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 feel comfortable.
Constipation affects an estimated 30% of people each year. It can cause abdominal discomfort, bloating, irritable mood, and pain. In some cases, it may lead to more severe issues like fecal impaction or incontinence. A functional medicine approach offers several options that may help support natural relief from constipation.
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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 may affect how the gut receives 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 may affect 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.
Hormone Disorders
Hypothyroidism - a disorder where the thyroid gland does not produce enough thyroid hormone to regulate cellular metabolism - can contribute to 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 known to have a side effect of constipation, as are medications for neurological disorders like Parkinson’s disease. Many of these drugs may affect motility (the regular contraction of colonic musculature that helps move bulk and stool through the intestines). Other medications can affect constipation by altering electrolyte balance in the gut.
Nutrient Deficiencies
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 known for its antioxidant properties and may help support digestive health.
- 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 may support digestive health through its effects on colonic membranes.
- Potassium is present in high amounts in foods like apricots and lentils. Adequate potassium levels are important for maintaining normal gastric motility.
- 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 support a healthy gastrointestinal tract, 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 may contribute to 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.
Functional Constipation
Lastly, constipation with no other known cause is generally referred to as functional constipation. It can be influenced by lifestyle factors such as dehydration, stress, a low fiber diet, and more. Commonly, lifestyle interventions may help manage 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 affecting you.
Micronutrient Testing
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.
Heavy Metals
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 exposure, 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.
Hormones
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.
Specialist Referrals
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 plan to address any imbalances that they find. Pelvic floor therapy can be very helpful in addressing postpartum issues.
A Functional Medicine Treatment for Constipation
The approach to managing your unique form of constipation will depend on identifying the root cause.
If you have a nutrient deficiency, your practitioner may help you design a food-as-medicine plan or suggest a supplement to help support your nutritional needs.
Commonly considered 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 may help support digestive health. Some fun ways to do this are to create drinkable meals like smoothies, add sparkling 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 suggest liquid mineral supplements that can easily be added to your daily water intake.
If you have a food allergy, it may be helpful 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 options that may support digestive health 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.
If your issue is related to hormones, your clinician may suggest hormone support or work to address the barriers to normal hormone production using a combination of lifestyle, nutrients, herbs, and even pharmaceuticals.
Thyroid hormone support can have a significant impact on the side effects associated with hypothyroidism like constipation, weight changes, mood, hair health, and more.
If your issue is functional constipation, your doctor may recommend a bowel retraining program. Bowel retraining programs are designed to help your gastrointestinal system develop a routine for bowel movements using habits, cues, hydration, eating, and other practices. These programs can be very effective for many individuals.
Summary
You’re not stuck with constipation! There are many options for managing it. Working with an integrative practitioner can help you explore potential root causes.
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