conquering constipation - why fibre isn’t helping
Constipation is more of a big deal than you may think.
And many people think they’re bloated, when really they’re constipated!
If you aren’t having at least one full, complete bowel movement per day, you’re constipated.
It may be tempting to reach for a laxative or a natural supplement for bowel movements, but they can sometimes do more harm than good.
Why is it such a big deal and can’t you just take a laxative?
Chronic constipation creates a great deal of inflammation in your gut due to bacterial imbalances in your microbiome called dysbiosis.
Long term, this can causes other issues including:
leaky gut and food sensitivities
brain fog and mental helath concerns
weight gain or unintended weight loss
poor appetite or nausea
chronic inflammation that can lead to aches and pains, headaches and even autoimmune diseases
If you’ve gone to your doctor with constipation, odds are they simply told you drink more water and eat more fibre. Maybe they prescribed you a laxative or a drug such as Linzess.
While this may help some people, often people with chronic gut issues feel worse when trying to increase fibre, especially if it’s a lot at once.
When you use laxatives, your body becomes dependant on them. You also may end up with frequent diarrhea which can lead to a host of other problems including dehydration and many nutrient deficiencies that can cause fatigue and other health issues.
However, laxatives do have their place. If you haven’t been to the bathroom in several days, or it lasts even longer, and nothing is working, you may want to try a laxative as you risk serious health issues including fecal impaction and sepsis which can become life threatening.
There are many root causes of constipation - let’s take a look at them one by one as well as some strategies for conquering constipation without laxatives.
7 COMMON CAUSES OF CONSTIPATION
GUT BACTERIA
Your gut microbiome does many things for your body including digestion, metabolism, immune function and hormone balancing.
Unfortunately, with our modern lifestyles, the gut microbiome can easily become imbalanced. The microbiome consists of bacteria, yeasts, viruses and even parasites, but for simplicity sake we’ll refer to these microbes as bacteria.
These imbalances are collectively referred to as “dysbiosis”.
There are many types of dysbiosis including SIBO (small intestine overgrowth), infections and insuffciiency dysbiosis (not enough healthy gut bacteria).
Dysbiosis can be caused by:
poor diet: high in processed foods, low in fibre, fruits and vegetables
chronic stress
medications: antibiotics, antacids, anti-depressants, anti-histamines, painkilleres
injuries including concussions
surgeries
People with constipation tend to have dysbiosis; often an overgrowth of more inflammatory microbes such as strep or staph and a reduction in healthy bacteria such as lactobacillus and bifidobacteria.
While fibre, probiotics and fermented foods can help, for some people, this can make them feel worse, especially if they have SIBO (small intestine bacterial overgrowth), or histamine intolerance.
If someone is eating a low fibre diet, I recommend the avoid all processed foods and gradually increase low FODMAP fibre options such as oatmeal, brown rice, green beans, kiwi and berries.
Most people with chronic gut issues including constipation have some degree of dysbiosis (gut bacteria imbalance, infection or overgrowth). Dysbiosis can be addressed with a 4 step, 4R protocol.
First we remove inflammatory bacteria or microbes, optimize digestive function, heal leaky gut then restore balance to the microbiome. This can take several months, and requires a personalized protocol.
However, constipation is rarely caused by just one factor; the microbiome may be imbalanced in some people and yet they don’t develop constipation. Often there are several factors at play.
BILE
Bile is produced by your liver and stored in your gallbladder and released in response to a meal. It is needed to digest and absorb fats from your diet, but it's also pro-kinetic meaning it helps keep your bowels moving.
Many people with chronic gut issues develop gallbladder issues - often either the gallbladder isn’t ejecting the bile efficiently, or it can become thickened and sludgy and can’t be excreted into the small intestine.
Bile can be supplemented with a digestive enzyme that contains ox bile, however, it’s important to optimize bile production and flow, which we can do using a liver support supplement and digestive bitters as well as specific foods to support liver and gallbladder function.
STRESS AND NERVOUS SYSTEM
Your gut and brain are constantly communicating through several means. We used to think the nervous system was comprised of just the brain and spinal cord, but we now know that there is an enteric nervous system in your gut. In fact, there are more neurons sending signals from your gut to your brain than there is going from your brain to your gut.
One of the other ways is via the vagus nerve which connects the brain and the gut, but also wanders all throughout the body.
When the body is in a stressed or “fight or flight” state, it’s in survival mode - all unnecessary systems are taken offline - this includes digestion; it gets shut down so you can run from danger. This includes peristalsis - the wave like contractions of the intestines that help move food along.
Many of us live our lives constantly in this fight or flight state which can contribute to constipation.
I often encourage my clients to add nervous system regulation practices to shift their body out of “fight or flight” and into “ rest and digest”.
This includes deep belly breathing, meditation and yoga. Anything that allows you to feel calm, grounded and relaxed.
GUT INFLAMMATION & AUTOIMMUNITY
Up to 70% of your immune system is in your gut, and your immune system is able to release inflammatory molecules called cytokines when it’s called into action.
