Chronic Constipation: Types, Causes, and Functional Medicine Solutions
What we’ll cover
Constipation, whether acute or chronic, is characterised by difficult, infrequent, or incomplete bowel movements. Typically, stools are small and hard. Ideally, bowel movements should occur daily to maintain optimal health.
How to Identify Constipation
The Bristol Stool Chart is a valuable tool for identifying constipation. If your stool matches types 1 or 2 on the chart—hard, lumpy, and difficult to pass—you may be experiencing constipation.
What Causes Constipation?
Understanding the underlying mechanisms is critical to effective treatment. Here are the three primary types:
1. Normal Transit Constipation (NTC)
Normal transit constipation occurs when stool typically moves through the colon, but the person still feels constipated. Symptoms include difficulty evacuating, hard stools, bloating, and abdominal discomfort. NTC is the most common type of constipation.
2. Slow Transit Constipation (STC)
In slow transit constipation, stool moves too slowly through the large intestine, leading to infrequent bowel movements, a lack of urgency, and straining during defecation.
3. Dyssynergic Constipation (Pelvic Floor Dysfunction)
Dyssynergic defecation occurs when the muscles and nerves in the pelvic floor fail to coordinate properly during a bowel movement, making it difficult to pass stool.
Pro Tip: Seek out a practitioner skilled in pelvic muscle rehabilitation (PMR). Pelvic floor therapy can address imbalances, tension, or weakness in the pelvic floor muscles.
Common Causes of Chronic Constipation
1. Insufficient Hydration, Fiber, and Exercise
- Water: Adequate hydration is crucial. Dehydration leads to harder stools, making them more challenging to pass. Drink 8-10 glasses of filtered water daily.
- Fibre: Aim for 25-30 grams of fibre daily from sources like psyllium husk and modified citrus pectin to bulk up stools and promote regularity.
- Exercise: 150 minutes of moderate-intensity aerobic exercise weekly to help relieve constipation.
2. Bacterial Overgrowth (SIBO)
Small Intestinal Bacterial Overgrowth (SIBO) can cause constipation by disrupting normal gut motility. SIBO leads to excessive gas production and slows stool transit.
Action Steps: Get evaluated for SIBO with non-invasive breath tests. Consider a low-FODMAP diet, probiotics, digestive enzymes, herbal therapies, or an elemental diet under professional guidance.
3. Structural Abnormalities of the Colon
A redundant or tortuous colon may loop or twist, leading to constipation. Abdominal massage and biofeedback therapy can promote bowel movements and help manage these structural issues.
4. Gut-Brain Axis Dysregulation
The gut-brain axis is a bi-directional communication pathway that plays a crucial role in gut health. Stress can impair gut motility, leading to constipation.
Stress Management Techniques:
- Spend time in nature to improve gut health.
- Practice meditation to balance stress hormones.
- Consider Cognitive Behavioral Therapy (CBT) to alleviate constipation linked to stress and anxiety.
The Vagus Nerve and Its Role in Constipation
The vagus nerve significantly impacts gut motility. Chronic stress can weaken the vagus nerve, slowing gut movement and leading to constipation.
Vagus Nerve Stimulation Techniques:
- Gargling and gagging
- Singing and humming
- Deep breathing exercises
- Cold exposure and sunlight
- Massage, acupuncture, essential oils, and supplements
Key Takeaways for Managing Chronic Constipation
Effectively managing chronic constipation requires a comprehensive approach:
- Hydration: Drink between 2.5-3L of water a day.
- Fiber Intake: Aim for 25-30 grams of fiber daily.
- Exercise: Engage in 150 minutes of moderate-intensity exercise weekly.
- SIBO Management: Get evaluated and follow a targeted treatment plan.
- Address Structural Issues: Consider abdominal massage and biofeedback therapy.
- Gut-Brain Connection: Incorporate stress-reducing practices like time in nature, meditation, and CBT.
Chronic constipation may be an early warning sign of underlying conditions such as hypothyroidism, diabetes, or neurological disorders like Parkinson’s disease. By implementing these evidence-based strategies, you can improve bowel function and reduce the incidence of constipation, promoting overall health and well-being.
