Authored by Dr. Aidanne
Constipation is one of the most common concerns I see. It can impact people at any age. Passing a regular, well formed bowel movement is not only important for our digestive tract, but also our mental and hormonal health.
Am I constipated?
A diagnosis of constipation can be made if you experience fewer than 3 natural, unmedicated bowel movements weekly or 25% of defecations:
Am I constipated?
A diagnosis of constipation can be made if you experience fewer than 3 natural, unmedicated bowel movements weekly or 25% of defecations:
- Require straining
- Result in lumpy or hard stools
- Feel incomplete on evacuation
- Feel as if there is an obstruction or blockage in the bowel
- Require maneuvers to complete
Root Causes:
Constipation can have multiple roots. Certain conditions such as hypothyroidism, diabetes, IBD, muscular dystrophy, etc. can make individuals more prone to insufficient bowel movements. Medications such as antidepressants, pain medications, NSAIDs, antihistamines, antacids, iron and calcium can also contribute. Ironically, overuse of laxatives can make constipation worse in the long term. Our bowels also respond to stress from daily life or the change in routine from travel, but this typically resolved once the system has time to recalibrate to normalcy.
I commonly see that constipation an indication of malnutrition, sedentary lifestyle, or poor gut micro biome health. We need adequate hydration, fiber intake, and regular physical activity to keep everything running smoothly.
Finally, we need sufficient stomach acid and digestive enzyme production in order to properly break our foods down. This is important as this process supports our intestines’ migratory motor complex (MMC) of nerves that produce wavelike movements that push food through our digestive tract, called peristalsis. If MMC signaling is disturbed, bowel transit time can slow and the micro biome can become imbalanced. I commonly see that this leads to bacterial or yeast overgrowth in the small intestine (SIBO or SIFO) that can cause bloating, abdominal pain and gas in addition to constipation.
Testing options:
As there are many potential contributing factors, testing is important to understand and best manage each individual’s case of constipation.
Depending on the history taken in our first visit, I like to start with either:
Management:
Increasing dietary fiber is step number one. The goal for most people is to achieve 25-30g of fiber daily, which is often under met. Vegetables, fruits, nuts, seeds and psyllium husk are rich sources of fiber. If you are someone who does not tolerate these foods well it could be sign of IBD, food sensitivities, or intestinal micro biome overgrowth. Keeping the potential for food sensitivities in mind, I commonly see that dairy, red meat, and gluten filled grains can be trigger foods for people.
Hydration is also key, so be sure to drink half your body weight (lbs) in ounces of water daily!
The standard CDC recommendations of aiming for 150 minutes of moderate exercise weekly apply here as well. Splitting this goal into 30-minute intervals on a daily basis can have even better effects when it comes to bowel regularity. If this is challenging for you, physical or pelvic floor therapy may be a beneficial place to start.
Patients of mine have also found relief with routine abdominal massage and use of castor oil packs. Castor oil works nicely as a topical anti inflammatory, and it also draws blood flow to the area it is applied.
If more support is needed than what the fundamentals of good health can provide, herbs and nutrients can relieve constipation. Some of my favorites include ginger, artichoke, fennel, and bitters which fall into a category of botanicals known as “prokinetics”. This means that they stimulate the MMC to improve transit time in the bowels. Senna, dandelion, burdock and aloe among other herbs have a laxative effect. Use of high dose magnesium and vitamin c can help to loosen the stool by drawing water into the intestines. Probiotics can be helpful but I typically wait to bring these into the mix until stool testing is completed. My goal with this approach is to avoid adding more microbes to an already overloaded system.
References:
Constipation can have multiple roots. Certain conditions such as hypothyroidism, diabetes, IBD, muscular dystrophy, etc. can make individuals more prone to insufficient bowel movements. Medications such as antidepressants, pain medications, NSAIDs, antihistamines, antacids, iron and calcium can also contribute. Ironically, overuse of laxatives can make constipation worse in the long term. Our bowels also respond to stress from daily life or the change in routine from travel, but this typically resolved once the system has time to recalibrate to normalcy.
I commonly see that constipation an indication of malnutrition, sedentary lifestyle, or poor gut micro biome health. We need adequate hydration, fiber intake, and regular physical activity to keep everything running smoothly.
Finally, we need sufficient stomach acid and digestive enzyme production in order to properly break our foods down. This is important as this process supports our intestines’ migratory motor complex (MMC) of nerves that produce wavelike movements that push food through our digestive tract, called peristalsis. If MMC signaling is disturbed, bowel transit time can slow and the micro biome can become imbalanced. I commonly see that this leads to bacterial or yeast overgrowth in the small intestine (SIBO or SIFO) that can cause bloating, abdominal pain and gas in addition to constipation.
Testing options:
As there are many potential contributing factors, testing is important to understand and best manage each individual’s case of constipation.
Depending on the history taken in our first visit, I like to start with either:
- Bloodwork: CBC, CMP, TSH, free T4, free T3, Insulin, cortisol, estradiol, progesterone
- Stool Panels
- Breath testing for SIBO
- IgG Food Sensitivity Testing
- Referral for imaging studies
Management:
Increasing dietary fiber is step number one. The goal for most people is to achieve 25-30g of fiber daily, which is often under met. Vegetables, fruits, nuts, seeds and psyllium husk are rich sources of fiber. If you are someone who does not tolerate these foods well it could be sign of IBD, food sensitivities, or intestinal micro biome overgrowth. Keeping the potential for food sensitivities in mind, I commonly see that dairy, red meat, and gluten filled grains can be trigger foods for people.
Hydration is also key, so be sure to drink half your body weight (lbs) in ounces of water daily!
The standard CDC recommendations of aiming for 150 minutes of moderate exercise weekly apply here as well. Splitting this goal into 30-minute intervals on a daily basis can have even better effects when it comes to bowel regularity. If this is challenging for you, physical or pelvic floor therapy may be a beneficial place to start.
Patients of mine have also found relief with routine abdominal massage and use of castor oil packs. Castor oil works nicely as a topical anti inflammatory, and it also draws blood flow to the area it is applied.
If more support is needed than what the fundamentals of good health can provide, herbs and nutrients can relieve constipation. Some of my favorites include ginger, artichoke, fennel, and bitters which fall into a category of botanicals known as “prokinetics”. This means that they stimulate the MMC to improve transit time in the bowels. Senna, dandelion, burdock and aloe among other herbs have a laxative effect. Use of high dose magnesium and vitamin c can help to loosen the stool by drawing water into the intestines. Probiotics can be helpful but I typically wait to bring these into the mix until stool testing is completed. My goal with this approach is to avoid adding more microbes to an already overloaded system.
References:
- Sadler, K. Arnold, F. Dean, S. Chronic Constipation in Adults. Am Fam Physician. 2022;106(3):299-306.
- Diaz, S. Bittar, K. Mendez, MD. Constipation. StatPearls. Updated: Jan 31, 2023.
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