Chronic constipation can be a horrible condition. Having struggled with constipation in my early twenties I can relate to clients who are currently suffering with it. The good news is that there are numerous strategies to try to support regular bowel movements. Some of these are discussed below.
Chronic constipation is a symptom-based gastrointestinal disorder characterized by difficult or infrequent passage of stool, hardness of stool, and/or a feeling of incomplete evacuation. It can result in some discomfort such as abdominal distension, abdominal pain, headache, dizziness and poor appetite. Constipation has an estimated prevalence reaching up to 20 % in some populations, and this condition affects patients of all ages and gender and severely impacts on their quality of life.
You may like to read my overview on digestive health here also.
Fibre & Chronic Constipation
Generally, it is well-known that water-insoluble fiber is helpful for constipation. However, some authors insist that intermediate soluble and fermentable fiber is helpful for constipation
There are many different dietary fibers, but in general, they fall into two categories:
- Insoluble fibers: Found in wheat bran, vegetables and whole grains. They add bulk to your stools and are thought to help them pass more quickly and easily through your digestive system.
- Soluble fibers: Found in oat bran, barley, nuts, seeds, beans, lentils and peas, as well as some fruits and vegetables. They absorb water and form a gel-like paste, which softens your stools and improves the consistency.
Studies examining the effects of insoluble fiber as treatment for constipation have been inconclusive.
This is because insoluble fiber can make the problem worse in some people with a functional bowel problem, such as IBS or chronic idiopathic constipation.
Some fermentable soluble fibers may also be ineffective at treating constipation, as they are fermented by bacteria in the gut and lose their water-holding capacity.
The best choice for a fiber supplement when constipated is a non-fermentable soluble fiber, such as psyllium.
Clients often mention they noticed a real change in their bowel habits when they increased their daily activity. I know I certainly did! Even walking more (I still like aiming for my 10,000 steps) can have benefits in some people.
For some people, coffee can increase the urge to go to the bathroom. This is because coffee stimulates the muscles in the digestive system.
Probiotics may help prevent chronic constipation.
A large randomized controlled trial demonstrated that the intake of an effective amount of Lactobacillus plantarum and Bifidobacterium breve, or Bifidobacterium lactis is able to significantly relieve the evacuation disorders and hard stools in patients with constipation (Del Piano et al. 2010).
The combination of probiotics and prebiotics, which is named synbiotics, may provide synergistic effects. Synbiotic administration may improve the survival of probiotics and restore intestinal microbial balance, which may have positive effects on the treatment of constipation (Khodadad and Sabbaghian 2010).
Prebiotics are non-digestible substances that provide a beneficial physiological effect on the host by selectively stimulating the growth or activity of a limited number of favourable indigenous gut bacteria. Prebiotics stimulate the preferential growth of a limited number of health-promoting commensal flora already residing in the colon, such as Lactobacilli and Bifidobacteria. Examples of prebiotics include fructo-oligosaccharides, galacto-oligosaccharides and inulin. Fibre and fibre supplements employed in the treatment of constipation also exert prebiotic effects
The low-FODMAP diet is an elimination diet that’s often used to treat constipation.
Taking magnesium citrate is a popular home remedy against constipation. It is a type of osmotic laxative that can be bought over-the-counter. recommend a starting dose of close to 400 mg
Vitamin C can also be beneficial in some people. Some clients have had significant improvement from supplementing 2g of vitamin C per day.
Chris Kresser discussed constipation on one of his podcasts, found here.
Chronic constipation is almost always caused by intestinal dysbiosis, so an imbalance of good and bacteria in the gut. And in particular, it’s often caused by a lack of bifidobacteria in the large intestine. There’s a strong association between low levels of bifido and constipation….. So, magnesium glycinate can be helpful in the transition period while you’re healing your gut and even long term, because a lot of people, as I’ve said before, don’t get enough magnesium through the diet even in the context of a healthy diet. But I wouldn’t only do that.
Khalif et al. reported that the levels of Bifidobacteria and Lactobacillus were significantly decreased in adult patients with constipation (Khalif et al. 2005). I certainly find this. I also have found, that every time someone had chronic constipation, there is an elevated level of methane producing bacteria in their stool results. Every time so far!
