Constipation includes the slow, incomplete, or difficult movement of stool from the gastrointestinal tract. In plain language, it means that you’re not able to poop as often as you’d like or need to to feel healthy.
Constipation affects an estimated 30% of people each year. It can cause abdominal discomfort, bloating, irritable mood, pain, and even more severe medical conditions like fecal impaction or incontinence. Thankfully, a functional medicine approach offers several effective treatment options for relieving constipation naturally.
Signs & Symptoms of Constipation
According to the NIDDK, symptoms of constipation can include:
- Fewer than three bowel movements a week
- Stools that are hard, dry, or lumpy
- Stools that are difficult or painful to pass
- A feeling that not all stool has passed
A typical person with constipation reports that they only have a bowel movement 1-3 times per week. When they have a bowel movement, they may have to strain to move stool out of the rectum. Others report that even after they go to the bathroom, they don’t feel “empty.” Children with constipation can have difficulty with potty training and may present with bloating and irritability.
Possible Root Causes of Constipation
Possible causes of constipation vary from person to person and include
- Anatomical issues include pelvic floor dysfunction.
- Intestinal nervous system disorders prevent the gut from getting signals from the nerves and brain.
- Pharmaceutical medications like certain antidepressants, pain relievers, and more.
- Toxicities of metals like lead or vitamins and minerals like vitamin D and calcium can slow or stop bowel movements.
- Nutrient deficiencies of fiber, potassium, magnesium, or vitamins C and E.
- Endocrine disorders like hypothyroidism and diabetes.
- Autoimmune disorders like scleroderma and celiac disease or other diseases.
- Food Allergies.
- Functional disorders like IBS and behavioral disorders.
Anatomical and Pelvic Floor Disorders
Muscles control the movement of stool out of the rectum. If those muscles are too tight, too loose, or unable to contract or relax appropriately due to nervous system or skeletal issues, constipation can occur. Many women report problems with defecation during pregnancy and after giving birth.
Hypothyroidism - a disorder where the thyroid gland does not produce enough thyroid hormone to regulate cellular metabolism - can cause slowed gastrointestinal motility and constipation. Diabetes can also contribute to constipation by affecting how the brain signals the gut through nerves.
Medications and Medical Conditions
Anticholinergics and pain medications are famous forms of drugs that have a side effect of constipation, as are medications for neurological disorders like Parkinson’s disease. Many of these drugs slow motility (the regular contraction of colonic musculature that helps move bulk and stool through the intestines). Other medications can cause constipation by altering electrolyte balance in the gut.
Several nutrient deficiencies are linked with constipation in the medical literature, including
- Vitamin C is present in foods like oranges and red peppers. Vitamin C is a laxative when used in large doses, and there’s evidence that it can address the oxidative stress that can play a role in constipation.
- Vitamin E is present in high amounts in foods like sunflower seeds. Vitamin E, like vitamin C, is also an antioxidant.
- Magnesium is present in foods like pumpkin seeds and chia seeds. Magnesium has a laxative effect when used in large doses as it helps to stimulate peristalsis through its osmotic effect across colonic membranes.
- Potassium is present in high amounts in foods like apricots and lentils. Hypokalemia (or low potassium) can impair gastric motility and even paralysis.
- Fiber is present in high amounts in prunes, figs, nuts, seeds, and other fruits and vegetables.
Nutrient deficiencies are common even in normal and overweight adults; 6% of the U.S. population - for example - is deficient in vitamin C. Inadequate intake of fiber is also common. Most medical associations recommend that adults consume 25-38 grams of fiber per day to maintain a healthy gastrointestinal tract and prevent constipation, but the average American adult consumes only 8-12 grams per day – less than half of what’s needed!
Nutrient or Mineral Excesses
Getting too many micronutrients is not a good thing, either! Evidence suggests that excess iron, vitamin D, and calcium can cause constipation. Additionally, excess metals like lead can result in constipation.
Food Allergies & Sensitivities
Food allergies to substances like casein (found in cow dairy products) have been extensively linked with constipation, as have certain types of food intolerances like celiac disease.
