Constipation affects, on average, 16% of the population worldwide, and up to 33.5% of those aged 60-110 years old[i]. Due to the tide of hormones, women are more likely to suffer from constipation than men[ii].
The experience of constipation includes: irregular bowel movements, passing stool less than three to five times per week, or the difficulty passing a stool that may require straining, or the insufficient, unsatisfactory, incomplete or painful stool. It may even include an obstruction of the gastrointestinal tract, which sometimes requires surgery.
Reasons for constipation vary and can be multi-dimensional. It can involve diet, colon motility, absorption, inflammation, infection, hormone balance, microbiome balance, genetics, pharmacological (drugs) and environmental (stress) factors.
There are Five Main Reasons for Constipation:
Diet lacks fibre and vegetables
Diet too high in proteins and carbs, especially in sugar, starch in processed foods
Dairy, wheat or other food sensitivity
Over consumption of dairy (too much cheese)
Insufficient water intake
Insufficient microflora (not enough Lactobacillus and Bifidobacterium)[iii]
Dysbiosis (overgrowth of the wrong kinds of gut bacteria, such as Baceteriodes[iv])
Small Intestinal Bacterial Overgrowth (SIBO) (root cause may be hypothyroid and migrating motor complex)
Hypothyroid affecting the migrating motor complex
Pregnancy, premenopausal, postmenopausal
Lack of regular daily exercise
4. Supplements and Medications
Overuse of laxatives
Supplements such as iron, calcium
Side effects of prescription drugs such as painkillers (opioids), anti-depressants
Irritable bowel syndrome or diseases
Nervous system disruption as in spinal cord lesions, Multiple Sclerosis and Parkinson’s disease
Poor functioning of the pelvic floor muscles
When someone has issues with constipation, the inevitable question that comes to mind, is “what is the person not letting go?” Sometimes when we emotional hold on to something, the body also goes into a holding pattern. In Traditional Chinese Medicine, the large intestine is responsible for “letting go” both physically and emotionally.
Left untreated, constipation can lead to complications. Stool is made of approximately 75% water, 25% expired gut bacteria, unabsorbed or excreted fat and toxins and other unabsorbed matter. Left to sit in the gastrointestinal tract, reabsorption of toxic elements can occur, including toxic byproducts of gut bacteria, plastics, drugs, hormones, bile, and cholesterol. Not to mention accumulation of physical mass.
Bleeding may occur while passing stool due to fissures/piles, or from passing hard stool
Pain and burning in rectum may occur and continue even after passing stool
Long standing constipation may lead to piles (swollen, dilated veins in rectal canal or anus), anal fissures (tear in the tissue lining of the anus) and rectal prolapse (protrusion of a part or the entire rectum from the anus)
Abdominal hernia (inguinal hernia/umbilical hernia) may arise from long standing constipation. An abdominal hernia is the protrusion of an organ through the abdominal wall or cavity which normally contains it
Constipation is common, bothersome and often ineffectively treated[vi]. A wholistic approach to the patient helps encompass the multi-factorial contributors to the condition. Herbal, dietary, nutraceutical, homeopathic, genomic and manual therapies are approaches to care included in a functional and naturopathic approach.
[i] Forootan M, Bagheri N, Darvishi M. Chronic constipation: A review of literature. Medicine (Baltimore). 2018 May;97(20):e10631. doi: 10.1097/MD.0000000000010631. PMID: 29768326; PMCID: PMC5976340.
[ii] Huerta-Franco MR, Vargas-Luna M, Somoza X, Delgadillo-Holtfort I, Balleza-Ordaz M, Kashina S. Gastric responses to acute psychological stress in climacteric women: a pilot study. Menopause. 2019 May;26(5):469-475. doi: 10.1097/GME.0000000000001274. PMID: 30586006.
[iii] Dimidi E, Christodoulides S, Scott SM, Whelan K. Mechanisms of Action of Probiotics and the Gastrointestinal Microbiota on Gut Motility and Constipation. Adv Nutr. 2017 May 15;8(3):484-494. doi: 10.3945/an.116.014407. PMID: 28507013; PMCID: PMC5421123.
[iv] Dimidi E, Christodoulides S, Scott SM, Whelan K. Mechanisms of Action of Probiotics and the Gastrointestinal Microbiota on Gut Motility and Constipation. Adv Nutr. 2017 May 15;8(3):484-494. doi: 10.3945/an.116.014407. PMID: 28507013; PMCID: PMC5421123.
[v] Rajindrajith S, Ranathunga N, Jayawickrama N, van Dijk M, Benninga MA, Devanarayana NM. Behavioral and emotional problems in adolescents with constipation and their association with quality of life. PLoS One. 2020 Oct 12;15(10):e0239092. doi: 10.1371/journal.pone.0239092. PMID: 33044960; PMCID: PMC7549826.
[vi] Johanson JF, Kralstein J. Chronic constipation: a survey of the patient perspective. Aliment Pharmacol Ther. 2007 Mar 1;25(5):599-608. doi: 10.1111/j.1365-2036.2006.03238.x. PMID: 17305761.