intestines, they just pass through.  I recommend products that will eventually take over the intestines and maintain healthy populations.

Such as

  • Ultra flora plus
  • Probiotic Pearls
  • Probiotic 50b


Please see the section on dysbiosis to further understand correcting gut intestinal bacteria population.

Causes of constipation include

  • Hemorrhoids
  • Dysbiosis (Candida or other intestinal infections)
  • Poor liver health
  • Lack digestive enzymes
  • Low stomach acid (or blocked stomach acid from reflux drugs)
  • Low fiber/ high carbohydrate meals
  • Excessive use of white flour and white pasta (flours stripped of fiber)
  • Hypothyroid
  • Hormonal problems
  • Dysfunctional nerve impulses
  • Decreased tone of intestine
  • Intestinal muscle in spasm
  • Stress/Anxiety
  • Magnesium deficiency
  • SIBO: Esp methane producing SIBO (small intestinal bacterial overgrowth)
  • Neurologic disruption
  • Neurotransmitter production and metabolism problem
  • Methylation defects


Drink enough water.  A general recommendation is 2 quarts a day or more.

Colon cleanses can help gently clean the intestines.  They must be done carefully or with a doctor’s supervision.  Taking laxatives and probiotics as a “colon cleanse” doesn’t necessarily solve SIBO or dysbiosis.  This is the same as gardening in the woods.  Just because you throw some seeds into the woods doesn’t mean you are going to end up in a garden.  You have to remove the plants, make the dirt nice and manage that growth.  The same holds true for probiotics.  If there are infections or inappropriate bacteria attached to your GI lining, then you have to remove those before you can re-establish a healthy colony of gut bugs.


My goal for fixing constipation is to find the underlying cause of the problem.  I suggest testing to rule out SIBO, dysbiosis, food reactions, hypothyroid and many other conditions.  I often get an email asking what the easy way to fix constipation is.  (How much magnesium should I take, etc).  That is not how a naturopath works!  We endeavor to find the underlying cause of the constipation and correct that.  I love tests!  I test and try to find the solution to the problem to create better management which leads to better digestion, absorption and assimilation of nutrients.  I believe the gut is the mother of the body.  If you can’t get your nutrients in, you can’t be healthy.  Using treatment to improve frequency of BM is sometimes necessary, but it’s always better to find the cause of the problem and correct it then it is to manage a symptom.