Constipation is a common digestive issue that affects millions of people, often resulting in significant discomfort and reduced quality of life. In this post, we’ll explore the symptoms, potential causes, complications, and when it’s important to consult a healthcare provider.
Symptoms of Constipation
Constipation presents with symptoms that are hard to ignore, including:
Fewer than three bowel movements per week
Hard, dry, or lumpy stools
Painful or difficult stool passage
Feeling that bowel movements are incomplete
Overall reduced quality of life
These symptoms impact day-to-day well-being, making it crucial to understand the underlying causes and take proactive steps for relief. While less than 3 bowel movements per week is the true definition of constipation, less than daily bowel movements can result in negative long-term health outcomes.
Causes of Constipation
Several factors contribute to constipation, ranging from lifestyle habits to underlying health conditions:
Low Fiber Intake
Low fiber intake can lead to hard, dry stools that are challenging to pass.
Fiber Bulks and Softens: Fiber both creates bulk and softens stool, helping it move through the intestines and stimulate bowel movements.
Soluble Fiber: Found in oats and fruits. Feeds the microbiome and becomes gelatinous when the microbiome breaks it down. Soluble fiber has the added benefit of regulating blood sugar and cholesterol.
Insoluble Fiber: Primarily found in whole grains and vegetables, adds bulk but doesn’t soften stool much.
Low Hydration
Water Softens Stools: Works with fiber to make stool easier to pass.
Dehydration: Leads to hard, dry stools that are difficult to pass.
Sedentary Lifestyle
Movement Matters: Research has shown that a sedentary lifestyle is associated with increased risk of constipation.
Exercise & Gut Motility: Aerobic exercise can speed up digestive processes, making bowel movements more regular.
Medication and Supplement Side Effects
Opioids: Slow down gut motility, causing significant constipation.
PPIs: Decrease stomach acid, impairing digestion and altering gut bacteria.
Iron Supplements: Known for causing hard, dense stools.
NSAIDs and Antidepressants: Often reduce gut motility.
Other medications that can result in constipation are anti-nausea medications,
Hypochlorhydria
Low Stomach Acid: Lack of adequate stomach acid can result in poor digestion and slow motility, ultimately leading to constipation.
Some of the common underlying causes are chronic stress, advanced age, H. pylori infection, medications like PPI (acid blockers), alcohol, smoking and nutrient deficiencies (especially Zn).
Food Sensitivities
Certain food sensitivities can lead to digestive discomfort and constipation. These sensitivities cause bloating and digestive distress, slowing down bowel movements.
Common Culprits: Dairy, gluten, eggs, soy, and corn can trigger digestive issues.
IBS-C (Irritable Bowel Syndrome with Constipation)
Gut-Brain Axis: Functional constipation can be due to IBS-C, which is related to the gut-brain axis. The condition involves communication disruptions between the brain and gut, affecting bowel motility.
Intestinal Methanogen Overgrowth (IMO)
Methane-Producing Bacteria: IMO is similar to SIBO (small intestinal bacterial overgrowth) but specifically involves the overgrowth of bacteria that produce methane.
Serotonin Deficiency: Serotonin is produced in the gut in high quantities, playing an important role in gut motility. Methane reduces the amount of serotonin produces, slowing motility and causing constipation.
Hypothyroidism
Slow Motility: Low thyroid function causes slowed digestion and motility. This leads to hard and infrequent bowel movements.
Diabetes
Nerve Damage: Chronically elevated blood sugar damages nerves. Over times, this affects digestion and motility.
Gastroparesis: This is a complication of diabetes in which nerve damage results in paralysis of the stomach. The resulting slowed motility leads to constipation.
Pelvic Floor Dysfunction
Weakened or uncoordinated pelvic muscles make stool passage challenging, resulting in infrequent and/or incomplete bowel movements.
Associated Symptoms: Pelvic floor dysfunction can also cause rectal prolapse and urinary issues, like urinary retention.
Lifestyle Factors
Withholding: Ignoring the urge to defecate can result in impaction, where stool becomes too hard to pass.
Traveling: Routine changes and new environments can disrupt bowel habits.
Aging and Pregnancy: Age-related slowdowns in digestion or hormone shifts during pregnancy also impact gut motility.
Other Health Conditions
Neurological Issues: Conditions like Parkinson’s, Alzheimer's and MS (multiple sclerosis) impact nerve signaling to the digestive system.
Autoimmune Diseases: Inflammatory conditions, like lupus, scleroderma, sarcoidosis and amyloidosis, can cause constipation by affecting gut health.
Complications of Constipation
Without treatment, constipation can lead to:
Impaction: Severe blockage that may require medical intervention.
Hemorrhoids and Anal Fissures: Straining causes these painful conditions around the anus.
SIBO/IMO: Over time, constipation can lead to microbiota imbalances.
Rectal Prolapse: Persistent straining weakens the pelvic floor, causing rectal tissue to protrude.
Poor Mental Health: Constipation can be very uncomfortable and affect activities of daily living and social interactions. This, and the likely microbiome imbalances associated with constipation, can lead to mental health concerns like anxiety and depression.
Early Mortality: Less than daily bowel movements has been associated with increased risk of all-cause mortality.
When to See a Doctor
While constipation can be managed with dietary and lifestyle changes, certain symptoms warrant medical evaluation:
- Blood in stool or rectal bleeding
- Constant abdominal pain
- Inability to pass gas
- Vomiting or fever
- Unexplained weight loss
- Lower back pain
Regular bowel movements are key to digestive health. If you’re experiencing chronic constipation, addressing diet, hydration, and exercise may provide relief, but professional support can help in persistent cases.
Disclaimer
The information provided in this blog and throughout the website is intended for educational purposes only and should not be considered, or used as a substitute for, medical advice. The content is not meant to diagnose, treat, or cure any medical condition. This blog does not constitute the practice of any medical, nursing or other professional health care advice, diagnosis or treatment. Always consult with a qualified healthcare provider before making any changes to your health regimen or starting new treatments, and never disregard professional medical advice or delay seeking care because of something that you have read on this blog, website or in any linked materials. Your individual needs and circumstances should be evaluated by a medical professional to ensure safe and appropriate care. If you are experiencing a medical emergency, please call 911 or call for emergency medical help on the nearest telephone immediately.
References
“Constipation: Symptoms & Causes.” Accessed November 14, 2024. https://my.clevelandclinic.org/health/diseases/4059-constipation.
“Pelvic Floor Symptom Related Distress in Chronic Constipation Correlates With a Diagnosis of Irritable Bowel Syndrome With Constipation and Constipation Severity but Not Pelvic Floor Dyssynergia - PMC.” Accessed November 7, 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC6326213/.
Peng, Xinwei, Jibin Li, Yuwan Wu, Hongji Dai, Henry S. Lynn, and Xi Zhang. “Association of Stool Frequency and Consistency with the Risk of All-Cause and Cause-Specific Mortality among U.S. Adults: Results from NHANES 2005–2010.” Healthcare 11, no. 1 (December 22, 2022): 29. https://doi.org/10.3390/healthcare11010029.
Wilson, Patrick B. “Associations between Physical Activity and Constipation in Adult Americans: Results from the National Health and Nutrition Examination Survey.” Neurogastroenterology and Motility 32, no. 5 (May 2020): e13789. https://doi.org/10.1111/nmo.13789.