Prunes and prune juice are often touted as nature’s remedy for constipation — and for good reason. In addition to fiber, prunes contain the natural laxative sorbitol. This is a sugar alcohol that has a laxative effect.
Gut Motility & Gut Brain Axis
The below quote is from Chris Kresser and summarises the fact that gut motility, the gut0brain axis and neurotransmitters synthesised from bacteria may be contributing to chronic constipation. The brain and nervous system is key in gut function and constipation, according to Dr. Perlmutter, is one of the first symptoms in Parkinson’s Disease. The gut is just an extension of the brain!
In some people, it’s not as much about the gut flora; it’s more about motility, and the natural peristaltic action isn’t happening property. And that can often be a gut-brain axis problem, which we’ve discussed a few times on the show. And so, to deal with that, you want to pay attention to stress management, to hypothalamic-pituitary-adrenal axis health, aka adrenal fatigue syndrome. Serotonin and GABA are two neurotransmitters that are produced in large amounts in the gut, in fact, much larger amounts than in the brain. Serotonin, in particular, is associated with gut motility. So, in some cases, 5-HTP, which is a precursor to serotonin, can improve constipation, and it’s pretty safe to take, so like 100 mg in the evening time. Some practitioners, myself included, will also recommend that if you’re taking 5-HTP in the evening, you want to take some tyrosine in the morning so that you don’t create an imbalance of neurotransmitters. Tyrosine is a dopamine precursor.
Research going back to the 1990’s has demonstrated this connection. An article in the British Medical Journal concluded:
There is increasing agreement that autonomic abnormalities can often be associated with functional disorders of the gut.
This includes constipation.
Autonomic abnormalities relates to the autonomic nervous system and the balance between the fight or flight response (stress response) and, what some people call, the ‘rest and digest’ response.
I recommend taking autonomic activity through monitoring your heart rate variability. This can be be done via the App HRV4Training.
I often find people with chronic constipation are in constant elevated parasympathetic activity, so to speak. This may be a form of burnout but could be related to immune activity and chronic infections, among other possible factors (we won’t get in to this now!).
Human colonic gases produced by microflora may also be associated with changes in gut motility.
The direct effect of methane on intestinal transit may be mediated through serotonin, a neurotransmitter that, among other functions, elicits peristaltic contractions in the gut. In one study, lactulose breath testing was performed on subjects with IBS, followed by a determination of serotonin before and aft er a 75-g oral glucose meal. Compared with hydrogen producers, methane producers had significantly lower postprandial serotonin levels
Methane production significantly influences colonic transit time, colonic pH, colonic motility, and anorectal sensorimotor function. All of these fi ndings suggest a strong association between methanogenesis and chronic constipation (Pimentel et al., 2012)
To test for methane production requires a breath test or stool test.
Eight weeks of electroacupuncture increases complete spontaneous bowel movements (CSBM) and is safe for the treatment. Additional study is warranted to evaluate a longer-term treatment and follow-up (Liu et al., 2016)
A food allergy to cow milk protein can also cause constipation (Bae, 2014)
Body Awareness Therapy (BAT)
It was reported that 12 wk of treatment with BAT gives symptomatic relief of both gastrointestinal and psychological symptoms, mostly to the constipated patients
Go and see a Feldenkrais practitioner, a ROLF practitioner, an excellent personal trainer (ideally some one with training from The Grey Institute who is trained and understands functional anatomy and Applied Functional Science).
This is why I whole heartedly believe in a complete lifestyle approach to optimising health.
This is why I am creating so much content on the Leaning Zone.
This is why I only work with clients for a minimum of three months.
You just can’t ignore that everything is interconnected – thoughts, feelings, emotions, relationships, beliefs, our movement capacity and proprioception, sleep, happiness, finances, work-life balance…..everything!
If you struggle with chronic constipation then do reach out.
There are numerous options to explore including upcoming webinars that will be sold in the shop, group programmes and of course 1-2-1 coaching.