Constipation can be a significant source of stress and discomfort, as many people who have experienced it know. 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
Constipation affects an estimated 2-27% of people per year. In addition to the symptoms above, it can also cause discomfort or pain, gas and bloating, anxiety and irritability, and abdominal distention. In severe cases, it may require medical attention to address fecal impaction.
If you’re someone with constipation, you might be interested to know that a Functional Medicine Approach to constipation focuses on exploring and addressing potential underlying factors.
Functional Medicine can be used alongside conventional treatments. Below is an example of Melissa’s integrative healthcare journey with constipation that led to improvements in her condition.
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CC: Chronic Constipation
Melissa* was a 20-year-old cis female who’d been experiencing constipation for most of her life. She described having 2-3 incomplete bowel movements per week. She was often uncomfortable due to abdominal bloating from being unable to move her bowels. As a result, she felt stuck in a cycle where every few weeks, she’d use laxatives or enemas to go to the bathroom.
Melissa was frustrated because she’d tried many common approaches for constipation, and they hadn’t helped. These included:
- Drinking more water
- Using fiber supplements like Metamucil
- Taking laxatives like Miralax, Exlax, saline enemas, and more
- Exercising regularly
- Eating lots of fruits and vegetables
We helped Melissa by taking a closer look at her symptoms and exploring potential underlying factors that could lead to a personalized plan for her.
Patient Background
Melissa was a college student who worked a full-time job while maintaining a full course load and providing caregiving support for several family members. She was passionate about solving global injustices and advocated strongly for children in foster care. Mel was concerned that her health was affecting her ability to accomplish many of her goals.
In addition to constipation, she experienced other health issues like anxiety, depression, insomnia, fatigue, headaches, body aches, stomach pains, and cystic acne.
Mel had normalized most of these symptoms and assumed they were due to stress. She was in therapy and followed a wellness routine to help manage her mental health symptoms naturally and improve her sleep, but without the desired success.
As a child, Mel recalled struggling to pass bowel movements and experiencing anxiety related to the feeling of fullness after a few days of not being able to go to the bathroom.
Mel came to our clinic looking for alternatives to what she’d already been told—that she’d have to live with her symptoms, that she had IBS, and that therapy and standard treatments were her only options.
Nutrient Analysis
Melissa’s nutrient analysis suggested she was not consuming enough fiber, omega 3’s, and minerals like magnesium, potassium, zinc, and most vitamins.
Vitamins C and E
Research suggests that people with constipation may have lower blood levels of two major antioxidants—vitamin C and E. Melissa’s eating pattern was consistent with this finding. Additionally, vitamin C is known to have a laxative effect when used at high doses as a supplement. It may be a gentle option for people with a history of low vitamin C intake.
Magnesium
Magnesium is an essential nutrient and may have a laxative effect when taken as a supplement. Additionally, bulk laxatives (plant-based and others) can lower serum magnesium levels over time and lead to deficiencies, potentially worsening constipation. Magnesium is also noted for its role in supporting mental health.
Potassium
Constipation can be a symptom of hypokalemia or potassium insufficiency. Potassium is a critical electrolyte that affects nervous system signaling and blood chemistry. Supplementation with potassium should be done carefully and safely as part of a plan to help people with an insufficient intake meet RDI.
Fiber
Fiber is one of the most studied interventions for supporting digestive health. A minimum of 25 grams of fiber per day is recommended for most adults. Increases in fiber intake of about 5-10 grams may help support regular bowel movements. Additionally, Mel had other symptoms of hormone metabolism issues (like cystic acne) that responded well to fiber intake.
Omega 3’s
Omega 3’s are an anti-inflammatory lipid class that may support various aspects of health. When consumed in their most nutrient-dense food form (walnuts, chia seeds, flax seeds), they contain a large amount of insoluble fiber, which may help encourage regular bowel movements. When supplemented as fish oil, they may have a gentle stool-softening effect.
Overall Diet
Melissa also under-consumed total energy (calories), carbohydrates, and fats. This eating pattern can often result in hypoglycemic events, fatigue, and mood and cognitive issues. Melissa also tended to consume high-fodmap foods and was eating fruits, meats, and dairy products at many meals, which can cause gastric upset in some people.
Laboratory Workup Ordered At Initial Visit
Electrolytes and Hyponatremia
Mel had years of lab work that revealed hyponatremia, hypochloremia, and hypokalemia by the time she came to see us.
Symptoms of mild hyponatremia (or low sodium) can include nausea, fatigue, headaches, altered mood, etc.
Symptoms of mild hypokalemia (low potassium) can include constipation, weakness, fatigue, and heart palpitations.
