As naturopaths we love to talk about to poo/poop/stools/bowel movements. It’s a fundamental part of the job! And that’s because they are an excellent report card for our digestive and gastrointestinal health which has important ramifications for our overall health and wellbeing.

Constipation is one of the most common gastrointestinal disorders worldwide, in both adults and children. Prevalence estimated at around 20% of the population. That is a lot of people not pooping enough!

So, while we can appreciate that it is REALLY common, and perhaps agree that ‘normal’ bowel movements for one person may be vastly different than ‘normal’ bowel movements for another, many people simply don’t place enough importance on the importance of regular, easy to pass bowel motions.

Other than for young children, constipation is rarely what patients come in to see us for. For many people it’s their ‘normal’. They don’t give it too much thought. For us, it is the number 1 foundational priority to address for any person we see in clinic. Having healthy digestion and eliminating waste (ideally twice a day) is crucial for systemic health.

Constipation is definitely not “normal” and can have incredibly serious and broad reaching implications.

What’s the big deal?

Aside from the obvious gastrointestinal distress, constipation can have far broader implications and may contribute to the severity or development of :-

· depression and anxiety (via gut brain axis)

· excess oestrogen (and related symptoms such as PMS, heavy periods, migraines, endometriosis, fibroids, low libido)

· elevated histamine

· skin conditions

· liver burden

Resolving constipation may resolve a host of other seemingly unrelated symptoms.

Signs and symptoms of constipation can include:

· Less than three bowel movements a week

· Bowel movements that are hard, dry and difficult to pass

· Pain while having a bowel movement

· Stomach pain

· Distended abdomen

· Soiling and incontinence – this is due to overspill syndrome where watery stool passes stool that is backed up in the rectum. It is often mistaken for diarrhoea.

· Blood on the surface of hard stool

· Early satiety / low appetite

Did you know, you can be passing stool daily and still be constipated?

3 key foundations to address to prevent or improve constipation:-

Water: First and foremost, make sure you are hydrated. If you are not drinking enough water, constipation is almost inevitable.

Have a glass of water on waking. Then fill a 1 – 2 litre water bottle and make sure its gone by the end of the day. Water requirements can differ vastly due to climate, activity levels, sweat levels. A general recommendation is 8 glasses per day. You can also use the colour of your urine as an indicator – if you are drinking enough water, it should be pale, straw yellow

Diet: It’s important to eat a diet high in both soluble and insoluble fibre. Consider fresh fruit and vegetables, whole grains, nuts, seeds and legumes. These foods are also commonly high in magnesium which is also required for healthy contraction of the bowel (peristalsis). Soaked ground flaxseeds and chia seeds are particularly good sources of fibre to add to smoothies or porridge to improve constipation.

If you are increasing your fibre intake you may also need to be mindful to increase your water intake. It is also important to always increase fibre intake gradually over time or you can risk worsening constipation.

Top tip: In cases of severe constipation, make sure veg are very well cooked, and avoid very fibrous veg like celery and cabbage.

It’s also important to include healthy fats like oily fish, olive oil and avocados in the diet.

Exercise: Exercise can be a great laxative – Get your body moving every day to help get bowels moving.

Other possible drivers of constipation

Not all constipation, particularly chronic constipation, can be resolved by simply eating more fibre and drinking more water.

Constipation may have important underlying drivers that need to be addressed in order for the constipation to be resolved.

- Gut dysbiosis - Studies suggest that people with chronic constipation, both adults and children, have altered intestinal microbiota. Caesarean birth, antibiotics, poor maternal gut microbiome, and low-fibre diets may all play a role in hindering a healthy intenstinal microbiome. In particular, reduced abundance of Lactobacillus and Bifidobacterium spp., is a commonly seen driver of chronic constipation

- Small Intestinal Bacterial overgrowth (SIBO) - An overgrowth of organisms in the small intestine that produce methane is commonly associated with constipation (hydrogen producing species are associated with diarrohea)

- Parasitic infections- Dientamoeba fragilis or Blastocystis hominis are two common examples. These parasites may not cause symptoms in some people but can contribute to constipation and / or diarrhea in others.

- Food allergies or sensitivities – cow milk allergy or dairy sensitivity are common culprits, other food sensitives may also be a driver.

- Under active thyroid function (hypothyroidism)

- Celiac disease

- Hypermobility (bendy on the outside = bendy on the inside!)

- Low muscle tone / mitochondrial dysfunction

- Mast cell activation – histamine can act to slow gut motility

- Poor bile production and liver function – bile acids act as natural laxatives, promoting bowel movements by softening stool and increasing gut motility

- Stress – In some cases stress can be a driver of constipation due to its effects of delaying gastric emptying, disrupting the intestinal microbiota, and increasing intestinal permeability (widening the tight junctions in the gut lining that is intended to only allow water and nutrients from our food into the blood stream).

- Anal fissures (which can be both a cause and effect)

- Some medications

- Other organic causes include anorectal malformations, neuromuscular disease or congenital disorders such as Hirschsprung’s disease

In children, constipation tends to peak at around 2- 4 years of age which also commonly coincides with potty training. Withholding and fear of going to the toilet can contribute to constipation at this age. This fear may then continue into childhood.

Psychological factors may play a role in the onset on constipation, particularly, but not exclusively, in adolescents. Therefore, we also consider depression, anxiety, sexual abuse or the presence of an eating disorder as possible drivers.

Treatment

Laxatives are the most common treatment for constipation. However, be they pharmaceutical or herbal, they should be for short-term use only. Finding and addressing the root cause is critical with constipation. Band-aiding potential gut dysbiosis, hypotonia, parasitic infection or under active thyroid with a laxative is madness and doesn’t bode well for the progression of disease.

Long-term laxative use can also lead to the development of ‘lazy bowel’ disorders and further complications.

If you are currently dependent on laxatives we can work together to slowly and safely wean off them. Short-term supplementation with magnesium, vitamin C, pre-biotics (like PHGG) and probiotics can be helpful alongside treatments for the underlying cause. Chiropractic adjustments have also helped many children with constipation.

See link here for one of my favourite recipes for constipation and gut health - Stewed apples – plus all the research explaining why its such an amazing superfood for constipation and general gut health. It’s an interesting read!

Testing

In addition to detailed questioning and case-taking, where applicable we may recommend testing to help identify the drivers specific to your individual case.

Comprehensive Gut microbiome mapping stool test or parasitology

SIBO (small intestinal bacterial overgrowth) breath test

Allergy panels (IgE, IgA, IgG)

H.pylori stool test

Gluten sensitivity panel

Full thyroid profile (hypothyroidism)

Not only do we love talking about poop, but we love treating gut and poop issues too! We’d love to help get your bowels moving optimally! Reach out to arrange a consultation to find and treat the underlying cause(s) of your constipation.

contact us