Conquering Chronic Constipation: Holistic Strategies for Regularity

While the occasional bout of sluggish digestion is a common nuisance that has affected each of us at some point in time, chronic constipation is a condition that can be far more serious and often leaves individuals trapped in a cycle of frustration and discomfort. Studies show that chronic constipation affects between 12 - 27% of the North American population, with females and adults over the age of 65 being particularly susceptible [1]. Although chronic constipation is common, it should not be considered normal, as it often serves as a red flag indicating underlying issues.

Besides general discomfort, chronic constipation often brings along a slew of unpleasant symptoms including distention, anxiety, bloating, gas, cramping, fatigue, irritability, brain fog, sleep disturbances, and in severe cases, trips to the emergency room to remove a fecal impaction [2]. No, thank you! In addition to the unpleasant symptoms that often go hand-in-hand with chronic constipation, incomplete waste elimination allows toxins and hormones to be reabsorbed into the body instead of being properly eliminated, which can have other health ramifications down the road (hormonal imbalances, acne, etc.). While this may sound scary, the good news is that chronic constipation is often treatable and does not have to control your life. Through the use of naturopathic medicine, nutritional interventions and lifestyle modifications you can address the underlying causes of chronic constipation in order to promote regularity and restore balance to your digestive system.

How Do I Know If I'm Constipated?

The reason why the diagnosis rate for constipation is so variable is due to the fact that doctors have different ideas of what it means to be constipated. Some traditional doctors believe it is within the range of normal to only go to the bathroom one to two times per week. In the holistic health space, it is commonly accepted that ideally we should all be having one to three bowel movements per day, and anything less than that may be considered constipation. Regularly experiencing any of the following may also qualify as chronic constipation:

1. Incomplete evacuation - feeling as if the bowel was not fully emptied.

2. Straining while going to the bathroom.

3. Irregularity - not going to the bathroom on a consistent schedule.

4. Small, skinny, hard, or difficult to pass stool.

Please note: If you have gone longer than seven (7) days without a bowel movement, we recommend seeing a medical professional in order to prevent a fecal impaction or any serious complications.

Causes of Chronic Constipation

A simple google search on the causes of constipation will tell you all the same reasons - a low fiber diet, sedentary lifestyle, and structural abnormalities. While these can certainly contribute to chronic constipation, these factors merely scratch the surface. If treating constipation was as simple as eating more fiber and moving more, then why would so many of our health-conscious DLW patients who exercise seven days a week and live off of salads and smoothies claim their constipation is only getting worse? The truth is that each individual has a unique set of dietary, lifestyle, and biological factors which are contributing to their lack of bowel motility, and it often requires the careful attention of an experienced healthcare professional and specialized testing to get to the root cause. Some common causes of chronic constipation we see at DLW include:

Diet

• Eating too little or too much fiber.

• For females we generally recommend around 25g per day, although if you have certain gastrointestinal overgrowths you may want to keep fiber consumption to a minimum during the treatment phase.

• Eating foods that you have a sensitivity to.

• Common offenders include dairy, gluten, eggs, and soy.

• Constant snacking, never giving the digestive system a break.

• Undereating. 

• Chronic undereating causes the body to preserve resources and directs attention away from digestion.

• Alcohol consumption.

• Overconsumption of processed, fried, fatty foods.

• Dehydration.

• Nutrient deficiencies.

• Vitamin B12, Vitamin B1, Vitamin D, Magnesium, Potassium, Vitamin C, Zinc.

Medical Conditions / Biological Factors

• SIBO (Small Intestinal Bacterial Overgrowth)

• Check out our SIBO Guide if you suspect you may have SIBO

• Dysbiosis

• H. Pylori

• Parasites

• Candida / yeast overgrowth

• Check out our Candida Ebook if you’d like to learn more about Candida

• Inadequate digestive enzyme production (stomach acid, pancreatic enzymes, bile)

• Electrolyte imbalances (hypokalemia, hypomagnesemia)

• Hypothyroidism

• Diabetes

• Celiac Disease

• Inflammatory Bowel Disease

Medications

• Opioids (Oxycodone, Morphine, Tramadol, Fentanyl, etc.)

• Certain antidepressants (Amitriptyline, Desipramine, etc.)

• NSAIDs (Ibuprofen, Aleve, etc.)

• Certain antihistamines (Benadryl)

• Certain blood pressure medications (Cardizem, Norvasc, Propranolol, etc.)

Lifestyle

• Sedentary lifestyle

• Over-exercising (this acts as a stressor on the body and can slow the digestive process)

• Rushing around in the morning, not giving yourself time to go to the bathroom

• Inadequate sleep

• Stress

Stress / Psychological Factors & Constipation - The Gut Brain Connection

The gut-brain connection, also known as the gut-brain axis, refers to the bidirectional communication loop between the gastrointestinal system and the central nervous system. When the body experiences stress, whether it’s emotional (such as a break-up), physical (such as over-exercising or an injury), or psychological stress (anxiety), the brain releases hormones like Cortisol and Adrenaline, aka: Epinephrine. Cortisol and Adrenaline / Epinephrine directly affect the muscles in the digestive tract, slowing down the movement of food and stool[3]. Additionally, stress can alter the composition of gut microbiota, leading to dysbiosis, inflammation, and changes in intestinal permeability, all of which can contribute to constipation. Because of this, stress, and lack of stress-management techniques, is one of the most commonly overlooked causes of chronic constipation.

