Are you chronically constipated? Have you tried every kind of laxative and still can’t get things moving? Bowel motions (or lack of) can be one of those symptoms people feel embarrassed talking about with their healthcare professional. It is an important conversation to have. Regular bowel motions eliminate waste and prevent the reabsorption of toxins back into the body.
What is regular?
Although many people say once a day is ideal, frequency of bowel motions vary among individuals. Anything between 3 per week and 3 per day is considered normal. You need to know what is usual for you.
It’s not just about the number
A healthy bowel motion should be easy to pass, no straining, not take to long to complete and leave you feeling completely evacuated. The shape can vary a little depending on what you’ve been eating but ideally is sausage like. A red flag for health issues is if your bowel motions change from what they usually are and there is no apparent cause, i.e., food poisoning or overeating cheese or fruit. Any blood in bowel motions should also be investigated further.
Definition of chronic constipation
Constipation is defined as having less than 3 bowel motions per week, with straining 25% of the time and a hard, dry difficult to pass stool and may also be accompanied by abdominal discomfort and bloating. Although most of us can suffer from acute constipation from time to time temporary changes to eating habits and travel about 16% of adults have chronic constipation.
Symptomatic treatment of constipation provides relief but often does not address the underlying cause. Symptomatic treatment includes laxatives and enemas. With the exception of bulk laxatives (fibre based), these can become habit forming and cause other digestive symptoms. They are not recommended long term.
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Complications of chronic constipation
Chronic constipation can be associated with other health issues:
- Haemorrhoids and anal fissures
- Poor skin health
- Heart attack
- A hernia
- Bowel Cancer
Treat the underlying cause
Common underlying causes of chronic constipation include lack of exercise, low fibre diets and not consuming enough fluids.
Research indicates that people who exercise at a moderate intensity or higher between 2-6 times per week have a 35% less risk of developing constipation 1. Activity is thought to increase the propulsive movements in the colon and may also stimulate hormonal changes that influence motility.
Although short-term stress can cause diarrhoea, long-term stress may contribute to constipation due to changes in gastric secretion and motility. Stress also impacts on the composition of the good bacteria in the gut, and an imbalance of methane-producing bacteria is often associated with constipation 2.
Maintaining an adequate fluid intake is a well-known recommendation for reducing constipation. While not a cure for chronic constipation it will make the stool easier to pass. If you are dehydrated, your body reabsorbs water from your colon, and your stool gets lumpy, cracked appearance and will not move through your colon as quickly. A baseline fluid consumption for adults is 30ml per kilogram of body weight and includes water, the liquid in foods, tea and coffee but not alcohol. This may increase or decrease depending on the weather and your level of physical activity. More is not better when it comes to fluid intake and no benefit for constipation has been shown in increasing your consumption above what is needed for adequate hydration 3.
Another well-known first line treatment is to ensure you are obtaining sufficient fibre from your diet.
Fibre provides bulk to the stool and attracts water into the colon. This increased bulk increases peristalsis and decreases the time taken to move the stool through the colon.
Fibre also provides food for your gut bugs to feed on and then they produce substances called short chain fatty acids. Amongst other things, these short-chain fatty acids help to improve the movement of your stool through the colon 4.
Recommendations for fibre are for a minimum of 25g per day. One of the best ways to get fibre in your diet is to eat 2 serves of whole fruit, and 5 serves of vegetables every day. Whole grains such as rolled oats are also a good source of fibre.
If your diet has been low fibre increase it gradually otherwise you may suffer from digestive discomfort.
If you are taking fibre supplements, make sure you increase your fluid intake. Fresh fruit and vegetables contain liquid, but powdered fibre doesn’t and may clog you up even more.
Less well-known causes of chronic constipation
Electrolytes are minerals that help with the electrical charge in your body. These small electrical charges are vital for cellular activity and communication. Essential electrolytes are sodium, potassium, calcium, magnesium and chloride. The correct balance of electrolytes helps to maintain gastrointestinal motility and also ensures water can get into the intestine 5. Things that can impact on your electrolyte balance include heavy sweating, hormonal imbalances, prolonged stress, a poor diet low in fruits and vegetables, medications including antibiotics, diuretics and corticosteroids.
Bile is produced in your liver and stored in your gallbladder. It has a detergent-like effect to help your digestive system absorb fats from your foods. Bile salts are considered to be your own internal laxative as they increase motility and enhance secretion of fluids into the gastrointestinal tract. This results in softer stools that move more efficiently through the colon.
Anything that impacts the function of the liver and/or gallbladder can result in a decreased secretion of bile such as inflammation, damage from excessive alcohol consumption and nutrient deficiencies such as protein (especially amino acids glycine and taurine). Signs that you may have decreased bile output include deficiencies of fat-soluble vitamins (A, E, D K) jaundice, elevated cholesterol readings on your blood test, intolerance of fatty foods with pale, greasy or foul-smelling stools, bloating and heartburn.
