Constipation: restoring regularity with functional medicine

Common constipation symptoms

Constipation can be functional i.e. a condition in its own right, or a symptom of a variety of other conditions e.g. IBS, SIBO and many more. Occurring at any age, constipation is more common in children and the elderly.

Slow motility, AKA the slow transit of food through the digestive system, allows for more water to be absorbed from the stool by the body, making it firmer and harder to pass. Slow motility allows the reabsorption of toxins or waste products back into the body which it is trying to eliminate, placing a greater load on the liver which can cause other health issues such as hormonal imbalances, skin issues, and brain fog. Improving motility supports healthy detoxification by the liver which supports general health.

The main symptoms of constipation are:

• Irregularity – a lack of a consistent pattern. Constipation can be acute, chronic or recurring
• Lack of frequency – regularly having no bowel movement for more than 1 day, or incomplete passing
• Difficulty/discomfort in passing a stool – straining, pain, rectal bleeding, or haemorrhoids
• Hardness of stool – small, round, very large or hard to pass stools
• Incomplete evacuation – the feeling that not all faeces were passed, needing to go back to the toilet
• Bloating, reflux, flatulence, abdominal pain and discomfort are symptoms that can accompany constipation

Many people are unaware they are constipated, having experienced what they have considered as ‘normal’ bowel movements for their entire lives. Ideally, we pass 1-2 easy bowel motions every day. Hard, firm, or difficult to pass stools, even when regular, are considered as constipation. The Bristol Stool Chart can help identify stool types, with types 1 – 2 indicating constipation and type 3 considered as tending towards constipation.

Headaches, haemorrhoids, rectal bleeding, brain fog and mood disturbances can accompany constipation. Patients who also have IBS or SIBO may also experience fluctuating diarrhoea, masking an underlying natural tendency to constipation.

Causes of constipation

Numerous factors can affect the transit time of a stool. Healthy digestion relies on all parts of the digestive system working well together, from chewing food properly, good saliva production, adequate hydrochloric acid in the stomach, and healthy digestive enzyme production, to the wave like constrictions of peristalsis moving food through the intestines.

Another stronger wave-like muscular constriction called the migrating motor complex (MMC) occurs around every 90 minutes (when we’re not eating/digesting) and is a necessary ‘cleaning cycle’ ensuring the mucosal lining is maintained, and pushes all food particles out of the small intestine into the large intestine for elimination.

The microbial species in the large intestines also seem to play a role in the movement of faecal matter through the bowel. A disturbance in any of these factors can cause constipation.

Stress and constipation

Playing an important part is the gut-brain axis, or the interaction of the nervous system and digestive system. During stress, either acute or chronic, our sympathetic nervous system slows down digestion, inhibiting production of digestive enzymes and hydrochloric acid, and processes such as peristalsis and the MMC. It does this to divert the body’s resources to respond to an emergency (real or imagined) in the fight or flight state.

Common causes of constipation can include:

• Low fibre intake
• High intake of refined carbohydrates, sugar and trans fats
• Poor hydration/inadequate water intake
• Laxative abuse/long term use
• Lack of physical activity (often due to illness, injury or travel)
• Food allergy/intolerance
• SIBO (small intestinal bacterial overgrowth)
• IBS (irritable bowel syndrome)
• Stress, anxiety, depression
• Microbiome dysbiosis, lack of diversity, species overgrowth
• Poor/sluggish liver function
• Structural abnormalities, tumours, haemorrhoids, anorectal fissures
• Hypothyroidism, diabetes, hyper/hypokaelaemia
• Pregnancy
• Medications: anti-histamines, opioids, NSAIDs, antacids, PPI’s, anticholinergics, sedatives, diuretics, calcium channel blockers, some iron or calcium supplements, narcotics, tranquilisers, sedatives and antidepressants
• Smooth muscle/connective tissue disorders e.g. scleroderma, amyloidosis
• Neurological disorders: Parkinson’s disease, dementia, cerebrovascular disorders, spinal injury, Alzheimers’ disease
• Congenital conditions: neuromuscular bowel impairment, Hirschsprung’s disease (aganglionic megacolon)
• Concern of lack of privacy when passing a bowel movement

Underlying medication conditions should first be ruled out, such as:

• Heavy metal poisoning
• Diverticular disease
• Intestinal obstruction
• Colorectal cancer
• Depression
• Thyroid disease/dysfunction
• Inflammatory bowel disease

Constipation treatment – the conventional approach

Conventional medicine treatments usually involve pharmaceutical medicines for laxation, or recommendations for over the counter laxatives from pharmacies.

Laxatives can take the form of:

• Bulking agents – which draw water into the stool, usually in the form of psyllium husk (Metamucil) or methylcellulose, with added colours and flavours
• Emollient laxatives/stool softeners – draw fats and water into the stool
• Osmotic/hyperosmolar laxatives – also draw water from surrounding tissue into the stool
• Stimulant laxatives – stimulate the lining of the gut for stool propulsion
• Prokinetics, also known as GCC receptor agonists – stimulate frequency and strength of intestinal contractions, and are generally only prescribed where other methods have been ineffective

Other treatments may include colonic irrigation and enemas. Suppositories for constipation are also used for delivering medications, particularly for children and the elderly.

These can be effective for short-term treatment and suppressing symptoms, however they don’t address the root cause and are therefore ineffective long-term solutions.

It is also possible to become reliant on laxatives for long-term use which can result in electrolyte imbalances, mineral deficiencies, dehydration, chronic constipation, and damage to nerves and muscular structure of the intestines and cardiac function.

Taking a holistic approach to constipation to address the underlying factors that contribute to the condition is a long-term and effective alternative.

Constipation – functional testing considerations

Our practitioners use state-of-the-art pathology testing in conjunction with detailed case taking involving your personal health history to determine the factors contributing to your constipation, and any other health problems you may be experiencing.

Testing might include:

• Gut microbiome testing
• Food allergy, intolerance or sensitivity testing
• Serum calcium and potassium
• Digestive function and nutrient absorption assessment
• Thyroid profile
• Cortisol awakening response to assess the stress response
• Other tests, as required for your specific symptoms

The gut is the seat of all health and so our team are all constipation specialists, versed in assisting patients with all types of digestive disorders.

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