Intuitive Health: Constipation
Common problem: Constipation
When bowels get blocked, it is arguably one of the more uncomfortable digestive situations in the human body given it's ricochet effect on our structure (read: back or pelvic pain), and mood. Constipation affects about 15-25% of the population at any given time. If you’re having trouble with elimination, know that you are certainly not alone.
Before we begin, it’s important to state that despite it's common occurrence, constipation is not normal. It can be extremely disruptive to daily life and should not be accepted as "just the way you are". There are a variety of things that can cause bowels to block up, but there is always a solution.
You’re suffering from constipation when:
- You have less than 3 bowel movements per week OR
- When 25% of bowel movements are associated with at least two of the following symptoms: straining, hard or lumpy stools, a sense of incomplete evacuation, a sense of anorectal obstruction or the need for manual manoeuvres of removal.
If your bowels are rarely uncomfortable and you’re defecating between 3 times per day and 3 times per week, constipation is not a concern.
Common misconceptions:
- Laxatives are an acceptable solution (they are not, more below)
- More fibre is always the answer (it can make things worse, more below)
Identifying the cause
Medical conditions
First and foremost, constipation can occur as a symptom of medical conditions, from digestive disorders like Crohn’s, IBS and diverticulosis, to others such as diabetes, Parkinson’s, or cancer. If you suffer from one of these conditions (or think you might be), please consult a medical professional for proper treatment and lifestyle recommendations.
Drugs/medications
Most drugs, both prescription and over-the-counter, cause constipation to a certain degree. Though there is a time and place for medication (and usage should always be discussed with your GP), it is good to be aware that the following pills can contribute to constipation:
- NSAIDS (Ibuprofen, Motrin, Aleve, etc.) These are the main offenders because people abuse them so regularly. The side-effects outweigh the benefits of taking NSAIDs in the vast majority of cases.
- Antidepressants (Prozac, Elavil, etc.)
- Opioids (Morphine, OxyContin, Vicodin, etc.)
- Anticholinergics/Antihistamines (Benadryl, Claritin, Ditropan XL, etc.)
- Calcium supplements
- Iron supplements
- Antacids
- Laxatives (more below)
Laxative abuse
While laxatives resolve the symptom of constipation, they exacerbate the cause of constipation. Without addressing the underlying cause, normal bowel movements will become harder and harder to achieve each time a laxative is used (a stronger purge will be needed every time). Laxative abuse results in forced diarrhea and electrolyte imbalances, leading to impaired intestinal function in the long run or, at worst, liver failure. Laxatives also clear out good gut bacteria, which leads to...
Dysbiosis
As mentioned in our post on bloating, Dysbiosis refers to an overgrowth of bad gut bacteria. The relationship between dysbiosis and constipation is poorly understood, but studies show that dysfunctional gut flora does contribute to constipation. Gut dysbiosis is often the result of a poor diet, sedentary lifestyle, excessive stress and/or laxative abuse, so if you address the root cause(s) of the issue, you’ll likely increase gut health and resolve constipation in one fell swoop.
Dehydration
Proper hydration is required to prevent stools from becoming too hard to effectively pass through the gastrointestinal system. If you consume less than 1L of water per day, this can contribute to constipation.
Fibre in the diet
While it is commonly believed that increasing dietary fibre is one of the keys to resolving constipation, sometimes reducing dietary fibre is the answer. Fibre is important for forming fecal bulk, but when the issue is that there is already enough fecal bulk stuck in the digestive system, adding more will only make things worse.
A lack of dietary fibre can absolutely contribute to constipation in some people, but increasing fibre in an already rich diet should not be the knee-jerk solution.
Sedentary lifestyle
The human body was designed to move. When physical activity decreases, bowel frequency decreases over time as well: compression of all the structural tissues around your bowels as Jackie discussed in Part 1 is a common occurrence for those at desk jobs in particular. Move daily in order to bowel-move daily.
Sleep impairment
Not many think about sleep quality when it comes to constipation, but studies have shown that shift workers and those with disturbed sleep tend to encounter more prevalent symptoms of constipation. Gastric emptying is a complex process regulated in part by hormones and stress (as noted below), both of which are directly impacted by shift work.
Pooping posture/process
There are 2 major red flags that can cause poor bowel evacuation over time:
- Sitting on the toilet for extended periods of time. If you take more than a few minutes to go poop- even if you're not straining- sitting there puts increased pressure on your rectum.
- If you sit instead of squat (if your knees are in line with or lower than your hips), you cannot achieve full elimination.
Back Pain
Experienced by a reported 70-80% of our population, back pain is frequently associated with constipation due to the close interaction of structures and nerves. Constipation can create abdominal pressure and bloat, thus contributing to lower back pain or pressure and mild inflammation through all tissues. In more severe cases, herniations or spinal cord injuries can result in functional changes to bowels or bladder due to nerve damage (unfortunately exacerbated by some medications such as opiates), all of which are symptoms monitored by primary health care practitioners.
Stress & anxiety
As mentioned in our post on bloating, there is a tight connection between the gut and the brain. Research shows that 25-50% of people with constipation demonstrate symptoms of depression or anxiety. The neurotransmitters that the brain releases during stressful situations also interact directly with receptors in the colon wall, so if you’re stressed, you’re unlikely to defecate.
Psycho-emotional
When looking into the emotional and psychological aspects of certain conditions, taking a step back to look at the bigger picture provides better insight.
Patterns of constipation can develop from a very young age or manifest throughout adulthood. If you were from a big family and there was only one bathroom, did you perfect the art of “holding it”? Have you experienced feelings of being powerless because of disciplinary authority? Are you someone who tends to be fearful and on-edge? Do you have financial strain? Are you experiencing a relationship conflict? These are some of the many questions to ask yourself if you suffer from constipation. With that said, it’s important that we highlight the common themes associated with constipation: control and power; the term “tight ass” didn’t come out of nowhere.
The act of having a bowel movement is one of surrender and letting-go. Struggles of control and power elicit the opposite effect. Many of our muscular and physical barriers tend to be reflective of psychological repression. Chronic emotions of fear and powerlessness will cause elevated stress levels which lead to increased physical tension. This tension will affect the nervous system and all bodily tissues, creating rigidity that can significantly impede the digestive process (see Stress & Anxiety above).
When faced with a chronic dysfunction in the body, it is critical to evaluate your psycho-emotional state. Discovering and addressing subconscious patterns or repressed emotions can be the key to sought-after physical changes.