As touched on earlier, if your gut bacteria is out of balance this can result in constipation. Key factors that affect the makeup of your microbiome are chronic stress, low-fibre diets and use of antibiotics 4,6. There is also emerging evidence that the widely used herbicide, glyphosate (Roundup) is harmful to your bacteria through the disruption of their metabolism (shikimate pathway). Humans don’t have this pathway so while glyphosate may not be directly toxic to us it seems to be very harmful to our bacteria and we are increasingly discovering how essential they are to our health 7.
Pelvic floor dyssynergia
This is a condition where the muscles around the pelvic floor, anal sphincter and rectum contract instead of relaxing when passing a bowel motion. This can give a feeling of incomplete evacuation and also cause problems with urination. Pelvic floor dyssynergia may result from trauma to the area often associated with childbirth or sexual abuse.
Disruption of the nerve signalling to the bowel and rectum can result in constipation. This can occur due to spinal cord injury, stroke, diabetes or nerve diseases such as Multiple Sclerosis.
It is well known that the side effects of opioid-based pain medications (codeine and morphine) cause constipation. They slow down transit time by decreasing the section of water and electrolytes into the colon and also make the muscles of the gastrointestinal tract more tense making decreasing the propulsion along the tract 8. Other medications that can cause constipation are anticholinergic drugs, antihistamines, calcium channel blockers and anticonvulsants 9.
Medical conditions associated with constipation
Constipation is a key symptom of hypothyroidism. Lack of thyroid hormone causes many processes in your body to slow down including the muscles in your intestinal tract. You may want to investigate this with your health professional if you also have dry skin, cold intolerance and are constantly fatigued.
Parkinsons Disease is characterised by a decrease in the neurotransmitter dopamine, and this impairs muscle movement throughout the body. A 2015 meta-analysis found that chronic constipation may be an early warning sign for the development of this disease10 .
Other causes of chronic constipation are an intestinal obstruction, often caused by impacted feces and colon cancer. If your bowel habits have recently changed and you are feeling fatigued and have lost a lot of weight that can’t be contributed to diet or exercise changes you need to get this investigated by your doctor as soon as possible.
Chronic constipation is a symptom of something else going on. Regular elimination of waste is vital for optimal health. Rather than relying on laxatives (either herbal or pharmaceutical) work with your healthcare professional to treat the underlying cause.
Norelle Hentschel is a degree qualified Naturopath and operates a clinic in Crows Nest, North Sydney. She enjoys helping people feel better and can assist with a broad range of digestive health conditions or general health maintenance.
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If you enjoyed this you might also be interested in:
- Dukas L, Willett WC, Giovannucci EL, Sc D. Association Between Physical Activity , Fiber Intake , and Other Lifestyle Variables and Constipation in a Study of Women. Am J Gastroenterol. 2003;98(8):1790-1796. doi:10.1016/S0002-9270(03)00442-8.
- Parthasarathy G, Chen J, Chen X. Constipation and the Microbiome: Lumen Versus Mucosa! Gastroenterology. 2016;150:300-314. doi:10.1053/j.gastro.2015.12.023.
- Nunes S, Tahan S, Canova F, et al. Water and fluid intake in the prevention and treatment of functional constipation in children and adolescents : is there evidence ? ଝ , ଝଝ. J Pediatr (Rio J). 2017;93(4):320-327. doi:10.1016/j.jped.2017.01.005.
- Christondoulides S, Dimidi E, Fragkos K, Farmer A, Whelan K, Scott S. Systematic review with meta-analysis : effect of fibre supplementation on chronic idiopathic constipation in adults . Aliment Pharmacol Ther. 2016;44:103-116. doi:10.1111/apt.13662.
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- Konturek P, Brzozowski T, Konturek SJ. Review article STRESS AND THE GUT : PATHOPHYSIOLOGY, CLINICAL CONSEQUENCES,DIAGNOSTIC APPROACH AND TREATMENT OPTIONS. J Physiol Pharmacol. 2011;62(6):591-599. http://jpp.krakow.pl/journal/archive/12_11/pdf/591_12_11_article.pdf. Accessed August 23, 2017.
- Claus SP, Guillou H, Ellero-simatos S. The gut microbiota : a major player in the toxicity of environmental pollutants ? Nat Publ Gr. 2016;2(2016):1-12. doi:10.1038/npjbiofilms.2016.3.
- Wald A. Constipation : pathophysiology and management. Curr Opin Gastroenterol. 2015;31(1):45-49. doi:10.1097/MOG.0000000000000137.
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- Adams-Carr K, Bestwick J, Shribman S, Lees A, Schrag A, Noyce A. Constipation preceding Parkinson’s disease – a systematic review and meta-analysis.