Constipation Isn't Always About Fibre: Common Causes and What else to Consider

If you're constantly feeling bloated, straining to go to the toilet or never quite feel empty after a bowel motion, you're certainly not alone.

Constipation is one of the most common concerns I see in clinic. While it can seem like a simple issue, there are actually many different reasons why it happens.

Understanding what's driving it is often the first step towards improving it.

Constipation by medical definition is having fewer than three bowel movements per week, or experiencing difficult, painful, or incomplete passage of stool 25% or more of the time. When I assess bowel habits, I'm looking for what's optimal, not just what's considered "normal". For example you could be going daily but if you are feeling in complete every day, straining or passing “rabbit pellets” then I still consider that constipation even when you are going every day.

So what is considered optimal bowel motions (from my perspective)?

As a gut health naturopath my view is that your gut plays an important role in many aspects of health. If your gut is happy then you have a better chance of the rest of your body, health and brain being happy too. So I want it to be optimal. Optimal bowel motions are:

• Every day

• Easy to pass (no straining)

• Formed

• Mostly smooth sausage shaped

• Feeling empty

• No pain

Why is this important?

Your bowels are an important part of your detoxification system. It is one of the main ways your body eliminates waste products that have already been processed by the liver. Regular bowel motions help remove these compounds from the body. If you are not emptying (properly) every day you are missing an important part of the chain and holding on to:

• waste

• hormones

• toxins

• cholesterol

And if your bowels are slow transit or really not moving much at all, that stool that is sitting there can lead to:

• Bacterial imbalances

• SIBO

• Inflammation

• Poor gut lining integrity

• Metabolic issues like high cholesterol, poor blood sugar regulation and poor weight management.

• Skin issues - acne, psoriasis, eczema etc.

So what might be causing your constipation?

Constipation, incomplete emptying and slow transit time can have many causes and can vary between benign and self-limiting to more serious.

Diet and lifestyle causes of constipation

Simply not having enough fibre, water and movement can contribute to constipation. Often patients will say to me they are fine as long as they keep up their water, or they notice they get constipated when they don’t have enough fruit and vegetables.

Most of the time this is the first port of call. If you don’t have these foundations right then they need to be addressed first.

Please note: Certain bacterial imbalances (like SIBO) or chronic prolonged constipation (eg not having a motion for 3-4 days) may make it difficult to get more fibre in and in cases like that the bacterial imbalances may need to be addressed first. This is why it is important for an individualised approach.

Microbiome Imbalances:

Well I already touched on one common culprit - Methane Dominant SIBO or what is now more accurately called Intestinal Methanogen Overgrowth (IMO).

A methanogen is a type microorganism called archaea that produce methane gas as part of their life cycle. They are an important part of the ecosystem but when they overgrow they can cause constipation. Methane slows the movement of the bowel by affecting the nerves that control gut motility. This can become a bit of vicious cycle as slow motility increases the overgrowth which then slows motility further.

On the flip side of that, not having enough beneficial bacterial species can worsen constipation. Beneficial bacteria help produce substances that nourish the gut lining, support communication between the gut and brain and help keep the bowels moving.

Medications + Supplements that may contribute to constipation

There are common medications that can alter bowel motility. Some anti-depressants, blood pressure medications, pain killers and iron supplements can increase chances of constipation. This may be from effects on the neurotransmitters that affect motility, or indirectly by reducing appetite and thirst reducing intake of fibre and water.

Medical Conditions / Structural Issues / Pelvic Floor Dysfunction

These are the type of things that need a multi-disciplinary approach working alongside GPs, pelvic floor physios and specialists like gastroenterologists, endocrinologists and neurologists.

Medical conditions that effect nerves and hormones such as Parkinson’s disease, Diabetes and hypothyroidism can contribute to constipation.

Structural issues like changes to the muscles or tissue of the gastrointestinal tract, blockages and pelvic floor dysfunction can cause or contribute to constipation.

Can stress cause constipation?

When you are stressed your body is not focusing on digestion or having a bowel motion, because lets face it when you are in fight or flight survival mode your body is just trying to survive! When you are stressed blood is diverted away from the digestive tract so it can be used for more important things like running away! This reduction in blood flow decreases digestive function and slows gut motility. Remember when you are in flight or flight, you are not in rest and digest.

When should you see a healthcare practitioner about constipation?

If you have any of the following symptoms then it is important you check in with your GP.

• if you see blood in your stool or when you wipe

• weight loss

• sudden changes in bowel motility

• severe pain

• unable to pass gas

Constipation is common, but it isn't something you simply have to live with. Understanding what's contributing to your symptoms is the first step towards finding an approach that's right for you.

If you'd like to know whether naturopathy might be the right fit, I offer a free discovery call where we can chat about the process and answer any questions you have. (Please note that individual health advice is not provided during this call.)

Lisa x

Book a gut health consultation to uncover what’s really driving your symptoms and start feeling comfortable in your body again.

Disclaimer: The information in this blog is for general educational purposes only and is not intended to replace individual medical or naturopathic advice. Please consult your healthcare practitioner before making changes to your diet, lifestyle, or supplements.