Have you ever had one of those days where you feel like you're carrying around a brick in your belly? Or you spend more time in the bathroom than you'd like, but nothing seems to be happening? This can sometimes mean that your bathroom habits are a little backed up.
Constipation might not be the most glamorous topic, but it's a common issue that many of us deal with at some point in our lives. For some it can be a chronic complaint that’s ongoing for a number of years, and others a shorter term problem that is easily sorted, once you get to the “bottom” of it.
As a nutritional therapist and health coach specialising in gut health, I've seen firsthand the awful impact it can have on how you feel both physically and emotionally. Whether it’s a longer term problem or a sporadic one, it really can be a pain in the arse (literally and figuratively speaking). Apart from the constant discomfort and heavy feeling, constipation can sap your energy and have a real impact on your mood. Finishing the smallest of jobs can become a major challenge as you battle abdominal pain, gas and bloating. All you want is to feel relief, that unfortunately is very hard to come by without over the counter (and sometimes prescribed) medication.
In this article we want to help you understand a little more about bowel dysfunction and how it affects your day to day life, how to recognise when there’s a problem and natural solutions that we use with clients to help alleviate the problem.
What is constipation
According to the Rome IV criteria, constipation is defined as experiencing at least 2 of these 3 symptoms over the last 6 months:
Fewer than three spontaneous bowel movements per week (as in, natural bowel movements without requiring laxatives).
Straining for more than 25% of defecation attempts.
Lumpy or hard stools for at least 25% of defecation attempts.
To put it another way, an ideal bowel pattern is to have a daily, easily passed poo that causes no discomfort or overthinking.You go, you’re done and you get on with your day.
If that’s you, excellent.If that’s not you then read on.
Side note: it is considered normal to go anywhere between 1 to 3 times a day.
Why constipation is bad for health
Constipation can have a significant impact on overall health, affecting not only gut health but overall energy levels and mood!
Mood and Energy
I know from clients that when they go from being constipated to having a daily bowel movement that they feel so much better in themselves with much less fatigue and with huge improvement in mood.This is the gut-brain axis at play which mostly involves the vagus nerve and the gut microbiota.(This is a whole other super interesting topic which I will write about soon).
Gut Health
Bloating is the bane of many people’s lives, and if you are constipated then bloating is its likely companion.Constipation can disrupt the bacterial balance of the gut which can increase the likelihood of digestive disorders such as IBS, diverticular disease or IBD.
Skin
Your skin serves as one of your organs for eliminating waste.When you are constipated you aren’t eliminating waste effectively through the digestive system so the skin has to step up to do more work. This can lead to dull looking skin, acne and worsening of skin conditions such as eczema.
Hormones
Chronic constipation (being constipated for more than 6 months) can disrupt hormonal balance in the body by various different mechanisms involving inflammation, the gut microbiome, nutrient absorption and more. This can impact the delicate balance of female hormones such as oestrogen but also the hormones involved in appetite regulation and metabolism.
What causes constipation?
Let me start by saying that maintaining regular bowel movements is not always as simple as drinking water and eating fibre.I have had countless clients over the years who diligently hydrate and eat very well yet are still struggling with constipation. So while diet can be a major factor, there are a number of other reasons why you might become constipated.
Dietary factors including too little fluids and fibre and too much overprocessed foods and sugar. You should be consuming around 30g of fibre per day, which in my experience not many people reach consistently. Failing to do so can have an impact on gastrointestinal motility and contribute to constipation.
Lifestyle factors –being too sedentary harms bowel function whereas when you build exercise or activity into your day you help support digestive health. Stress can also worsen constipation, when your body enters ‘fight or flight' mode it raises cortisol levels and muscle tension, which impacts bowel movements.
Gut related conditions – including IBD, IBS, SIBO, intestinal inflammation or disrupted gut microflora will all impact your gut greatly and slow down transit time of the bowel.
