As a society, we rarely talk about our bowel habits. Even the mention of it can cause people to blush with embarrassment or make them attempt to divert the conversation in another direction.
However, apart from the social discomfort that it can bring the physical discomfort of altered bowel habits is also an issue for many. IBS, heaviness, bloating, sluggishness and even migraines, joint pain and brain fog can all stem from slow bowel movements.
It is important to systematically work through the most common causes of constipation before delving deeper into the less common causes. The simple suggestions are important to set a firm foundation for gut health and improving symptoms of IBS and constipation.
What is constipation?
Using the ROME IV criteria, constipation can be classified using a specific checklist.
For a diagnosis of constipation, 2 or more of the following need to be present.
- Straining during more than ¼ (25%) of defecations
- Lumpy or hard stools (Bristol Stool Form Scale 1-2) more than ¼ (25%) of defecations
- The sensation of incomplete evacuation for more than ¼ (25%) of defecations
- The sensation of anorectal obstruction/blockage of more than ¼ (25%) of defecations
- Manual manoeuvres to facilitate more than ¼ (25%) of defecations (e.g., digital evacuation, support of the pelvic floor)
- Fewer than three spontaneous bowel movements per week
- Loose stools are rarely present without the use of laxatives
- Insufficient criteria for irritable bowel syndrome.
These 8 points for constipation describe the various aspects that can be present with slow bowel movements and constipation.
These points can still be considered symptoms rather than causes. This means, that even if these constipation symptoms are present the important question is why are they happening?
Is constipation the same as IBS?
While there may be similar underlying reasons for both constipation and IBS, the gut symptom of constipation alone is not enough to be classified as IBS.
This is due to IBS requiring not only changes in stool form or frequency, but importantly a symptom that has to be present for IBS to be diagnosed is abdominal pain.
While constipation may lead to discomfort, if slow bowel movements are present without pain it will likely be diagnosed as functional constipation and not IBS.
Many of the approaches that can be taken to identify and address the underlying issues of constipation are similar to what can be used in IBS patients.
What causes constipation?
Constipation is a digestive symptom but this symptom alone does not tell us why it’s taking place. Diving deeper, there can be several possible reasons for constipation and gut symptoms.
Certain approaches can be helpful to manage the symptoms of constipation (such as laxatives and stool softeners) however, to resolve constipation the root causes may need to be considered.
Constipation can be divided into 3 sub-types. This does not mean that the symptoms for each type of constipation are different from each other. However, it does mean that these 3 categories of constipation can help to understand the causes of constipation and how best to resolve it.
There are 3 main categories of constipation:
- Primary – no presence of underlying medical issue and responds well to simple dietary and lifestyle adjustments.
- Secondary – as a consequence of certain conditions such as; gut imbalances, diabetes or hypothyroidism.
- Latrogenic –constipation is the result of side effects caused by medication
For each category of constipation, they may be a different approach to using the right tools to get the bowels moving again.
Can medications cause constipation?
Medications can be an important medical intervention for many health conditions. However, they are not without side effects.
One of these side effects can be the impact on the gut in the form of constipation.
- Narcotic pain medications (e.g codeine, morphine)
- Iron supplements (Ferrous fumarate)
- Antacids that contain calcium (e.g. Maalox) or aluminium (e.g. Mylanta)
- Some anti-depressants (e.g. Sertraline)
- Calcium channel blocker medication used to treat high blood pressure and heart disease (e.g. Adalat)
- Some diuretic medications (e.g. chlorthalidone)
- Medications used to treat Parkinson’s disease (e.g. Sinemet)
Pain-killing medications such as morphine can lead to constipation due to their impact on water absorption. The use of this medication increases water absorption for the large intestine, drying out the stool and making it harder to pass.
Also, iron supplements in the form of Ferrous fumarate also commonly lead to slow bowel movements. This can be due to only a small amount of the iron being absorbed with the raining amount left if the gut then impacting digestive function.
Is constipation bad?
