Constipation

Let’s get things moving…

 

As a society we rarely talk about our bowel habits and what one person considers normal may be very different from another.  It is also important to understand what is a symptom and what is a condition.  Constipation is a sign that there is an imbalance which may stem from a number of different areas, many of which are disconnected from the digestive system itself and can result not just in discomfort but hormonal dysregulation and increased risk of colon cancer.

Let's get graphic....

From studies of indigenous people ideal bowel movement would be:

  • 1 – 3 easily passed stools a day

  • Little sustained aroma

  • Medium brown in colour

  • Long, log-like piece or few pieces

  • No discomfort, no training, do delay

Whereas constipation would be:

  • Infrequent bowel movements (less than 3 / week)

  • Having to strain to pass a stool

  • Hard, pellet-like or incomplete stools

Toxin build up
Once the stool reaches the large intestines the final stages of water absorbed is carried out along with electrolytes and vitamin K.  However, if the stool remains in the gut for a prolonged period of time toxins and excreted hormones will also be reabsorbed.  This places the burden back on the liver to reprocess them for elimination.
Chronic constipation also increases the risk of colorectal cancer which is part of the reason why a high fibre diet is suggested to keep things moving and therefore decrease the risk.  So, what if just adding extra fibre doesn't work?  Read on to find out...

Constipation Check List

It is important to systematically work through the most common causes of constipation before delving deeper.  However, if you have been diagnosed with any of the conditions mentioned later in this article ensuring that they are properly managed is vital for resolution of symptoms.

Eating hygiene
There are only 2 parts of the digestive process that we control - chewing and swallowing.  It is important that we thoroughly chew out food properly.  Eating in relaxed environment is also paramount as activation of the fight or flight part of the nervous system which does not favour digestion or motility.

Behaviour
Public toilets or going to the loo at social gatherings can make some people nervous and they with hold the bowel movement and supress the urge.  If the stool is with held for a prolonged period of time the urge with pass, the stool will impact in the bowel, more water will be reabsorbed and the stool will be even harder to pass.  This impaction may require the one off use of a laxative to get things moving. 

Stress
As briefly mention above, activation of the 'fight or flight' response has a negative impact on digestion.  It directs blood away from the organs of digestion and decreases the release digestive enzymes.  Chronic (long term) stress will also wreak havoc on the gut wall increasing undesirable permeability which can results in IBS symptoms and be a contributing factor to the development of auto-immune conditions.

Eating the correct amount
The stomach is the body’s blender.  If we over eat then there in not enough room to blend the food down into smaller particles which can cause:

  • Post meal fatigue

  • Belching

  • Feeling over full

  • Constipation

  • Malabsorption

It takes 10-15 minutes for the body to register that it is full so eat slowly and mindfully of how much food is on it's way to your stomach.

Don’t graze
Grazing may result in slower bowel movements as it is the distention in the stomach from a significant meal that stimulates the peristaltic waves down the digestive tract.  Smaller, frequent meals do active this motor response in the gut which results in slower movement down the digestive tract.

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Insuffi­cient water or fibre (soluble or insoluble)
Soluble fibre can bulk up the stool; and soften it so it’s easier to pass while insoluble fibre helps to move it along.  If you are suffering from other IBS symptoms (bloating, distention) fibre may not be the best option.  One option would be psyllium husks (contains both type of fibre) slowly increasing by 1 teaspoon every few days.  Make sure 6+ glasses of water are being consumed first.  1 – 2 tablespoons of ground flaxseeds can also provide gentle relief.

Soluble

·      Oats

·      Fruit (especially bananas)

Insoluble

·      Seeds (ground flax seeds)

·      Non-starchy vegetables

 

Squatting
Squatting is the most natural position to pass a stool as it allows the colon to fully release.  There are food stools on the market (eg the squatty potty) that simulated this position.  The important things is to have your knees above your hips.

squat-poop-muscle.jpg

Food sensitivities
Food sensitivities don’t just present with symptoms such as pain or loose bowel movements.  Dairy and gluten containing foods can commonly cause constipation but individuals can be sensitive to many other foods.  In these instances removing the suspected food for a period of 3 weeks is a good test.  If it’s hard to pin point the troublesome food a more complete eliminated diet may be required.

Hypothyroidism
A common symptom of hypothyroidism is that of constipation.  Thyroid hormones regulate metabolism a decrease in their activity leads to a ‘slowing’ of many areas of the body.  There can be many reasons why thyroid hormones are low, read my in-depth article to understand the ways in which you can support your thyroid here.

Dysbiosis
An imbalance in the probiotic bacteria in the large intestine can promote constipation with an overgrowth of strains such as citrobacter, klebsiella and enterobacter being the most common.  In some cases a good quality probiotic supplement can help to readdress this balance.  In other instances a gut cleansing protocol could be implements using specific antimicrobial herbs which would taking into account the strain of the bacteria and the level of overgrowth.  I find a combination of oil of oregano, berberine and goldenseal to be of help.

SIBO
SIBO (small intestinal bacterial overgrowth) is where beneficial strains of probiotic bacteria migrate from the colon to the small intestine.  This is a case of the right microbes in the wrong place.  They can cause constipation through a mechanism where the methane gas these bacteria release causes a reduction in the production of serotonin in the gut.  The serotonin found in the gut is required for motility.

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Menopause
Oestrogen and progesterone regulate many areas of the body, especially bowel motility.  Read my in-depth article about ways to tackle the menopause here.

 

Supplement Overload

Iron
Due to it’s poor absorption the form of iron used in many supplements, ferrous fumerate, can cause constipation.  Simply switching to a more absorbable form such a iron bisglycinate can be of great help with bowel movements.

Calcium
Due to its role is muscle contraction an excess intake of supplemental calcium can prevent the peristaltic muscle actions which are vital for bowel movements from functioning effectively.  This can be mitigated by taking magnesium along side calcium in a 1:2 ratio.

Vitamin D
Vitamin D deficiency is the most common vitamin deficiency in the western world which has lead to a large amount of the population to supplement with it.  However, is vitamin D intake is too high and too fast it can result in a magnesium deficiency and reduce bowel motility.

 

Short-term Solutions

These are not suggested for prolonged usage as they do not address the root cause

  • Prunes – high in a sugar alcohol known as sorbitol that may aggravate IBS symptoms

  • Xylitol chewing gum – another sugar alcohol but should not aggravate IBS symptoms. This will loosen stooly gently as the act of chewing stimulates motility.

  • Olive oil – promotes the motion of peristalsis as well as the emptying of the gall bladder. Add 3 – 4 tablespoons in a smoothie in the evening before bed.

  • Herbal formulas - teas usually contain senna or aloe have a strong laxative effect. Take in the evening before and expect a movement in the morning.