When theres a microbial imbalance or infection, your body kicks into action to try to get rid of it to keep you healthy, but in the process, this can release a lot of inflammation.
There are even specific microbes such as Klebsiella, Morganella and Citrobacter that can cause intestinal inflammation and increase your risk of developing an autoimmune disease.
Gut inflammation can also be caused by food sensitivities, which, ironically are caused by having leaky gut - which is often caused by inflammatory gut bacteria, but also by infections and medications such as antibiotics and painkillers.
When the gut is constantly inflamed, it narrows the lumen (the inside part of the intestines that carries waste to the colon for excretion). You may notice very narrow or pencil like stools if you have gut inflammation. Some people may even notice mucous in their stools.
This is one of the reasons that simply adding fibre or even addressing dysbiosis doesn’t always resolve constipation - we also have to manage the inflammation in order to have a healthy, full and complete bowel movement.
I support clients in managing gut inflammation by:
addressing dysbiosis
using demulcent herbs
minimizing the intake of gut irritants: caffeine, alcohol and medications, processed foods
anti-inflammatory supplements such as curcumin, quercetin and resveratrol
specific combinations of immune modulating supplements to balance the immune system response (TH1 vs. TH2 and TH17 in autoimmunity)
PELVIC INFLAMMATION & Hormones
Because the gut and the pelvic area are connected, especially in terms of microbes, any inflammation in the gut can contribute to pelvic inflammation, and vice versa.
This is especially the case in women with endometriosis in which endometrial tissue grows outside of the uterus and can twist around the intestines and contribute to constipation.
PMS
Some women find that leading up to their period, in their luteal phase, they tend to experience constipation.
This is due to the increasing levels of pelvic inflammation, which is natural, and necessary in order to have a menstrual bleed. This is caused by prostaglandins, which help you shed your uterine lining.
Progesterone is a highly anti-inflammatory hormone, but it drops off before your period.
Estrogen is a pro-kinetic hormone, meaning it helps keep you regular, but it also drops off in your luteal phase.
All of this combined can lead to increased pelvic inflammation, constipation and “bloating” premenstrually.
MENOPAUSE
In menopause, women may have issues with chronic constipation as estrogen and progesterone become chronically low, which impacts motility in the gut.
In addition, as we age, we tend to have an increase number of methanogens - those constipation-causing microbes.
While I don’t specialize in hormones, when we restore balance to the gut microbiome, optimize digestion and absorption, liver and gallbladder function and support the adrenals, this often allows hormones to come back into balance.
However, in menopause, some women may find that they need additional support from bioidentical hormones, which can be prescribed by a gynocologist or naturopathic doctor.
HASHIMOTO’S THYROIDITIS
People with long term gut issues and dysbiosis, especially those with a history of autoimmunity in their family or those that have undergone major hormone shifts (pregnancy and/or menopause) and those in larger bodies with a higher percentage of adipose tissue, especially in the midsection are at a higher risk for Hashimoto’s thyroiditis, which is on the rise in women.
This is an autoimmune condition in which your body starts attacking your thyroid gland, reducing it’s function.
Your thyroid is the master of metabolism and controls many major body functions including digestive function.
You can think of it like this, with Hashimoto’s (which can eventually lead to full blown hypothyroidism), everything slows down: brain function, energy, mood, metabolism and the gut.
This slowing down can contribute to chronic constipation.
I feel it’s important for every woman, especially those with autoimmune conditions or who have been through pregnancy or menopause, to get a full thyroid panel including not just TSH, T3 and T4, but also reverse T3, and thyroid antibodies: anti-TPO and anti-TG.
If you’ve been diagnosed with Hashimoto’s or hypothyroidism by your doctor, they may prescribe thyroid hormone such as Synthroid. While some people find this helpful, if autoimmunity is a factor, many people don’t find relief from their constipation, low mood and low energy until they address the autoimmune component.
While hypothyroidism isn’t my speciality, I support clients in reducing autoimmune function in the body and gut with:
specific supplement protocols that balance the arms of the immune system (TH1 vs TH2 vs TH17)
lifestyle recommendations
dietary changes
STRUCTURAL
There are several structural issues that can contribute to chronic constipation as well.
One of the most common ones I see in my practice is surgeries. Abdominal surgeries such as an appendectomy or C section causes scar tissue and adhesions that can impair the flow of waste through the intestines.
Osteopathic practitioners and massage therapists with specific training can be helpful in dealing with this.
There may also be issues with spinal alignment (subluxations) that impede proper nerve signalling to your gut including your large intestine and colon, slowing peristalsis and contributing to constipation. This can be remedied with regular adjustments with a chiropractor. I highly recommend Dr. Gordon McPherson-Rayner at Bruce Street Family Chiropractic.
Let’s heal your gut together.
If you’ve tried several of these approach already and you’re still struggling with chronic constipation you may need 1:1 coaching and a personalized gut healing plan.
Let’s chat - book your free Meet & Greet session so you can get clarity and determine whether we’re a good fit.