Medical conditions and medications including hypothyroidism, neurological disorders, pelvic floor dysfunction or diabetes can be a factor in constipation. It is also a common side effect of some medications including opioid painkillers, high dose antacids and antidepressants.
Psychological factors, like embarrassment or anxiety about using public toilets, can lead to ignoring the urge to go, worsening constipation over time.
What can help with constipation?
If you’re finding constipation is becoming a regular problem, it’s important to first identify what might be causing it. This is crucial to finding a solution that works to minimise the impact on your health. Regardless of the root problem, consider the following strategies to alleviate constipation and maintain digestive health.
Hydration
Water is a basic one, but is so important. You should aim to drink approximately 2 litres or about 8 glasses a day.If the body is dehydrated it will take water from the colon for use in other parts of the body leading to harder, more difficult to passed stools. Fluid helps to soften the stool and acts as a natural lubricant.Hydration is also important for the digestive process overall e.g. activating the digestive enzymes and absorption of nutrients.
Daily movement
Regular movement or exercise will encourage the bowel to move. Raising your knees on a step stool on the loo can be very effective as can a little abdominal massage. You can also include some, stretching or even a relaxing Epsom salts bath can help.
Foods and Fibre
Kiwis have a level 1 evidence with a grade B recommendation for alleviation of constipation based on a 2021 systematic review. This means that the evidence stands up quite highly from a systematic review of all relevant randomized controlled trials on this topic.
Increasing fibres such as chia and flaxseeds, stewed fruits like apples and pears, including oats and other wholegrains and upping your fluid intake if it is low are first line interventions.
Functional fibres such as PHGG or psyllium husk are clinically proven to help constipation although these are best introduced with help of a nutritional therapist as dosages are important and some are best to start on a low dose and increase slowly after a period of adjustment.
Supplementation support
Magnesium supplementation also has level 1 evidence with grade B recommendation. Data shows that significant improvements in stool consistency and frequency were demonstrated at doses between 100 and 500mg per day.Too much magnesium can have the opposite effect and cause diarrhoea so again, best to get professional advice on this.
There can be a tendency to think that probiotics are the answer to all gut related problems.This isn’t true, in fact there’s not a huge body of evidence to show that probiotics are the way to go for constipation. There are a few strains such as lactobacillus reuteri DSM17938 which is usually well tolerated and can work well for chronic constipation.Bifidobacteriumlactis is another with good data behind it.
That’s not to say, of course, that if you have a non-diverse microbiome with low numbers of key species that supplementing with a probiotic isn’t going to be good for you.
Watch your stress
Incorporating stress-reducing practices like deep breathing exercises, meditation, or gentle yoga can help calm the body's stress response and ease tension in the gut. Check out The Impact of Stress on our Health for more help in this area.
Constipation can have wide-ranging effects on health, extending beyond gut discomfort to impact energy levels, hormonal function, skin health, mental well-being, and overall quality of life. It doesn’t have to be this way.The key point is to get to the root cause of your constipation. If it’s lack of fibre, water and movement then of course, it’s an easier fix. If it’s something a little more complex (such as motility issues, bacterial overgrowth, IBS ) then it may need a different approach. Everybody is individual with different microbiomes, lifestyles, dietary patterns, stress levels and medical history.Addressing constipation through figuring out what the root cause is, dietary and lifestyle interventions, along with appropriate medical treatment when and if necessary, can result in long-lasting relief.
Here's to a happier, healthier gut!
What are your takeaways from this article? Have you been able to pin-point the cause of your constipation? What solutions help you to get things moving when you’re feeling sluggish and backed up?
Side note - It's essential to pay attention to changes in bowel habits. If someone experiences a sudden and persistent change in bowel movements, such as a significant increase or decrease in frequency, or if there are other concerning symptoms like pain, blood in the stool, or unexplained weight loss, it's important to consult with a healthcare professional for further evaluation.