Lastly, constipation with no other known cause is generally referred to as functional constipation. It can be caused by lifestyle factors such as dehydration, stress, a low fiber diet, and more. Commonly, lifestyle interventions help resolve this type of constipation.
Functional Medicine Labs to Find the Root Causes of Constipation
Your doctor is the best person to help you determine which of the above causes of constipation could be causing your issue.
If they suspect you have a nutrient deficiency, they can run blood tests to determine which ones may be affecting you. Even a standard CBC and CMP that your doctor runs every year at your check-up can detect some B vitamin and iron deficiencies.
Additionally, a trained practitioner can help you evaluate your diet to see if your typical eating pattern has nutrient gaps that may be affecting your ability to have regular bowel movements. Here is an excellent example of a case study on a functional medicine approach to constipation.
To detect heavy metal abnormalities, practitioners can check hair, blood, and urine to ensure none are above the reference range. If findings are normal, but you still suspect you may have heavy metal toxicity, you can do a provocation challenge test, where you take a small dose of a heavy metal chelator and then check how much of that metal is excreted into the urine.
Food Allergies & Sensitivities
When assessing food allergies & sensitivities, there are many blood draw collection kits that your practitioner can use to find the foods you may be reacting to. Note: for food sensitivities - The suspected food must have been consumed in the last two weeks (preferably three days) for your body to make enough immunoglobulins to detect a reaction. Ask your practitioner for more information if you’re confused about this.
With The Dutch Plus Test, your practitioner can measure various sex hormones in the urine and saliva, including progesterone, testosterone, DHEA, cortisol, and estrogen. A Complete Thyroid Panel should include at least TSH, Free T4, Free T3, and Reverse T3 to get a comprehensive overview of how well the thyroid is functioning.
If your doctor suspects you have an anatomic or pelvic floor issue, they may refer you to a specialist, including a physical therapist, pelvic floor physical therapist, or a gastroenterologist, for more workup and a prescription plan to correct any imbalances that they find. I recommend pelvic floor therapy for pretty much all of my new moms, as it can be very helpful in healing postpartum issues quickly!
Functional Medicine Treatments for Constipation
A Functional Medicine Treatment for Constipation
The treatment for your unique form of constipation will determine your root cause.
If you have a nutrient deficiency, your practitioner will help you design either a food-as-medicine plan or prescribe a supplement to help replete you and fix your constipation.
Commonly prescribed supplements for constipation include magnesium, vitamin c, trace minerals, and, less commonly, potassium since it has to be used in small doses to avoid interactions.
Your practitioner should also work closely with you to ensure you get enough fiber, minerals, and fluids, which also help address constipation. Some fun ways to do this are to create drinkable meals like smoothies, add sparking or fizzy water if you need help making hydration more interesting, or consume liquid dinners like soups.
If you’re deficient in a mineral, your practitioner may prescribe liquid mineral supplements that can easily be added to your daily water intake.
If you have a food allergy, it pays to see a nutrition expert so they can develop a nutrition plan that allows you to avoid the foods you’re intolerant to while still ensuring that you get great nutrition.
Biofeedback and acupuncture are effective treatments for constipation and are worth considering, especially if you want to try a lifestyle-based intervention that doesn’t require pills or significant dietary change. Bonus - they also help increase mindfulness and overall well-being and heal constipation.
If your issue is hormonal, your clinician will prescribe hormone replacement or work to eliminate the barriers to normal hormone production using a combination of lifestyle, nutrients, herbs, and even pharmaceuticals.
Thyroid hormones supplementation can profoundly affect the side effects caused by hypothyroidism like constipation, weight gain, depression, hair loss, and more.
If your issue is functional constipation, your doctor may recommend a bowel retraining program. Bowel retraining programs are designed to recondition your gastrointestinal system to have a bowel movement at the same time each day using habits, cues, hydration, eating, and other habits. These retraining programs are wildly successful for many of my clients.
You’re not stuck with constipation! There are many options for treating it. Working with an integrative practitioner can help you narrow down your root cause.
