The normal frequency of bowel actions varies greatly between people. Ideally you should have from one to three bowel actions daily. They should be a brownish colour, be soft and grainy and passed without undue straining. Signs to worry about are red blood or a black colour in the stools, or an obvious change in bowel habits from your normal pattern. It is good to look at each bowel action after you pass it to check for general appearance and colour.

What are the Effects of Chronic Constipation?

If constipation becomes chronic and the bowel is not emptied effectively, waste products and faeces will accumulate in loops, pockets, nooks and crannies in the bowel. In such places unfriendly bacteria and parasites may grow and this can cause a build up of toxins, which can affect general health. Toxins from the bowel may recirculate back to the liver. An overworked liver causes fatigue and poor general health.

The bowel may become inflated causing abdominal bloating, cramps and unpleasant gas and this is embarrassing for many people. If you have these problems it is wise to have a colonoscopy by a specialist doctor to exclude serious disease such as bowel cancer.

Chronic constipation can lead to haemorrhoids and anal fissures, which are painful and can bleed producing bright red blood. Constipation can lead to pockets in the bowel which may become inflamed – this is known as diverticulitis. Repetitive straining to pass hard faeces can lead to a prolapsed rectum and/or faecal incontinence.

The Facts about Laxatives

Laxatives are used to induce a bowel action and/or to prevent constipation.

Strong Laxatives

Some laxatives are very strong and may overstimulate the muscles of the bowel leading to irritation, colonic spasm and in the long-term, enlargement and permanent damage of the colon. For this reason they should not be used on a regular basis. Strong laxatives (cathartics) can be used occasionally for severe constipation. They include senna and cascara. Conventional laxatives are things like phenolphthalein and dioctyl sodium sulphosuccinate, and although they work swiftly, they can cause diarrhoea and cramping. Strong laxatives can be habit forming.

Osmotic Laxatives

Osmotic laxatives such as magnesium sulphate (Epsom’s salts), magnesium oxide and lactulose are a much safer alternative to cathartics, and I prefer to use them in cases of chronic constipation. Osmotic laxatives draw water into the colon and make the bowel actions soft and more liquid. They do not generally irritate the bowels. OsmoLax and Movicol are popular brands of osmotic laxatives that contain macrogol 3350 (polyethylene glycol). Macrogol is an inert substance that passes through the gut without being absorbed into the body and has been clinically proven to relieve constipation. It works by restoring the natural rhythm by using the body’s own water to gently increase the frequency of bowel movements and to soften the stool. It relieves constipation because it causes the water it is taken with, to be retained in the bowel instead of being absorbed into the body. This increases the water content and volume of the stools in the bowel, making them softer and easier to pass. Macrogol usually produces a bowel movement within 1 to 3 days. Macrogol can be used for children over 4 years of age as well as adults. 

Suppositories and Enemas

Suppositories and enemas are effective for sudden severe constipation of the lower bowel or faecal impaction. Some bowel therapists add herbs such as catnip or coffee to enemas to improve their cleansing effect. Faecal impaction means that hard faeces get stuck in the rectum and lower colon, and obstruct the passage of softer faeces higher up. This can lead to “spurious diarrhoea” where the softer faeces above the hard impacted faeces liquefy and are then able to pass around the hard faeces and it appears as though the patient has diarrhoea when in reality they have severe constipation. This can occur in the very elderly, immobilized persons, over medicated patients or those with neurological diseases. This is why a doctor should perform a rectal examination in severely constipated patients. Faecal impaction may require manual extraction of the faeces if an enema does not work. Thereafter regular enemas or colonic irrigations need to be given to prevent a recurrence.

Many people find that colonic irrigations are very beneficial in removing waste products from the bowel, and in experienced hands this is safe to do. If you have severe constipation, colonic irrigations from a registered practitioner every 2 to 4 weeks can be of great benefit.

However even if you have regular enemas or colonic irrigations you still need a high fibre diet and plenty of water, and if possible regular exercise. Enemas and/or colonic irrigations should not be performed in cases of inflammatory bowel disease, severe diverticulitis, or where there is a structural defect of the bowel. This is to avoid mechanical damage to the bowel in these cases.


A high fibre diet is best obtained from eating plentiful vegetables and fruits. Dried fruits and nuts are also a good source of fibre. Grinding linseeds (flaxseeds), sunflower seeds and almonds into a fine powder can help stubborn constipation and can be eaten instead of bran. This powder mixture is known as LSA and can be purchased from supermarkets and health food stores or make it yourself in a grinder and store it in the freezer. Chia seeds are excellent for constipation and reduce bowel inflammation. Add chia seeds to smoothies or gluten free muesli.

Hemp seeds can be eaten regularly in salads and homemade muffins and smoothies and are excellent for constipation as they are high in fibre. You do not need to grind hemp seeds.

Fibre products can help constipation and the best known one is psyllium husks. An excellent gluten free fibre product is called FibreTone and is available from health food stores or online. FibreTone contains psyllium combined with glycine and taurine for healthy bile, as well as the liver herbs St Mary’s Thistle and dandelion. Fibretone is a super food for the bowels; the dose is 1 or more teaspoons of Fibretone powder daily on cereal or in juice or water. FibreTone is suitable for all types of constipation as it acts like an “intestinal broom,” sweeping the walls of the colon clean. Make sure that you drink plenty of pure water (2 litres daily) to help this powder do its work.

Fibretone can reduce irritable bowel syndrome and chronic constipation. It can also reduce bowel toxicity caused by faecal stagnation. Fibretone is also suitable for those who are allergic to gluten (found in bran containing wheat, oat, barley or rye). There are many types of fibre powders on the market that can increase the bulk of the faeces and reduce constipation. These are safe to use in the long term and confer general health benefits. Other brands that I have found effective are Normacol and Fybogel.

Some people become constipated after having their gall bladder removed and this can be helped by taking Oxbile capsules with meals.

Many of my patients tell me that when they are constipated it affects their mental and emotional health adversely – they feel depressed, tired or irritable and after a good bowel action they feel much more relaxed and cheerful. There is a powerful connection between gut health and brain health and we now know that inflammation in the gut can cause inflammation in the brain. Your intestines make more serotonin than your brain does and serotonin is the chemical our body needs to function in a balanced way physically and mentally. Serotonin is an anti-depressant neuro-transmitter so we want to ensure that our intestines are healthy enough to manufacture plenty of serotonin. For more information see my new book titled Healthy Bowel Healthy Body

You can find all of my books at
United States and International Online Book Store

Australian Online Book Store

Or search for the word Sandra Cabot on your favorite eBook reader


The above statements have not been evaluated by the FDA and are not intended to diagnose, treat or cure any disease.