A Chinese Medicine Look at Constipation and Fall
Constipation is very common in the fall, which often surprises people! This year it seems especially frequent, and many of my patients are experiencing it right now, so I wanted to explain how Chinese medicine views constipation, why it shows up more in the fall, and what you can do at home to manage occasional constipation.
This can feel like an uncomfortable or weird topic, but it's something medical providers are very used to talking about, so don't worry it's TMI! In fact, asking about bowel movements is one of the classic "Ten Questions" Chinese medicine practitioners have been asking patients for centuries. Your digestion tells us a lot about what's going on in the rest of your body.
Why is constipation more common in the fall?
There are a few reasons:
Fall is the season of the Lung and Large Intestine. In Chinese medicine, these two organs are paired together. When the dry fall air irritates the Lungs, the Large Intestine often feels it too. (If you've ever noticed a dry cough and constipation showing up at the same time, this is why!)
Fall brings increasing dryness and cooler temperatures. Both of these can slow things down, as you'll see in the patterns below.
We're still eating like it's summer. It's often not quite cold enough yet for us to instinctively crave warm food and cozy clothes, so we're still reaching for salads, smoothies, and iced drinks.
We move our bodies less. As the days get shorter, we transition to more indoor activities and have less physical movement than we did in the summer.
Each of these aspects on their own can lead to constipation, but in the fall, we often have overlapping things - so it's a bit of a perfect storm! Often, people experience more than one of the patterns below overlapping.
What healthy bowel movements look like in Chinese medicine
Ideally, bowel movements are one or more times per day, easy to pass (no straining), smooth, brown, and well formed.
Western medicine’s definition of normal bowel movements is anywhere from three times a day to three times a week, and constipation generally means fewer than three bowel movements a week, along with symptoms like straining, hard or lumpy stools, or feeling like you didn't fully empty.
Chinese medicine uses a stricter definition: it's considered constipation any time there is less than one stool per day, if the stools are "pellet" like, or if it takes a lot of straining to start or pass a bowel movement.
Neither view is necessarily wrong - we’re just looking for different things. Western medicine is focused on identifying when something needs medical treatment, while Chinese medicine is looking for early signs that things are slightly out of balance, so we can make small adjustments before they become bigger problems.
The Bristol Stool Chart
One helpful tool for describing your bowel movements is the Bristol Stool Chart, which sorts stools into seven types:
Types 1-2: Hard, separate lumps or a lumpy sausage shape. These point toward constipation.
Types 3-4: A sausage shape with cracks on the surface, or smooth and soft. This is the goal!
Types 5-7: Soft blobs, mushy, or watery. These lean toward loose stools or diarrhea.
You can find the chart with a quick Google search for "Bristol Stool Chart."
Why it's worth tracking your bowel movements
Even though it may feel weird, tracking your bowel movements is useful from both a Chinese medicine and a Western medicine perspective!
Temporary changes in your bowel movements give us useful information, and simple tweaks to your routine can often improve things. Tracking helps you be more specific with your practitioner, which leads to more helpful suggestions. "I've been constipated" is the starting point, but "I'm going every two to three days, it's usually a Type 2, I have to strain to start, and it never feels complete" tells us much more.
If you'd like a simple way to track, I have a free tracking sheet you can print out in the Resource Library once you sign up for my email newsletter - sign up here! You can also keep track in symptom tracker apps - I like the Bearable app because they take privacy seriously, and its settings match the information medical providers look for.
Any sudden change in bowel movements, especially one that doesn't respond to home care, should be checked by your doctor. See the "When to see your doctor" section at the end of this post for specific signs to watch for!
Three common patterns I see in the clinic
There are a variety of causes of constipation, but I see three main patterns most often, especially in the fall. Figuring out which one (or ones) you have is key, because a remedy that helps one type could make another type worse. For example, eating a ton of raw salads can make cold-type constipation worse, and eating lots of spicy, warming foods can dry out someone who is already dealing with dryness.
Qi Stagnation
What it looks like: This type is often related to stress, pain (especially low back or lower abdominal pain), and/or lack of movement. It often shows up as missing a few days, having trouble getting a bowel movement started, and then sometimes having loose stools once things get going. Many people go two or three (or more) days without a bowel movement, then have several in one day or over a few days. It's more of a "pendulum swing": can't go, then can't stop going. Bloating, gas, and feeling the urge to have a bowel movement without anything happening are also common, and symptoms often get worse with stress or travel.
