Why Does Constipation Worsen in Winter?

Constipation is a very common problem; eighty percent of people have experienced it. But most people's constipation is easy to resolve — just take a mild laxative. However, some patients with habitual constipation have a much more serious situation, and in winter their constipation worsens.

This is mainly related to the significant reduction in physical activity in winter and the dry winter climate. Having a bowel movement one to three times a day is normal; for a few people, once every two to three days is also normal. But if more than three days pass without a bowel movement, some measures are needed. I once encountered a patient who went 27 days without a bowel movement — that counts as severe constipation.

There are many causes of constipation; the most common is insufficient dietary fiber and water intake, so people must eat enough vegetables and fruits every day and drink enough water to avoid constipation. Many health problems also cause constipation: diabetes, spinal cord injury, abdominal or pelvic tumors, intestinal obstruction, thyroid disease, uremia, poor gastrointestinal motility, irritable bowel syndrome, hypercalcemia, and stroke can all cause constipation. Certain medications also cause constipation, such as painkillers commonly used by advanced tumor patients, targeted drugs, or antidepressants used by depression patients. Long-term laxative users develop habitual constipation; some patients, seeking momentary relief, abuse laxatives, and eventually the constipation becomes so severe that no medication can resolve it and they must manually extract stool.

In elderly or frail people, the gut's probiotics are disrupted, which also causes constipation. Moreover, constipation itself worsens the loss of probiotics, so constipation patients often fall into a vicious cycle that becomes progressively worse.

Because the patients I serve are mainly cancer patients, most of whom are middle-aged or elderly, the constipation of most such patients is long-term habitual constipation. We can often only briefly relieve their constipation symptoms, and it rebounds soon after.

For such patients, a comprehensive approach is needed. First and most important is to supplement probiotics, prebiotics, enzymes, and vitamins C and E; supplementing only one alone is not very effective. This must be sustained long-term; elderly patients should persist for half a year or more.

My father has had constipation since he was young, and it worsened in old age. He is an impatient person and always wanted to use laxatives, but I refused. When constipation was severe, I brought him to live with me and cared for him myself, persistently urging him to eat vegetables and fruits and supplementing him with probiotics, prebiotics, enzymes, and vitamins C and E. For the first two or three months he always complained that the effect was slow, but I withstood the pressure and would not let him give up. After persisting for half a year, his situation improved greatly; after about a year, he finally escaped intractable constipation.

For intractable constipation in middle-aged and elderly people, don't expect to solve it all at once; you must be patient. And you must control the urge to take laxatives — once you take laxatives, you fall into a vicious cycle that gets worse and worse. Even in winter, you must urge elderly people to do various moderate-intensity exercises at home, such as Baduanjin (Eight Pieces of Brocade) or Tai Chi; this helps relieve their constipation to some extent.

For elderly patients and frail cancer patients with especially severe constipation, consider using Sheng Huangqi (raw Astragalus) 120g and Taoren (Peach Kernel) 6g decocted into a decoction for oral use; at the same time, mash one clove of garlic into a paste and apply it externally on the navel, leaving it on from bedtime until morning. This is a laxative method I have used with fairly good results. TCM considers raw Huangqi to be qi-supplementing; in fact, when used in large doses, it can induce sweating, loosen the bowels, and promote diuresis, with especially good effects in reducing edema. The Qing-dynasty physician Chen Shiduo particularly liked using large doses of raw Huangqi; my use of large-dose raw Huangqi to loosen the bowels is borrowed from his approach.