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It’s generally recognized that constipation is having a bowel movement less than once daily. But because the large intestine (colon) reabsorbs water during this time, the longer stool sits there, the harder and dryer it can become. This contributes to painful bowel movements and impaction of fecal matter. And it can eventually lead to complications like megacolon, hemorrhoids, anal fissures or rectal prolapse.
Moreover, stool contains chemicals that were just previously detoxified by the liver and excreted with the bile (water insoluble molecules) and that were intended for elimination from the body. The longer stool sits in the colon, the more likely it is that these unwanted chemicals will be reabsorbed into the body through the mechanism previously described called enterohepatic circulation. 
This process proceeds in this manner:
What factors contribute to this slow stool transit of constipation?
Here’s a list:
- A low-fiber diet: Over time, causes stool to become compacted, hard and larger.
- Medications: Can slow intestinal smooth muscle peristalsis (contractions). Problematic substances include narcotic analgesics, antacids, calcium channel blockers, Parkinson’s disease medications, antispasmodics, iron supplementation, some antidepressants, diuretics and anti-seizure medications.
- Overuse of laxatives: Weakens colon peristalsis over time and worsens constipation if used consistently and continuously.
- Lack of physical activity: If you sit too long every day, are sedentary while traveling, commute a long distance or are subject to prolonged bed rest (i.e., after surgery) your parasympathetic impulses for peristalsis decrease.
- Ignoring bowel movement urges: Being too busy to pay attention to bowel signals because you are too busy can stretch and weaken the muscles of the colon wall over time.
- Medical conditions: Low thyroid function, diabetes, Parkinson’s disease and other neurological disorders can contribute to the condition.
- Intestinal tract problems: Celiac disease, tumors, polyps, diverticulosis and irritable bowel syndrome can complicate constipation.
- Obstetric difficulties: Older women with excessive perineal descent  from previous pregnancies or pelvic surgery  may have constipation problems.
- Environmental toxins: Constipation may be linked to chemicals like organochlorine insecticides and heavy metals, as well as toxins released during bacterial or parasitic infections. 
Often, I hear patients report they cannot find a cause of their constipation and that it developed slowly over many years. In these people I suspect they have an undiagnosed low thyroid function.
Other likely possibilities are that the percentage of raw food in their diet is still not enough for their bowels to function properly or that they are being adversely affected by chemicals from personal care products, non-prescription medications or other environmental sources. Rarely is there a need to undergo colonoscopy in search of bowel disease or tumor, unless the history and risk factors suggest that the test is necessary.
Whatever the cause, there are safe and effective ways to reverse constipation. I’ll discuss these in my next article. I’ll discuss subtle toxins that contribute to constipation, and how to reduce them, in my subsequent report.
To feeling good,
Michael Cutler, M.D.
Easy Health Options
 Camilleri M, Lee JS, Viramontes B, Bharucha AE, Tangalos EG. Insights into the pathophysiology and mechanisms of constipation, irritable bowel syndrome, and diverticulosis in older people. J Am Geriatr Soc. 2000 Sep;48(9):1142-50.
 Johanson JF, Sonnenberg A, Koch TR. Clinical epidemiology of chronic constipation. J Clin Gastroenterol. 1989 Oct;11(5):525-36.