What can help:
Move a little after meals. A short walk after eating, even 10-15ish minutes, helps get things moving. Adding gentle exercise throughout your week helps too (qi gong is a great fit!).
Breathe into your belly. Taking five slow, deep breaths into your belly before meals can help your body shift out of "stress mode" and into "digest mode."
Pay attention to what you’re doing when you eat. Try to avoid eating in high-stress times, while watching stressful TV/movies, during high-stress conversations, etc. Make sure your abdomen isn’t compressed while eating, such as eating while leaning over a low table (like eating at a coffee table).
Abdominal massage and acupressure. See the "Things that help every type" section below for specifics.
Lemon, ginger, and honey tea. Tea with a few slices of fresh ginger, a squeeze of lemon, and a little honey is a gentle, warming drink. Try 1-2 cups per day. This is also great if you have the Cold pattern below.
Kiwi fruit. One to two kiwis per day can help move stools that feel "stuck." There's also good research supporting kiwi for constipation. One note: kiwi is cooling, so skip it if you also fit the Cold pattern below.
Dryness
What it looks like: If we don't have enough fluids, it's difficult for stool to pass through the colon and out of the body. This often shows up as small, hard, pellet-like stools (Types 1-2 on the Bristol chart) and a lot of straining. Over time, this straining could lead to hemorrhoids. Dryness often shows up alongside other dry symptoms in the fall, like dry skin, dry lips, or a dry cough.
What can help:
Hemp seeds. Hemp seeds or hemp hearts are one of my favorite ways to help with dry constipation. Hemp seed (Huo Ma Ren) is a main ingredient in classical Chinese herbal formulas for dry constipation, but it's easy to simply add the seeds to your food! The grocery store kind is perfect (and no, they don't contain THC!). Start by adding 1-2 teaspoons per day, and increase as needed. They're great sprinkled on oatmeal, soups, or rice.
Warm, cooked foods and porridge. I love oatmeal for this! Many people think increasing fiber in general helps with constipation, but it's important to focus on soluble fiber, the "gooey" kind. This is part of the reason that just eating more raw vegetables won’t help! Soluble fiber pulls moisture into the stool so it can pass more easily. Oats, ground flaxseed, and chia seeds that have been soaked in liquid are all good sources. Add fiber slowly and increase your fluids at the same time, or it could make things worse.
Moistening foods. Other foods that help “moisten the intestines” include:
Pears, especially cooked (a poached or baked pear with a drizzle of honey is a classic fall food in Chinese medicine)
Black sesame seeds
Prunes
Sweet potatoes
Ripe bananas (unripe bananas tend to be binding)
Honey
More fluids, but not ice water. Sip warm or room temperature fluids throughout the day. Hot tea is great, and so are soups and broths. A good general sign that you're drinking enough liquid during the day is pale yellow urine.
Go easy on spicy food. Lots of spicy, warming foods can dry you out further. Avoid spicy foods if you tend to run dry!
Cold
What it looks like: In addition to having enough fluids, our digestive tract needs to stay warm for digestion to happen smoothly. If we eat too much cold food or have too many cold drinks, we cool our digestive "fire," which slows digestion, including bowel movements. Think of it like a pot on the stove: if the burner is turned down too low, nothing will cook!
One way to tell if you have this type of constipation is to feel your abdomen. It may literally feel cool to the touch! But also look at the foods you eat; even if you don’t feel cold, consuming mostly cold, raw foods and cold drinks will cool down digestion.
What can help:
Warm food at every meal. While all types of constipation benefit from warm food, this type requires it to resolve. Make sure more than half of each meal is warm food (ideally, the entire meal is warm and cooked). Soups, stews, broths, and cooked grains are all great options. Roasted veggies are also great!
Skip cold drinks. This includes iced coffee, smoothies, chilled drinks, and ice water.
Add warming spices. Fresh ginger, cinnamon, cardamom, etc., are all gently warming and easy to add to food or tea.
Take a break from raw foods. Salads, raw vegetables, and cold fruit (including kiwi) are harder to digest for this type. Try lightly steamed or roasted vegetables instead.
Use a heating pad. If your stomach feels cool, place a heating pad on your abdomen after meals.
