Constipation | Majid Ali MD
Majid Ali, M.D.
A healthy bowel eliminates waste effortlessly and odorlessly once or twice daily. The frequency with which people roll their eyes when I use these words in my lectures indicates how far removed from their nature many people are.
The bowel is forgiving, not forgetful. It is tolerant but to a point. Its vocabulary is rather limited; when insulted, it bloats, cramps, screams, or becomes lifeless. When the offense continues, it ulcerates and bleeds. The bowel does not write poetry, even though people appreciate art and beauty at the gut level.
Some Simple Words
Below are some additional words which I often offer to my patients with a weakened bowel, as well as all others with chronic illnesses:
1. You must be kind to your bowel so your bowel can be kind to you—the bowel, not the mind, should decide whether or not you are indeed kind;
2. Just as a non-runner cannot condition leg muscles in a week or two, sluggish bowel muscles cannot gain optimal strength in some days or even weeks;
3. For chronic constipation, any or all measures are okay initially—use whatever assures emptying and later consider what might be optimal in the long run.
4. For all oxygen functions in the body, the bowel is more important than the lungs; and
5. If doctors had one-tenth the concern about the exhaust system of their patients as engineers have of their machines, their patients would be far healthier.
What Is Constipation?
Constipation is not merely the presence of pellets of dried, shrunken, and hard material, eliminated with a struggle a few times weekly. Constipation is a weak bowel. It is the absence of two or three effortless and odorless bowel movements a day — without bloating, urgency, discomfort, mucus, or need to spend reading time on the toilet bowl. The stool should be formed—shaped as a cast of the colon—and sink readily in the water in the bowl. There should be no visible mucus on the stool or in the toilet bowl.
From the standpoint of optimal health—in my view—constipation also includes any or all abdominal symptoms related to ingestion, digestion, and absorption of food substances, as well as elimination of the waste produced as a consequence of those processes. My primary purpose for proposing this expanded definition of constipation is to underscore the importance of symptoms that patients find hard to describe and clinicians find cumbersome to cope with. I suggest all cases of bowel irritability with episodes of diarrhea and constipation—the so-called irritable bowel syndrome, a label that reveals the underlying intellectual bankruptcy of the clinicians employing the term—should be designated as constipation.
Causes of Constipation
The bowel loses its strength primarily for the following reasons:
1. Habitual neglect of the bowel urge (the colorectal reflex)—children often hold back for fear of rectal pain caused by hard stools and/or anal fissure;
2. Chronic dehydration (the body is too dry to have well hydrated bowel);
3. Overpopulation of fermenting microbes in the bowel (vaginitis, prostatitis, and fungal infections of toes are clues);
4. Foods that bind (see the note below about individuality of responses);
5. The bowel is trapped in a belly that does not breath;
6. The mind beats up on the bowel;
7. Synthetic chemicals poison the bowel;
8. Prescription drugs insult the bowel;
9. Intestinal adhesions, inflammatory lesions, and tumors; and
10. Toxic information from some doctors
Needless to point out, it is essential to rule out the presence of tumors of the bowel as a cause of constipation.
Nighttime Magnesium/Psyllium, Over-hydration With Limbic Exercise in the Morning
No other remedies have helped me eliminate long-standing constipation of my patients more than my guidelines for “Nighttime Magnesium/Psyllium, Morning Over-hydration with Limbic Exercise.” How much fluid? As much as is needed to move the bowels—four, five, or more glasses. Where can I put that much fluid? In that lifeless, bloated and stagnant gut. Oops! Won’t that hurt? Yes, it might, but not as much as a stagnant and toxic bowel can, now and for decades to come. Oh, get serious please! My stomach simply will not accept that much fluid. Oh yes, it will if you move it around with gentle Limbic Exercise—non-goal-oriented rebounding with a mini-trampoline or with jumping-jacks. How much Limbic Exercise then? As much as is needed to obtain effortless elimination. Now, it you ask any more questions, you know your mind is punishing your bowel. (For detailed information about Limbic breathing).
