Written by Pala Senabulya, Naturopathic Nutritionist
Pala is a naturopathic nutritionist and founder of Pala Nutrition, an online nutrition clinic specialising in helping women struggling with bloating and chronic constipation transform their lives with wholefoods and mind-body practices.
Drinking more water is often heralded as a remedy for constipation (alongside eating more fibre and exercising) but far too often it doesn’t work. In this article, we will explore the connection between water, hydration and constipation. We will delve into some of the complexity of healing chronic constipation and why drinking water is not a cure-all. Get ready to learn how to hydrate properly and why hydration is only one part of any effective solution to constipation.
Why is chronic constipation so difficult to fix?
Constipation is generally defined as having fewer than three bowel movements a week and/or hard/lumpy stools that are difficult to pass stool and/or incomplete evacuation of your stool.
Whilst this may often result in bloating, discomfort, pain, haemorrhoids, headaches, anxiety, nausea and more; only a small percentage of sufferers seek medical attention and end up relying on an endless cycle of laxatives.
Online advice to resolve constipation tends to focus on increasing fibre, drinking water and exercising as the key remedies. The reality is that chronic constipation is a highly complex condition that requires a nuanced personalised approach depending on the root cause of your constipation. If you don’t know what is causing your constipation it becomes difficult to choose the most effective remedy.
10 causes of constipation: It’s not just low fibre and water
Constipation can be caused by many different factors including the commonly quoted:
Diet: Eating a diet low in fibre is often a major culprit, initiating poor stool formation in the colon.
Dehydration: If your body is dehydrated it will absorb water from your stool making your poop dry, lumpy and hard to pass.
Lack of physical movement: A sedentary lifestyle with little physical activity can often lead to slow and sluggish bowels.
However, there are many other causes of constipation rarely mentioned that may be critical to your understanding of why you are constipated and how to heal permanently including:
Hypothyroidism: Low thyroid hormones are a well-established factor causing impaired colonic motility that may be at the root of your ongoing constipation.
Small Intestinal Bowel Overgrowth / Intestinal Methanogen Overgrowth: An overgrowth in methane-producing bacteria in your intestines is a cause of chronic constipation.
Medications: (opioids, for example) have well-documented side effects like constipation
Changes in routine: Travelling, changes in eating habits or disruptions to your daily schedule
Food sensitivities: Intolerance to foods like gluten, dairy, eggs etc may play a part in constipation
Defecation dysfunction: Issues with your pelvic floor and rectal muscles that impair muscle contraction and release.
And more... surgery, Crohn’s and many other diseases may result in chronic constipation.
You can start to see why despite your best efforts you may still be constipated. There is no one-size-fits-all approach to resolving chronic constipation. Healing will require a personalised approach. Dehydration is only one of many possible factors that might be causing your constipation. Why then is drinking more water touted as a sure-fire remedy to resolving your constipation?
How water affects your digestive system
Water is essential to the smooth running of your digestion as it is involved in:
Producing saliva: Water is a key component of saliva which is a critical element in our digestion of food.
Nutrient absorption: Your small intestine relies on water to dissolve water-soluble nutrients like B and C vitamins and transport them into your bloodstream.
Gastric mucous: The protective mucous lining our intestines wall is 95% water. Keeping this mucous functioning optimally requires that you are sufficiently hydrated.
Poop formation: The water content of your stool determines how soft and easy they are to pass. Without water, dehydrated poop becomes hard and lumpy. It is always fun and useful to compare your poop to the Bristol Stool Chart; the ideal poop is a 3 or 4.
Unfortunately, our constipated poop tends towards number 1 which is rabbit-like, hard and lumpy poop.
Why dehydration causes constipation
Water is not only essential for your digestive system; it is the most abundant fluid and vital to the function of every cell in your body which is why we have internal controls that carefully maintain our water balance (homeostasis).
When your body is dehydrated it signals thirst so that you drink more water and your kidneys reduce excretion of water as urine. Your body also prioritises your internal water requirements which are critical for survival over poop formation and absorbs water from your colon.
Absorption of water from your colon causes your stool to become dehydrated and hard to pass.
How much water should you drink every day?
There are a few things you should consider:
What do we mean by water?
Believe it or not when we are discussing what your recommended daily intake of water should be we need to clarify what we mean by “water”. Water in this context means plain water, the water in beverages and water-rich food.
How much water should I drink?
There is a consensus guideline of 2-3 litres of water per day which includes all water-containing beverages as well as the water content in the food you eat.
What should I eat and drink to meet my daily water intake?
Your daily target of 2-3 litres could be made up of-
Water: Plain water. Either bottled or clean filtered water.
Other beverages: Herbal tea, green tea, tea, coffee, juices, milk all contain large amounts of water
Fruit and Vegetables: Cucumbers, watermelon, lettuce, celery, oranges, and apples are helpful due to their high water content.
