Constipation is a condition that affects all age groups. It is the most common gastrointestinal complaint. In fact, 16 in every 100 adults have constipation, although that statistic increases to 33 out of 100 adults after age 60. While constipation can affect people of all ages and ethnicities, it is more common in older adults, non-Caucasians, and women after childbirth. Dietary factors can also make people susceptible to constipation, especially low-fiber diets and lack of hydration. Sedentary lifestyles, specific supplements, medications, and other medical conditions can cause constipation, too. Constipation can be a temporary problem, or it can be lifelong.
What is The Medical Definition of Constipation?
Constipation is a condition of the gastrointestinal tract, encompassing the following:
- Stools that are painful or difficult to pass
- Stools that are dry and hard
- Fewer than three bowels movements per week
- Not having a complete bowel movement
Common constipation symptoms include:
- Stools that are difficult to pass
- Lumpy or hard stools
- Having less than three bowel movements per week
- Feeling a blockage preventing a bowel movement
- Not having a complete bowel movement
- Needing an aid to have a bowel movement
It may be hard to communicate or identify if you have constipation if you've had the same type of bowel movements your entire life. The Bristol Stool Chart can be helpful when assessing stool and constipation.
4 Medical Conditions That Can Cause Constipation
Medical conditions that cause constipation include:
- Cancers, including rectal and colon
- Anal fissures, or tiny tears around the anus
- Rectocele, a bulge of rectal tissue into the back wall of the vagina
- Bowel obstruction, a blockage in the intestines
- Bowel stricture, a narrowing of the intestine
- Multiple sclerosis
- Parkinson's disease
- Spinal cord injuries
- Autonomic neuropathy, nerve damage causing an array of bodily functions to work improperly
- Dyssynergia, where pelvic muscles have difficulty coordinating contracting and relaxing
- Anismus, where the pelvic muscles are unable to relax
- Weak pelvic muscles
- Hormone Imbalance
Functional constipation, or constipation not caused by an underlying medical condition, may be due to the following:
- Sedentary lifestyle or lack of exercise
- Low fiber diet
- Chronic use of laxatives
- Dysbiosis, or an imbalance in the microbiome
Functional Medicine Labs to Test for Root Cause of Constipation
Comprehensive Stool Analysis
The gut microbiome is a group of collective organisms, including bacteria, viruses, and fungi, that help with digestion, hormone and immune production, and other processes. Dysbiosis, or an imbalance in the microbiome, can cause constipation. The GI-MAP test can detect dysbiosis and provide an insight into the bacteria of the microbiome, looking at both pathogenic or harmful bacteria and some microbes that are a part of the normal flora.
SIBO Breath Test
Small Intestine Bacterial Overgrowth (SIBO) is another condition involving the microbiome. It occurs when some of the microbiome microbes move into the small intestine. A small amount of these microbes can always be found in the small intestines. But, when they are present in large quantities, they can cause problems, one of which is constipation. In turn, constipation can also cause SIBO. The best way to assess SIBO is through a Breath Test, which can test various gases produced by the bacteria in the small intestine.
The thyroid gland, located in the neck, releases hormones that affect every body system. Hypothyroidism is a condition where the thyroid gland does not make enough hormones. When this occurs, GI transit can be affected, causing constipation. A Thyroid Panel can help evaluate the health and function of the thyroid.
A full hormone panel, such as the DUTCH Complete test, is beneficial when assessing constipation. Sex hormones, including progesterone and estrogen, can affect motility within the GI tract and thus influence the frequency of stools. For women, these hormones fluctuate monthly, and men have hormones that fluctuate daily. These fluctuations in hormones may cause constipation. In addition, this test shows cortisol, our body's primary stress hormone, metabolism. High levels of stress hormones can affect gut motility and the microbiome, leading to constipation.
Other Lab Test to Check
To properly assess constipation, the following labs may be recommended:
- Endoscopy, a procedure using a camera to see inside the GI tract
- Colonoscopy, a procedure to view the large intestine
- Sigmoidoscopy, a procedure to view the lower portion of the large intestine and the rectum
- Transit study, a test that assesses movement through the colon and rectum
- Radiopaque markers, x-rays that track a radioactive substance through the GI tract
- Scintigraphy, similar to a radiopaque, except small cameras and computers are used to monitor movement
- Balloon expulsion test, a test that pushes a small water balloon through the rectum and then assesses the ability to push
- Anorectal manometry, a test to evaluate anal sphincters, how sensitive the rectum is, and how it is functioning
- Defecography: X-ray of the anus and rectum to see how well stool can be held and expelled
- Lower GI series: a series of x-rays of the colon using barium, a substance that makes the colon show up clearer on x-rays
- Magnetic resonance imaging (MRI), images produced from a large magnet and radio waves
- Computed tomography (CT)
Integrative Medicine Treatment For Constipation
Nutrition and Lifestyle
Dietary fiber is a main nutritional recommendation for those with constipation. Increased fiber intake helps improve stool consistency, making it softer. It also increases the weight and size of the stool. Fruits, vegetables, whole grains, legumes, nuts, and seeds are good sources of fiber. Current data suggests the average dietary fiber intake should be 25-30g per day for optimal health. However, most Americans are only consuming about 15g per day.
Increasing water intake and exercise should also be included in every treatment plan for constipation, as both can help to alleviate it.
Complementary and Alternative Medicine
Besides increasing fiber in the diet, fiber supplements are also beneficial. The American Journal of Clinical Nutrition published a meta-analysis of randomized control trials (RCT) regarding fiber supplementation for chronic constipation. Their review of 16 RCT with over 1,200 participants concluded that fiber supplementation improved constipation. Optimal recommendations included Psyllium fiber at over 10g/day for at least four weeks.
Probiotics may also be useful supplements for the relief of constipation. In a RCT of 132 people, a combination formula including Lactobacillus and Bifidobacterium species were given at differing doses for 30 days. Both groups saw an improvement in both frequency and stool quality.
Acupressure is a physical treatment based on the belief that everyone's body has Qi or energy flow. Pressure points are found throughout the body based on energy pathways referred to as meridians. Pregnant women were instructed to do 15 minutes of self-acupressure to a specific acupressure point believed to relieve constipation. The acupressure group saw a significant improvement in bowel movement frequency compared to the control group.
If hypothyroidism is an underlying cause for your specific constipation, the addition of certain thyroid cofactors, such as vitamin A, zinc, vitamin D, omega-3 fatty acids, and selenium, may help since they are all nutrients required by the thyroid to function properly.
Adaptogenic herbs are herbs that help the body adapt to, or combat, stress. Ashwagandha, licorice root, and Rhodiola are herbs that have been shown to reduce stress and can balance stress hormone levels. Because of their ability to reduce stress, they may help with constipation.
Constipation, the most common gastrointestinal complaint, affects people of all ages and ethnicities. To get to the root cause and adequately treat constipation, it is essential to rule out other medical conditions that could be causing constipation.
For functional constipation, functional medicine testing can help to find the root cause or causes and aid in the creation of a personalized treatment plan.