Extended clinical experience has taught me the value of taking fiber—psyllium from Pakistinian and Indian stores is my preferred form. Exercise is best done in the morning to tone the body that houses that bowel—an atonic body simply cannot sustain a toned-up bowel. Fluids are best taken concurrently with intermittent exercise for expeditious distribution throughout the body in general, and to provide bulk to the bowel contents in particular. Long years of guiding chronically-ill patients with sluggish bowels has convinced me that all of the above elements are necessary for establishing a habit for effective bowel elimination in the morning. I list my top priorities in the Table.
I do not recommend coffee and other caffeinated drinks. However, so important is optimal elimination that I make this an exception for my patients.
Individuality in Laxative Effects of Vegetables and Fruits
Not unexpectedly, there is a broad range of bowel responses to individual vegetables and fruits among different persons. Beyond that is the issue of how varying portions of those vegetables and fruits exert different effects on the bowel transit time in the same individual. Optimization of those choices can be done only by true-to-life experiments. I strongly urge my patients with chronic constipation to take the time to delineate those responses for themselves. What is food for one is poison for another also applies to this area, though not so directly. Fruits contain considerable amounts of sugars which, in general, are not advisable in chronic constipation. However, the bowel transit time is such a critical issue for me that, in my view, compromises made in this area often are necessary for optimal long-term results.
Everyone with chronic constipation should consider a four-week gluten-free/sugar-free trial. The details of the trial and discussion are given in th evideos below:
Enemas and Colonics
Enemas and colonics (colon hydrotherapy) are useful for severe chronic constipation. For three years, I ran colonic units in both my New York City and Denville, New Jersey offices. After testing the benefits of colon hydrotherapy for several hundred patients, my colleagues and I recognized that, in our hands, the oral protocols yield superior clinical results. Notwithstanding their short-term benefits, it should be self-evident that neither enemas nor colonics strengthen the bowel.
When needed on short-term basis, I suggest simple Probiotics or soap water enemas. The widely available Fleet’s enema may be used for convenience or if other elements are not readily available. For longer and intermittent use, black sesame oil may be employed (use two ounces of the oil gently injected with a 60 ml syringe (without needle) or a rectal tube). The oil can also be mixed with warm (temperature 100° to 105° Fahrenheit) water in the enema bag for longer retention and greater efficacy.
Castor oil has also been used for enemas. The commonly used enema recipe uses two ounces of the oil mixed well with two quarts of warm water. I suggest that this oil be used cautiously and in smaller volumes initially.
The Author’s Guidelines for Minerals-Castor-Cise Plan for Constipation
Magnesium 450 to 1,500 mg
Potassium 150 to 300 mg
Taurine 750 to 1,000 mg
Psyllium husks Two to three heaping tablespoons
Castor oil rub* For chronic constipation
Fluids, cold and hot
Probiotics – yougurt / kefir; and IN ROTATION goat’s milk and cow’s milk products
I have seen a large number of patients who developed various gastrointestinal symptoms after colonoscopy, such as cramps, abdominal bloating, alternating constipation and loose bowel movements. I now advise all my patients to take yogurt or kefir – goat milk products for individuals with dairy intolerance – as often as convenient for a period of 24 hours after the procedure. This simple measure markedly reduces the incidence and frequency of gut symptoms induced by colonoscopy. Such benefits appear to be related to the restoration of bowel flora following the disruption caused by bowel cleaning procedures required for proper visualization. Probiotics, of course, are important for far more important reasons.
Five days a week, my lunch is yogurt or kefir rotating among various brands of cow milk and goat milk products. I prescribe yogurt and kefir (to be consumed in rotation) for nearly all my patients and take liberal amounts of a mixture of probiotics species (lactobacillus and bifidobacterium) for cold symptoms. I do so on the basis of what I have from my own gut and what my elders and my patients taught me. I do not say this because of silly notions of “scientific studies” conducted by companies that charge exorbitant amounts for their branded yogurts.
For severe constipation
Senna tea or capsules 50 to 100 mg at bed time
Cascara tea or capsules 250 to 500 mg at bed time
Enema with probiotics (only for severe constipation in initial period of recovery)
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