Articles That May Interest You
Lab Tests in This Article
- Symptoms & Causes of Constipation. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/symptoms-causes
- Diaz S, Bittar K, Mendez MD. Constipation. Nih.gov. https://www.ncbi.nlm.nih.gov/books/NBK513291/
- Bouras E, Vazquez-Roque M. Epidemiology and management of chronic constipation in elderly patients. Clinical Interventions in Aging. Published online June 2015:919. doi:10.2147/cia.s54304
- Zhou JF. Potential oxidative stress in children with chronic constipation. World Journal of Gastroenterology. 2005;11(3):368. doi:10.3748/wjg.v11.i3.368
- Tsuji. Effectiveness and safety of a new regimen of polyethylene glycol plus ascorbic acid for same-day bowel cleansing in constipated patients. Acta gastro-enterologica Belgica. 2018;81(4). https://pubmed.ncbi.nlm.nih.gov/30645916/
- Morishita D, Tomita T, Mori S, et al. Senna Versus Magnesium Oxide for the Treatment of Chronic Constipation: A Randomized, Placebo-Controlled Trial. American Journal of Gastroenterology. 2020;116(1):152-161. doi:10.14309/ajg.0000000000000942
- Kinnunen O, Salokannel J. Comparison of the Effects of Magnesium Hydroxide and a Bulk Laxative on Lipids, Carbohydrates, Vitamins A and E, and Minerals in Geriatric Hospital Patients in the Treatment of Constipation. Journal of International Medical Research. 1989;17(5):442-454. doi:10.1177/030006058901700506
- Weir MR, Espaillat R. Clinical perspectives on the rationale for potassium supplementation. Postgraduate Medicine. 2015;127(5):539-548. doi:10.1080/00325481.2015.1045814
- Yang J. Effect of dietary fiber on constipation: A meta analysis. World Journal of Gastroenterology. 2012;18(48):7378. doi:10.3748/wjg.v18.i48.7378
- Morais MB, Vítolo MR, Aguirre ANC, Fagundes-Neto U. Measurement of Low Dietary Fiber Intake As a Risk Factor for Chronic Constipation in Children. Journal of Pediatric Gastroenterology and Nutrition. 1999;29(2):132-135. doi:10.1097/00005176-199908000-00007
- UpToDate. Uptodate.com. Published 2022. https://www.uptodate.com/contents/manifestations-of-hyponatremia-and-hypernatremia-in-adults?search=hyponatremia&source=search_result&selectedTitle=6~150&usage_type=default&display_rank=4
- Kucharska A, Szmurło A, Sińska B. Significance of diet in treated and untreated acne vulgaris. Advances in Dermatology and Allergology. 2016;2:81-86. doi:10.5114/ada.2016.59146
- Kardalas E, Paschou SA, Anagnostis P, Muscogiuri G, Siasos G, Vryonidou A. Hypokalemia: a clinical update. Endocrine Connections. 2018;7(4):R135-R146. doi:10.1530/ec-18-0109
- Mohammadi. Effect of Cow’s-milk-free diet on chronic constipation in children; A randomized clinical trial. Caspian journal of internal medicine. 2021;12(1). doi:10.22088/cjim.12.1.91
- Liu Z, Yan S, Wu J, et al. Acupuncture for Chronic Severe Functional Constipation. Annals of Internal Medicine. Published online September 13, 2016. doi:10.7326/m15-3118
- Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead WE. Randomized, Controlled Trial Shows Biofeedback to be Superior to Alternative Treatments for Patients with Pelvic Floor Dyssynergia-Type Constipation. Diseases of the Colon & Rectum. 2007;50(4):428-441. doi:10.1007/s10350-006-0814-9
- Management of Chronic Constipation. Uptodate.com. Published 2022. https://www.uptodate.com/contents/management-of-chronic-constipation-in-adults?search=constipation&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
- Shin GH, Toto EL, Schey R. Pregnancy and Postpartum Bowel Changes: Constipation and Fecal Incontinence. American Journal of Gastroenterology. 2015;110(4):521-529. doi:10.1038/ajg.2015.76