How to Resolve Constipation and Maintain a Healthy Gut

How to Resolve Constipation and Maintain a Healthy Gut |Women's Health|Sara Gottfried MD

Many women hesitate to bring up the topic of constipation with their doctor. While it’s common, few women want to talk about it. But constipation is not an issue you want to keep under wraps. When your bowel movements are regular, chances are that your hormones—cortisol, estrogen, and thyroid—are working at their best.[1] Below are my natural remedies for constipation, and trust me, it’s not about prescribing some harsh laxative.

Regularity, Constipation, and Women

Before I delve into solutions for constipation and how they relate to estrogen, cortisol, and thyroid, I’ll discuss the basics. Constipation is a condition of the intestines in which the stool is dry and hardened, and evacuation is infrequent and/or difficult.

Ideally, you should have a bowel movement at least once per day. I consider anything less than that constipation. My definition is more stringent than conventional medicine, which calls the cutoff for constipation at not one or two days, but three days for a bowel movement. About 50 percent of people have one bowel movement per day or more, which means the other half are likely suffering from constipation, even though their doctor may not see it as a medical problem.

Personally, I wouldn’t want that kind of back up in my system. Why? It makes the stool more hard, which slows down transit even more. And if I just ate seafood at a restaurant, I may absorb the mercury more than if my transit time were normal. Additionally, women are particularly affected because bowel movements remove unnecessary estrogen from the body. The golden rule with estrogen is to use it once and then poop or pee it out, not keep recirculating it like bad karma. That can lead to estrogen overload—and that can lead downstream to hypothyroidism, as well as breast, endometrial, and cervical cancers.[2]

Women are more likely affected by constipation by threefold compared with men. The female colon is longer and has more twists and turns, like a rollercoaster. We experience more stress and dysregulated cortisol. We’re more likely to overuse laxatives, leading to weaker bowel muscles. We’re more likely to have painful hemorrhoids, which occur in 40 percent of pregnancies,[3] and to restrain from pooping in public places. Women are also more vulnerable to social conditioning that it’s not ladylike to poop, again leading to conscious withholding of stools, and contributing further to constipation. Hopefully I’ll convince you that pooping is normal, healthy, and essential to your hormone balance.

How to Avoid and Reverse Constipation

Here are my recommendations for avoiding constipation and maintaining a healthy gut.

  1. Supplement with probiotics. Adding good bacteria from probiotics may improve transit time, stool frequency, and stool consistency. establish a healthy gut microbiome, which can ease constipation.[4] Probiotics keep estrogen in balance and may flush out xenoestrogens and thyroid disruptors such as bisphenol A.[5] Food sources of probiotics are sauerkraut, kim chee, and plain yogurt. Consume two to four spoonfuls at the start of a meal. If you don’t like those options, I recommend supplementing with nondairy options, such as coconut kefir or a probiotic containing the bifidobacterium strain because it seems to be most effective. Since probiotic dosing can be highly individualized, consult with an functional medicine practitioner to get yours adjusted to your current situation.
  2. Drink water. If we think of our GI tract as one big water slide, you can see why not getting enough fluids is problematic. After all, you can’t ride the slide without water. Low fluid intake can cause constipation.[6] Fluids keep food matter moving through your intestines, and nourish your intestines with H2O to make them smooth and flexible. According to the Institute of Medicine, the recommended daily intake of water for adult women is 2.7 liters, of which a ½ liter can come from water in foods, such as fruits and vegetables.
  3. De-stress. Studies show that stress decreases gastric emptying, pokes holes in the gut wall, and accelerates transit time. Plus, excess cortisol (the main stress hormone) may weaken your gut’s ability to absorb the micronutrients, namely copper, zinc, and selenium, you need for making thyroid hormones.[7]
  4. Stop sitting. Sitting not only makes you fat, it slows down transit time. Regular exercise stimulates peristalsis. I’m a fan of yoga twists for compressing the gut and then releasing (when you release the twist), which can stimulate feces to move along.
  5. Up the fiber. Fiber is magic for constipation. It helps to remove toxins, facilitates intestinal movement, and protects your digestive tract from inflammation, injury, and disease. Most American women only consume about 14 grams of my recommended 35-50 grams of fiber per day. Fiber also aids in weight loss and maintenance because it can curb your appetite by helping you feel full, and it helps dispose of estrogen to keep you in fat-burning zone. Not bad, right? Fiber-rich foods include quinoa, legumes, berries, and green leafy vegetables. Keep in mind that it can be challenging to eat your daily fiber minimum, so you might need to supplement with an excellent fiber blend. Whether you use food or supplements to get your fiber, I recommend increasing fiber intake by a maximum of 5 grams per day, starting at 20 grams on Day 1. If you get gassy, scale back and increase more slowly.

Constipation can be either a symptom of dysfunction or the cause. In either case, it’s an important message about an imbalance in your body that needs to be addressed. By maintaining healthy digestion with ample hydration, good nutrition, probiotics, and stress coping, you’ll be on your way toward optimal intestinal health and keeping your thyroid and estrogen levels steady.

To find out more about maintaining optimal health and encouraging longevity, read my latest book, Younger.      


[1] Werhun., A., et al. “Thyroid function testing in primary care: overused and under-evidenced? A study examining which clinical features correspond to an abnormal thyroid function result.” Family practice 32, no. 2 (2015): 187-91.

[2] Key TJ. “Endogenous oestrogens and breast cancer risk in premenopausal and postmenopausal women.” Steroids 76, no. 8 (2011): 812–15.

[3] Hollingshead JR, Phillips RK. Haemorrhoids: modern diagnosis and treatment. Postgraduate Medicine 92, no. 1083 (2016):4-8.

[4] Dimidi, E., et al. “The effect of probiotics on functional constipation in adults: a systematic review and meta-analysis of randomized controlled trials.” The American Journal of Clinical Nutrition, July 3, 2014.

[5] Oishi, K., et al. “Effect of probiotics, Bifidobacterium breve and Lactobacillus casei, on bisphenol A exposure in rats.” Bioscience, biotechnology, and biochemistry 72, no. 6 (2008): 1409-15

[6] Arnaud, M.J. “Mild hydration: A risk factor of constipation?” European Journal of Clinical Nutrition 57, no. 2 (2003): S88-S95. 

[7] Mertz, H. “Stress and the Gut.” UNC Center for Functional GI and Motility Disorders, 2011.