Keep your body warm! Wear socks, pants, a sweatshirt, and/or a jacket outside if needed. Even if it doesn't feel very cold yet, our bodies notice the temperature change more than we think!
Another common pattern: Qi Deficiency
Another type of constipation I occasionally see isn't specific to fall, so I won't go into as much detail, but it's worth mentioning. If your stools aren't necessarily hard or dry, but passing them feels exhausting, and you feel wiped out afterward or are generally very tired, this may be Qi Deficiency. If that sounds like you, bring it up at your next appointment so we can discuss it!
Things that help every type of constipation
Use your body's natural rhythms
In Chinese medicine, the Large Intestine's time on the body clock is between 5 - 7 am. You don't have to get up that early, but mornings are a great time to support your bowels! Here are a few suggestions:
Start your day with a cup of warm water or tea (try the ginger tea above!).
Eat breakfast. Eating naturally triggers the urge to have a bowel movement. Bonus points for including a porridge, like oatmeal.
Give yourself time. Plan for some unhurried bathroom time after breakfast.
Don’t wait! Don't ignore the urge when it comes. Putting off having a bowel movement regularly when you have the urge to can make constipation worse.
Try a footstool
Raising your feet on a small stool while you're on the toilet puts your body in more of a squatting position, which makes it easier for stool to pass. You don't need anything fancy - a small step stool works. You can also look for products like the Squatty Potty, which is designed to help with this exact thing!
Abdominal massage
Abdominal massage helps move stool along and "reminds" it which direction to go.
Lie on your back with your knees bent or sit in a chair with your back straight.
Place a flat hand on your lower right belly, just inside your hip bone.
Using gentle but firm pressure, move your hand in a clockwise direction (as you look down at your belly): up the right side toward your ribs, across your upper belly above your belly button, and down the left side toward your left hip bone.
Repeat for 5-10ish minutes.
This follows the path of your large intestine. For cold-type constipation, try it after using a heating pad, or rub your hands together first to warm them up. If you’re a current patient, I can send you a video example of how to do an abominal massage in the Jing app!
Acupressure
These two points are commonly used for constipation. Press firmly (but comfortably - it shouldn’t be painful!) for 1-2ish minutes on each side, breathing slowly.
Tian Shu (ST 25): About three finger-widths out to either side of your belly button. You can press both sides at once, and it's easy to include in your abdominal massage.
Zhi Gou (SJ 6): On the back of your forearm, about four finger-widths up from your wrist crease, in the center of your arm in the space between the two bones. This is one of the classic points for constipation!
If you're pregnant, check with your acupuncturist or midwife before using acupressure or abdominal massage!
A note on laxatives
Many people reach for laxatives when they start feeling constipated. Laxatives like senna (the main ingredient in Smooth Move tea) can help in a pinch, but they don't address why things slowed down in the first place, they can cause cramping, and it's easy to start relying on them. That's why I recommend starting with the approaches above when you can.
If your doctor has recommended a laxative, keep following their guidance, and talk with them before making any changes! Things like MiraLAX, psyllium husk, etc. are safe to use and are a better option than things like senna, which is why doctors often recommend them instead.
It's also worth knowing that some medications and supplements commonly cause constipation, including iron supplements and opioid pain medications. If you've recently started something new, talk with your doctor or pharmacist!
When to see your doctor
Home care is great for occasional or seasonal constipation, but some changes need to be checked out by your doctor. Reach out to your doctor if you notice:
A sudden change in your bowel movements that doesn't improve with home care. This could be a change in consistency, size (such as stools suddenly becoming very thin), color, or frequency.
Blood in your stool, whether it's bright red or your stools look black and tarry.
Unexplained weight loss.
Feeling unusually tired or weak, or a diagnosis of anemia, along with changes in your bowel movements.
A new change in your bowel movements if you're in your 40s or older, or if you have a family history of colon cancer.
Seek urgent care if you have severe or worsening abdominal pain, vomiting, fever, or you can't pass gas. This could be a sign that the stool has gotten impacted (or stuck), and it is past the point of home care - it is an emergency.
Putting it all together
It's likely you're experiencing more than one type of constipation overlapping, so mixing and matching from each category is completely fine! If you're not sure where to start, it's hard to go wrong with sticking to warm, cooked foods, sipping warm fluids throughout the day, and a short walk after meals.
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