Once the stool reaches the large intestines the final stages of water absorption are carried out along with electrolytes and vitamin K. However, if the stool remains in the gut for a prolonged period of time toxins and excreted hormones will also be reabsorbed back into circulation. This places the burden back on the liver to reprocess them for elimination where they go back into the colon – only to be reabsorbed again. Round and round they go.
Chronic constipation also increases the risk of colorectal cancer which is part of the reason why a high-fibre diet is suggested to keep things moving and therefore decrease the risk. So, what if just adding extra fibre doesn’t work? In some cases, it may even make things worse.
While laxatives may seem like the only option it’s important to understand that long-term use can result in higher doses being required to have the desired effect which can then lead to poor muscle tone in the colon.
How do I get rid of constipation fast?
There are many approaches that can be considered to get rid of constipation quickly. Not all of these are suitable for everyone and get depend on factors such as medications and if IBS is also present. These approaches include senna, magnesium and lactulose.
There are several ways to get the bowel moving quickly which can be important to improve symptoms of discomfort. Alongside this, it’s important that the root cause is also identified and addressed. This prevents the need for the long-term use of laxatives, which are a tool to manage symptoms.
How do I take senna for constipation?
Senna is a herb that can support bowel movements and is classed as a stimulant laxative. This means it stimulates or activates the muscles in the bowel to help improve constipation. Senna is available in various forms such as tablets, syrup as well as a tea all of which can be considered for constipation.
For most, senna can take 8 hours to work so it is generally taken at bedtime, with a bowel movement the following morning.
Senna, if taken in too high a dose may lead to discomfort or griping pain. While this may only last for a short time if new to using senna for constipation starting with a low dose is often advised.
For senna tables and syrup:
- adults and children aged 12 years and over – 1 or 2 tablets (7.5mg or 15mg) at bedtime (or 1 tablet of Senokot Max Strength)
- adults and children aged 12 years and over – one or two 5ml spoonfuls (7.5mg or 15mg) of syrup at bedtime
How do I take magnesium for constipation?
Magnesium is a mineral that is essential for human health. This mineral is absorbed within the digestive tract and then taken into circulation to support many areas of biology such as muscle and nerve function as well as energy production. It can also be used to support constipation.
When taken at low doses, magnesium is absorbed into the body and does not impact gut health. However, when taken at sufficient doses it stops being absorbed and has a stool-softening effect.
Magnesium is classed as an osmotic laxative which is due to its ability to draw water into the gut. This increase in water in the gut softens the stool and makes it easier to page.
The dose for magnesium is individual, so start with a low dose and increase the dosage as needed. This is generally best approached by starting with a low dose of between 100-200mg of magnesium citrate or oxide, an increase over a period of time until a bowel movement is achieved.
This can be done by either taking another dose every hour or taking just before bedtime and increasing it each evening. The maximum dose is considered to be 2g/2000mg per day, however, a bowel movement if often achieved at under 1g/1000mg of magnesium.
Can I keep taking laxatives for constipation?
Laxatives can be a very helpful tool to keep the bowels moving in the short term. However, the long-term use of laxatives may have consequences, both in the short term and potentially the long these.
These can include:
- Constipation
- Dehydration
- Electrolyte imbalances
Constipation. Long-term laxative use for constipation can impact the nerves and the muscles in the intestines. This means that the bowel may become dilated and the muscles no longer function as though should to push out a stool. This can lead to a dependency on the laxatives and as the bowel becomes less strong, high and higher doses are required.
Dehydration. Laxative use can lead to loose bowel movements which may be similar to diarrhoea. This can lead to an increased amount of water being lost through bowel movements which may lead to dehydration. This may be seen in symptoms such as thirst, decreased urination, headache, light-headedness, diminished sweating, dry mouth and weakness.
Electrolyte abnormalities. Along with the water lost through looser bowel movements, electrolytes are also excreted at higher rates. These are minerals such as sodium, potassium, and chloride and low levels may lead to weakness and irregular heartbeats.
As mentioned, short-term us of laxatives is safe for most but their long-term use is something to approach with caution.
Does methane cause constipation?
Imbalances in the gut microbiome can lead to increased levels of certain bacteria and other organisms. These imbalances (term dysbiosis) have been linked to a range of gut symptoms such as constipation, bloating and IBS.
