You may be surprised by how many people take laxatives or stool softeners every day. Many of these products were prescribed by a medical provider. When people who have chronic constipation come to our office, we ask questions to determine the cause of their constipation so that we can treat their constipation without the side effects associated with laxatives.
No Single Cause of Constipation
There is no single cause of constipation and often people will have more than one of the root causes on this list.
- Inadequate water intake – This is a very common cause of constipation especially in professions like medical providers, utility workers, and educators where it is difficult to go to the bathroom. There are many other health benefits to drinking water because water helps your body eliminate what it does not need. People who are chronically dehydrated often complain of headaches, muscle cramps, and fatigue.
- Inadequate fiber intake – Prevention of constipation is yet another reason to eat your vegetables. Excessive intake of simple carbohydrates and meats can cause constipation. Some people take a psyllium husk fiber supplement which is a great option but you get more nutritional benefit from eating vegetables, flax seeds, or chia seeds.
- Lack of exercise – Your intestines rely on full body movement to support the movement of food and stool through the intestines. People who are constipated because of being sedentary often notice improvement with simple changes like parking farther away from the door and taking the stairs instead of the elevator.
- SIBO with high methanogens – SIBO (small intestinal bacterial overgrowth) often causes painful bloating. There are some normal gut bacteria that process foods into methane gas. When these bacteria overgrow, they can cause constipation by multiple mechanisms. If you have painful bloating, we may want to consider testing for SIBO which involves breath testing for levels of hydrogen and methane.
- Hypothyroidism – People with hypothyroidism (low thyroid function) often experience fatigue, constipation, hair loss, weight gain, and dry skin. Sometimes people will present with symptoms of hypothyroidism but their thyroid is fine. This is often related to stress hormones which affect the function of thyroid hormones in the body. More on this in the future.
- Pelvic floor muscle tightness (also known as dyssynergic defecation) – There are multiple muscles in the pelvic floor that can cause constipation because they prevent the passage of stool. These are the levator ani, the anal sphincters, and the puborectalis. These muscles become tight due to injury, the chronic holding of stool, or as a reaction to painful bowel movements. I (Dr. Gwenn) use Holistic Pelvic Care, a manual therapy to release those muscles and help people retrain the muscles to contract and release. People with constipation due to tight pelvic floor muscles often experience a lot of straining with bowel movements and sometimes experience burning pain around the rectum.
- Food intolerances – Cheese, bread, and underripe bananas are constipating foods for many people without technically being food intolerances. Food intolerances are often associated with diarrhea but I have seen many patients note a significant improvement in their constipation after doing food intolerance testing and removing the foods that were indicated. Constipation related to food intolerances is often intermittent and is often associated with hemorrhoids.
- Hormonal imbalances – It is normal for women to have some bowel changes during their menstrual cycle but sometimes when estrogen and progesterone are out of balance, women will get severely constipated. This type of constipation often follows the menstrual cycle and may be associated with heavy periods, painful menstrual cramps, breast tenderness, and/or migraines.
- Low levels of digestive enzymes – When people complain of food feeling like a brick in their stomach or feeling excessively full after small meals, we often need to address digestive enzymes. Digestive enzyme production can decrease with aging, stress, hormonal imbalance, or gallbladder removal.
No two people with constipation will leave with the same treatment plan because our goal is to prevent the constipation by addressing whatever caused it in the first place. Our primary diagnostic tool is a thorough conversation about the onset, triggers, and nature of the constipation as well as a larger conversation about systems that are related to the function and movement of the gastrointestinal system. If needed, we order stool testing, blood work, or imaging to confirm a diagnosis.
If you’re experiencing constipation, please contact our office for a consultation so we can work together to treat the root causes.