Other factors that influence how much water you should drink each day
You may need to drink more than the recommended 2-3 litres of water per day if:
You are more physically active
You sweat a lot in the normal course of a day
You are pregnant
You consume a lot of coffee and/or alcohol (which can be dehydrating)
You live in a hot country or are experiencing warm weather
Signs you're not drinking enough water
If your water is sourced from these various dietary inputs how can you know if you are getting enough each day? Your body has its ways of signalling to you. Common signs of dehydration may include:
Dry mouth and skin.
Dark yellow urine: If it is dark yellow later on in the day then it’s likely you are not drinking enough.
Fatigue and dizziness: Dehydration can make you feel unusually tired or light-headed.
Headaches: Frequent headaches can often be linked to a lack of hydration.
Reduced cognition: especially in older folks, dehydration can be a factor in poor memory and cognition.
Dry, hard stools: Clearly, the most relevant and direct link to constipation as dehydration contributes towards making your poop hard and difficult to pass.
If you notice these symptoms, it may be time to up your hydration game.
Why proper hydration requires more than water
You might be thinking, “If I’m drinking enough water, isn’t that enough?”. However, hydration goes beyond simply drinking your daily recommendation of water, it also requires sufficient electrolytes.
Hydration is the balance of fluids and electrolytes in your body, requiring sufficient electrolytes like sodium, potassium and magnesium as well as water to ensure your body functions optimally.
An imbalance in electrolytes like sodium, potassium, magnesium and chloride can lead to weakness in our intestinal muscles, poor peristalsis (the concerted contraction of muscles that pushes our stool through to our anus) and ineffective osmosis.
If you are drinking litres of water but are thirsty, always running to the loo and still constipated, then it is time to shift your focus from drinking water to hydration.
Top 6 tips for staying hydrated
Staying hydrated doesn't have to be complicated. The following tips will help you maintain proper hydration throughout the day:
1. Start your day with a glass of electrolyte-rich water: Salt, lemons, and ginger are all affordable and accessible ingredients rich in electrolytes. Ginger is also an established prokinetic, supporting digestive motility. I recommend:
250 ml — 500 ml warm water with a pinch of Himalayan or sea salt
250 ml — 500 ml water + juice of half a lemon
250 ml — 500 ml of ginger tea
Drink your water on an empty stomach before you consume anything else.
2. Drink throughout the day: If you are someone who forgets to drink or who doesn’t typically feel thirsty. There are some excellent apps available like “WaterMinder," “Water Drink Reminder” or “WaterBalance” which you can set up to remind you to drink water. Alternatively, set your reminders on your phone.
3. Mix it up with flavoured water: Keep it interesting and enjoy a variety of drinks during the day to maintain your fluid levels including herbal teas like ginger, fennel and mint or infuse your water with slices of lemon, berries, cucumber and mint.
4. Eat hydrating foods: Focus on water-rich and electrolyte-rich foods like cucumbers, oranges, strawberries, watermelon, citrus fruit, kiwi fruit, avocados, coconut water and dark green leafy vegetables like spinach and chard.
5. Carry a water bottle: Keeping a reusable water bottle with you will make it easier to take sips throughout the day.
6. Increase your fluid and electrolyte intake on warm weather days, when active or travelling. Take extra care to ensure you replenish both your water and electrolytes.
How to make an electrolyte drink
Creating a homemade electrolyte drink is easy and requires only a few ingredients. Ingredients:
1 litre of filtered/clean water
1/2 teaspoon of salt: (Himalayan pink salt or sea salt)
Juice of half a lemon: Adds potassium and vitamin C.
Optional: 200 mg of Magnesium powder Mix the ingredients and sip throughout the day.
Conclusion
Dehydration is a common cause of constipation as our body prioritises our internal functions and will act to absorb water from our intestines and stool to maintain water homeostasis.
When chronically constipated, drinking water may not be an effective solution on its own because you need both water and electrolytes to hydrate your body properly. If you are not getting enough water or electrolytes you will remain dehydrated.
However, dehydration is only one of many causes of constipation. Without investigating the root cause of your chronic constipation it can be tricky to resolve as it may require more than the often- cited solutions of fibre, water and exercise. A personalised approach that systematically investigates the root cause of your chronic constipation and heals your digestive function is essential.
Discover your healing journey
If you suffer with chronic constipation and are feeling toxic and stuck with no idea what to try next then it might be time to dig deeper and investigate the possible root causes, allowing you to cease endless trial and error remedies that may give you temporary relief but never fully resolve your constipation.
I offer a personalised 3-month 1:1 programme based on my 6-step Blissful Bowels framework. Take the first step on your healing journey by booking a free 30-minute session with me and learning how my framework can help you transform your health, setting you free to live life more fully.
Read more from Pala Senabulya
Pala Senabulya, Naturopathic Nutritionist
Pala is a Registered Nutritionist and passionate advocate of a holistic approach to health and wellness. Having successfully resolved her own gut and menstrual health issues with wholefoods, yoga and meditation she now runs an online nutrition clinic to support women in transforming their lives so that they can have more energy and freedom. Pala often takes a left-field approach by encouraging her clients to try different healing modalities like drinking cacao, practicing yoga nidra or EFT as part of their healing journey. Pala offers a three month 1:1 personalised nutrition programme based on her signature Blissful Bowel framework for healing constipation.
