Constipation occurs in many conditions including hypothyroid disease, irritable bowel syndrome, small intestinal bacteria overgrowth, stress, pregnancy, diabetes, Lyme’s disease, multiple sclerosis, Parkinson’s disease, chronic kidney disease and colon cancer. It affects, on average, 16% of the population worldwide, and up to 33.5% of those aged 60-110 years old^[1].  Due to the tide of hormones, women are more likely to suffer from constipation than men^[2].

The experience of constipation includes: irregular bowel movements, passing stool less than three to five times per week, or the difficulty passing a stool that may require straining, or the insufficient, unsatisfactory, incomplete or painful stool.  It may even include an obstruction of the gastrointestinal tract, which sometimes requires surgery. 

Reasons for constipation vary and can be multi-dimensional. It can involve diet, lifestyle, factors in colon motility, absorption, inflammation, infection, hormone balance, microbiome balance, genetics, pharmacological (drugs) and environmental (stress) factors.  Some cultural variation in habits reveal the ancestral position of squatting may even help move stool more effectively. A stool such as the “squatty potty” to raise your feet while sitting on the toilet supports this positional posture.

Reasons for constipation:

Diet

• Diet lacks fibre and vegetables
• Diet too high in proteins and carbs, especially in sugar, starch in processed foods
• Dairy, wheat or other food sensitivity
• Over consumption of dairy (too much cheese)
• Insufficient water intake

Microflora

• Insufficient microflora (not enough Lactobacillus and Bifidobacterium)[3]
• Dysbiosis (overgrowth of the wrong kinds of gut bacteria, such as Baceteriodes[4])
• Small Intestinal Bacterial Overgrowth (SIBO) (root cause may be hypothyroid and migrating motor complex)

 
Hormones

• Hypothyroid affecting the migrating motor complex
• Stress
• Pregnancy, premenopausal, postmenopausal
• Lack of regular daily exercise

Supplements and Medications

• Overuse of laxatives
• Supplements such as iron, calcium
• Side effects of prescription drugs such as painkillers (opioids), anti-depressants

 
Conditions

• Irritable bowel syndrome or diseases
• Chronic Kidney Disease (CKD)
• Colon cancer
• Lyme’s disease
• Diabetes mellitus
• Hemorrhoids
• Nervous system disruption as in spinal cord lesions, Multiple Sclerosis and Parkinson’s disease
• Poor functioning of the pelvic floor muscles

When someone has issues with constipation, the inevitable question that comes to mind, is “what is the person not letting go?”  Sometimes when we emotionally hold on to something, the body also goes into a holding pattern. In Traditional Chinese Medicine, the large intestine is responsible for “letting go” both physically and emotionally. Reflection and relaxation helps shift the body to a parasympathetic (“rest and digest”) state, encouraging motility in the gastrointestinal tract. Proper sleep and support of biorhythms (daily routines), also help regulate internal clocks and bowel function.

Symptoms and complications of constipation:

Left untreated, constipation can lead to complications. Stool is made of approximately 75% water, 25% expired gut bacteria, unabsorbed or excreted fat and toxins and other unabsorbed matter. Left to sit in the gastrointestinal tract, reabsorption of toxic elements can occur, including toxic byproducts of gut bacteria, plastics, drugs, hormones, bile, and cholesterol. Not to mention physical discomfort and possible damage due to accumulation of physical mass. 

• Accumulated gas in abdomen, bloating abdomen, pain in abdomen
• Headaches and nausea
• Behavioural and emotional problems[5]
• Bleeding may occur while passing stool due to fissures/piles, or from passing hard stool
• Pain and burning in rectum may occur and continue even after passing stool
• Long standing constipation may lead to piles (swollen, dilated veins in rectal canal or anus), anal fissures (tear in the tissue lining of the anus) and rectal prolapse (protrusion of a part or the entire rectum from the anus)
• Abdominal hernia (inguinal hernia/umbilical hernia) may arise from long standing constipation. An abdominal hernia is the protrusion of an organ through the abdominal wall or cavity which normally contains it

Relief for constipation

Constipation is common, bothersome and often ineffectively treated[6]. A wholistic and individual approach to patient care helps encompass the multi-factorial contributors of the condition. Laboratory and imaging tests will help rule out primary reasons for constipation and functional reasons may be addressed with herbal, dietary, nutraceutical, homeopathic, genomic, lifestyle, and manual therapies. More on How GUT Health Connects to Your Mind, Body and Soul in this author’s international bestseller book: Beyond Digestion 

References:

[1] Forootan M, Bagheri N, Darvishi M. Chronic constipation: A review of literature. Medicine (Baltimore). 2018 May;97(20):e10631. doi: 10.1097/MD.0000000000010631. PMID: 29768326; PMCID: PMC5976340.

[2] Huerta-Franco MR, Vargas-Luna M, Somoza X, Delgadillo-Holtfort I, Balleza-Ordaz M, Kashina S. Gastric responses to acute psychological stress in climacteric women: a pilot study. Menopause. 2019 May;26(5):469-475. doi: 10.1097/GME.0000000000001274. PMID: 30586006.

[3] Dimidi E, Christodoulides S, Scott SM, Whelan K. Mechanisms of Action of Probiotics and the Gastrointestinal Microbiota on Gut Motility and Constipation. Adv Nutr. 2017 May 15;8(3):484-494. doi: 10.3945/an.116.014407. PMID: 28507013; PMCID: PMC5421123.

[4] Dimidi E, Christodoulides S, Scott SM, Whelan K. Mechanisms of Action of Probiotics and the Gastrointestinal Microbiota on Gut Motility and Constipation. Adv Nutr. 2017 May 15;8(3):484-494. doi: 10.3945/an.116.014407. PMID: 28507013; PMCID: PMC5421123.

[5] Rajindrajith S, Ranathunga N, Jayawickrama N, van Dijk M, Benninga MA, Devanarayana NM. Behavioral and emotional problems in adolescents with constipation and their association with quality of life. PLoS One. 2020 Oct 12;15(10):e0239092. doi: 10.1371/journal.pone.0239092. PMID: 33044960; PMCID: PMC7549826.

[6] Johanson JF, Kralstein J. Chronic constipation: a survey of the patient perspective. Aliment Pharmacol Ther. 2007 Mar 1;25(5):599-608. doi: 10.1111/j.1365-2036.2006.03238.x. PMID: 17305761.