Melissa had many of these symptoms, which she (and surprisingly, her previous doctors) had attributed to stress and poor sleep. Disorders of electrolyte metabolism are often overlooked in non-urgent clinical situations. Still, they should always be worked up and discussed with the client.
Food Sensitivities
Mel had several food sensitivities to the foods that she consumed daily. In particular, Mel had eggs or dairy almost every day as part of her “healthy” diet. There is evidence that eliminating cow dairy may help people with treatment-non-responsive constipation to manage their symptoms.
Normal Labs and Imaging
It’s important to rule out causes of constipation disorders like thyroid disorders, severe GI disorders, and more, as they can cause slowed bowel transit that does not respond to typical constipation management. Melissa’s lab work revealed that she had healthy thyroid function.
Her previous workup from gastroenterology revealed that she had a normal GI tract except for some inflammation near her ileocecal valve. This was encouraging news, which meant that we could focus on optimizing other aspects of her health.
Interventions
To help Melissa, we did the following:
Nutrition
My team and I worked with Mel to create a customized food-as-medicine meal plan that allowed her to meet RDI for all vitamins, minerals, fiber, and omega 3’s, which are associated with improved outcomes in digestive health. It was free of her top food sensitivities: dairy, eggs, wheat, beef, and almonds.
We also made the following key changes:
- Added 1 cup of organic coffee per morning
- Added trace mineral drops to each glass of water (and encouraged her to avoid plain water without electrolytes). These drops were high in magnesium, which is an effective intervention for supporting digestive health. She was started on ten drops a day with a taper plan to take her up to 50-100 drops per day, for a total of 400mg+ of magnesium.
- Emphasized low FODMAP foods and educated Melissa about proper food combining to avoid gas, bloating, and other GI symptoms.
- We focused on meeting RDI for vitamin C, E, potassium, magnesium, and fiber each day. We designed a meal plan that helped her do this without having to think about food or track it.
Bowel Retraining Protocol
We encouraged Melissa to give herself an extra hour in the morning where she could eat, drink, and walk around to support a bowel movement before she got going for the day. The protocol we suggested was as follows.
- Try to wake up at roughly the same time each day.
- Slowly over the first 60 minutes after waking up, alternate between drinking a hot cup of liquid (like coffee or tea) and a cold cup of water. Drink sips of each - 1 sip of hot coffee, then one sip of water. Each liquid should have trace minerals added.
- Walk around for about 500-1000 or more steps between bites. Doing house chores or taking care of a pet in the morning usually helps accomplish this goal!
- If possible, between sips of fluid, munch on some fiber-rich fruit like berries.
- At the 45-minute mark, go to the bathroom. Sit on the toilet and read for 10 minutes and allow a bowel movement to naturally happen if possible.
- Don’t stress if you don’t have a bowel movement at first. Over time, this pattern may help train both your gut and your brain that morning is a good time to go!
Supplements
- Comprehensive once-daily multivitamin to serve as nutritional support so that Melissa could stay flexible with her diet and lifestyle but still meet her goals. The vitamin recommended contains vitamins A-K, biotin, choline, iodine, zinc, selenium, manganese, chromium, molybdenum, boron, inositol, CoQ10, Alpha lipoic acid, lutein, zeaxanthin, lycopene.
- Omega 3’s 2000mg per day in pill form
Follow Up Analysis
Melissa’s individualized nutrition plan was designed to be healthy, easy to cook, and enjoyable to eat. It was also intended to support her intake of vitamins C and E, fiber, and minerals like magnesium and potassium. The nutrient analysis below reveals that she now consistently meets RDI for these nutrients or more. Our current work for Melissa is now centered on optimizing calcium, potassium, and omega 3 intake.
Results from a Functional Medicine Treatment Program
Melissa’s constipation improved after two weeks of following this protocol. She now has one regular, easy-to-pass bowel movement each morning and describes a life with reduced constipation and bloating.
Her acne has reduced, and her feelings of depression and anxiety have decreased to manageable levels. Additionally, her sleep has improved enough to allow her to experience normal energy levels during the day. As a result, she feels like she’s thriving!
Constipation may be managed naturally using a combination of food-as-medicine, bowel retraining, food sensitivity elimination, lifestyle changes, and more. If you’ve experienced constipation for years, consider seeking a healthcare provider who can help you explore a personalized plan to support your health and well-being.
*Note: The client’s name has been changed to protect her privacy. All other details are the same!
Articles That May Interest You
- A Functional Medicine Approach to IBS
- FODMAP Diet
- The American Epidemic of Micronutrient-Related Malnutrition
- A Functional Medicine Approach to Acne (A Case Study with Chief Complaint: Constipation)
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