Where Laxatives and Traditional Treatments Fall Short

If you've sought help from a conventional doctor or clinic for chronic constipation, you've likely heard the standard advice: boost your fiber intake and consider using a laxative like Miralax or Dulcolax. However, these one-size-fits-all recommendations can backfire and worsen constipation over time, especially when given without a thorough understanding of your individual health profile. As mentioned, one of the most common causes of constipation is Dysbiosis and / or Small Intestinal Bacterial Overgrowth [4]. When “bad” bacteria are overgrown in the digestive tract, they can cause impaired gut motility as well as inflammation and intestinal permeability, leading to constipation. As it turns out, fiber acts as the main source of food for these organisms. While feeding your gut microbiome is usually beneficial, it can spell trouble when your microbial organisms are imbalanced, exacerbating symptoms instead of alleviating them.

Most people who struggle with chronic constipation have turned to over-the-counter or prescription laxatives for symptom relief at some point. While there are cases where laxatives may be necessary, it is important to be aware of the risks that come with prolonged laxative usage. 

• Dependency and tolerance. Like with any drug, the body can develop a tolerance to laxatives, to the point where you not only depend on laxatives to have a bowel movement, but you need to continuously increase your dose in order to achieve the same effect.

• Dehydration. Many laxatives work by drawing water into the intestines to soften stool and promote bowel movements. In the absence of sufficient fluid intake, this redirection of water in the body can lead to dehydration, which can worsen constipation, among other potential health issues.

• Electrolyte imbalances. Laxatives can cause electrolyte imbalances by increased fluid loss in the stool. Prolonged electrolyte imbalances can have detrimental health effects, including worsened constipation, muscle weakness, and cardiac arrhythmias.

• Damage to the nerves and muscles of the intestines. Prolonged laxative use can irritate and damage the colon lining, which can permanently impair bowel functioning [5]. 

How to Address Constipation Naturopathically

Testing

The first step in treating chronic constipation is determining each individual’s unique dietary, lifestyle, and biological contributing factors. Along with your healthcare provider taking a thorough personal history, tests can be conducted to determine possible underlying causes:

• GI MAP - This comprehensive stool test provides detailed information about the abundance and diversity of bacteria, parasites, fungi, and viruses present in the gut, as well as markers of gut inflammation and digestive function.

• Food Sensitivity Test 

• Bloodwork

• Thyroid Panel (TSH, T3, T4, free T3, free T4, reverse T3, TPO, antithyroglobulin)

• Comprehensive Metabolic Panel: Electrolytes, kidney markers

• Cortisol-AM

• Vitamin B12, Magnesium, Zinc

• Inflammation: hs-CRP, sedimentation rate, homocysteine 

Dietary Interventions

Depending on your unique health and dietary history, nutritional interventions for alleviating chronic constipation may vary from person to person. Some common dietary suggestions include:

• Reduce intake of positive food sensitivity foods

• Reduce intake of processed foods 

• Decrease or eliminate alcohol

• Consider a low FODMAP diet

• Increase or decrease fiber intake, depending on test results

• Address any nutrient deficiencies

• Increase fluid and electrolyte intake (DLW loves LMNT)

Supplements

Supplements for treating constipation will be highly individualized. We recommend speaking with your healthcare provider before starting any new supplements. Some common supplements we may use for chronic constipation include:

• Magnesium Citrate or Oxide Powder

• Buffered Vitamin C

• Pre + Probiotics (DRLANA10 for 10% off)

• Digestive Enzymes (DRLANA10 for 10% off)

• Certain types of fiber including psyllium husk + slippery elm + marshmallow root

• Herbal laxative alternatives (Triphala, Senna)

• Adaptogens + nutrients such as Ashwagandha, L-Theanine, and GABA for stress relief

• Herbs such as Valerian, Passionflower, and Lemon Balm as nerve relaxants

Lifestyle

• Incorporate daily stress management techniques (yoga, meditation, acupuncture, gratitude practice, time in nature) to lower Cortisol and bring the body into a parasympathetic (rest and digest) state.

• Get moving! But no need to overdo it. A regular exercise routine, or even just incorporating daily walks, is a great way to increase blood flow as well as lymphatic drainage, in addition to  the muscles of the colon to promote bowel movements [6]. 

• Try not to rush out the door first thing in the morning. Create a calming morning environment and give the body ample time to get things moving. 

If you’re one of the millions of Americans who struggle with chronic constipation, you know how uncomfortable and debilitating of a condition it can be. Luckily, there are natural treatment options that can help you find relief and regularity without the side effects of laxatives. To work with a member of the DLW team to get to the bottom of your chronic constipation, click here.

References

1. Higgins, P. D., & Johanson, J. F. (2004). Epidemiology of constipation in North America: a systematic review. The American journal of gastroenterology, 99(4), 750–759. https://doi.org/10.1111/j.1572-0241.2004.04114.x

2. Costilla, V. C., & Foxx-Orenstein, A. E. (2014). Constipation in adults: diagnosis and management. Current treatment options in gastroenterology, 12(3), 310–321. https://doi.org/10.1007/s11938-014-0025-8

3. Devanarayana, N. M., & Rajindrajith, S. (2010). Association between constipation and stressful life events in a cohort of Sri Lankan children and adolescents. Journal of tropical pediatrics, 56(3), 144–148. https://doi.org/10.1093/tropej/fmp077

4. Skrzydło-Radomańska, B., & Cukrowska, B. (2022). How to Recognize and Treat Small Intestinal Bacterial Overgrowth?. Journal of clinical medicine, 11(20), 6017. https://doi.org/10.3390/jcm11206017

5. Xing, J. H., & Soffer, E. E. (2001). Adverse effects of laxatives. Diseases of the colon and rectum, 44(8), 1201–1209. https://doi.org/10.1007/BF02234645

6. Gao, R., Tao, Y., Zhou, C., Li, J., Wang, X., Chen, L., Li, F., & Guo, L. (2019). Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials. Scandinavian journal of gastroenterology, 54(2), 169–177. https://doi.org/10.1080/00365521.2019.1568544