Elevations in certain organisms (known as archaea) may play a role in constipation. This is due to these organisms’ producing methane, a gas that has been shown to impact gut health and slow muscle contractions, leading to constipation.
Methane levels can be assessed, via a SIBO breath test. Elevated levels of methane in these breath samples can indicate high levels of methane being produced in the gut. This is commonly referred to as IMO (intestinal methane overgrowth).
Can stress causes constipation?
There are only 2 parts of the digestive process that we consciously control – chewing and swallowing. It is important that we thoroughly chew out food properly. Eating in a relaxed environment is also paramount as activation of the fight or flight arm of the central nervous system.
Evolutionary, the fight or flight arm of the central nervous system (parasympathetic activation) was activated during periods of stress, think being chased by a lion, in these situations digestion isn’t at the top of the list so blood is directed to skeletal muscle to power the getaway from the threat and the release of digestive enzymes is suppressed.
Chronic (long-term) stress will also wreak havoc on the gut wall increasing undesirable permeability which can also result in immune imbalances and may worsen constipation-type symptoms.
How to go to the toilet naturally
Public toilets or going to the loo at social gatherings can make some people nervous and they withhold the bowel movement and suppress the urge.
If the stool is withheld for a prolonged period of time the urge with pass, the stool will impact the bowel, more water will be reabsorbed and the stool will be even harder to pass. This impaction may require the one-off use of a laxative to get things moving.
Is there good exercise for constipation?
In addition to the benefit, exercise has on our entire body it can also help to stimulate colonic muscle activity. Also, it can help to reduce stress thus sending us from the “fight or flight” part of the nervous system and into to the “rest and digest”.
While there isn’t a specific exercise for constipation movement such as running or cycling can support bowel movements as they interact with the bowel abdominal region.
Should I eat regularly for constipation?
Grazing may result in slower bowel movements as it is the distention in the stomach from a significant meal that stimulates the peristaltic waves down the digestive tract. Smaller, frequent meals do not activate this motor response in the gut which results in slower movement down the digestive tract.
Also, grazers are also more likely to have a more eating episode throughout the day which can interrupt a mechanism known as the migrating motor complex (MMC). The role of the MMC is to act as a sweeping mechanism to push removing debris and dead bacteria from the small intestine.
While eating and food are crucial for human health, time away from food allows the gut to reset. This can be as simple as leaving 4 hours between eating events as well as leaving 4 hours from the last meal until bedtime.
Insufficient water or fibre (soluble or insoluble)
Soluble fibre can bulk up the stool; and soften it so it’s easier to pass while insoluble fibre helps to move it along. If you are suffering from other IBS symptoms (bloating, distention) fibre may not be the best option and a Low FODMAP diet may be a more suitable approach.
One option would be psyllium husks (which contain both types of fibre) slowly increasing by 1 teaspoon every few days. Make sure 6+ glasses of water are being consumed first. 1 – 2 tablespoons of ground flaxseeds can also provide gentle relief.
Soluble fibre
- Oats
- Peas
- Beans
- Apples
- Citrus fruits
- Carrots
- Barley
- Psyllium
Insoluble
- Seeds (ground flax seeds)
- Kiwi (with the skin)
- Whole-wheat flour
- Wheat bran
- Nuts
- Beans
- Cauliflower
- Green beans
- Potatoes
What is the best toilet position for constipation?
Squatting is the most natural position to pass a stool as it allows the colon to fully release. Squatting is the way humans have evolved to pass a stool and in many traditional cultures, this is still the norm.
With the invention of the seated toilet, this had changed and may have impacted the ability for a complete bowel movement.
There are footstools on the market (eg the squatty potty) that simulated this position. This is placed under the feel whilst seated on the toilet and raises the knees above the hips.
Conclusion
As with all gut issues, it’s important to differentiate between symptoms and causes. While constipation is a common gut symptom, understanding the actual cause of this is important to address the underlying issue and prevent long-term constipation as well as the long-term use of laxatives.
Working with a gut health specialist can help identify the underlying issue and help resolve symptoms for good.
