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What is constipation?

Understanding your condition

Constipation is the irregular or difficult passing of an often firm/hard stool. 

The ideal stool is easily passed 1-2 times daily, is a soft, formed sausage shape around 20-30com in length, mid brown in colour, takes on average around 12 seconds to pass and is not particularly offensive in odour.

However, that isn’t the case for around 19% of the population worldwide experiencing chronic constipation. It is an uncomfortable problem that can, if left untreated, contribute to other health conditions.

man wearing jeans walking towards toilet holding full roll toilet paper
functional medicine health coach jessica showing gi map dna stool analysis test kit to patient

Constipation natural treatment 

Many people think constipation can be relieved by drinking more water, or taking a fibre supplement, although sometimes the cause may not be related to hydration or diet.

Natural treatment for constipation will first identify the cause, which might be as simple as removing foods contributing to constipation, building resilience to stress by doing activities such as meditation, or a morning walk to promote bowel movement. Alongside these root cause intervention, herbal medicines that stimulate the bowel to work more efficiently may be used as a more gentle option to taking harsh laxatives.

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Common constipation symptoms

Constipation can be functional i.e. a condition in its own right, or a symptom of a variety of other conditions e.g. IBS, SIBO and many more. Occurring at any age, constipation is more common in children and the elderly.

Slow motility, AKA the slow transit of food through the digestive system, allows for more water to be absorbed from the stool by the body, making it firmer and harder to pass. Slow motility allows the reabsorption of toxins or waste products back into the body which it is trying to eliminate, placing a greater load on the liver which can cause other health issues such as hormonal imbalances, skin issues, and brain fog. Improving motility supports healthy detoxification by the liver which supports general health.

The main symptoms of constipation are:

  • Irregularity - a lack of a consistent pattern. Constipation can be acute, chronic or recurring
  • Lack of frequency - regularly having no bowel movement for more than 1 day, or incomplete passing 
  • Difficulty/discomfort in passing a stool - straining, pain, rectal bleeding, or haemorrhoids
  • Hardness of stool - small, round, very large or hard to pass stools
  • Incomplete evacuation - the feeling that not all faeces were passed, needing to go back to the toilet
  • Bloating, reflux, flatulence, abdominal pain and discomfort are symptoms that can accompany constipation

Many people are unaware they are constipated, having experienced what they have considered as ‘normal’ bowel movements for their entire lives. Ideally, we pass 1-2 easy bowel motions every day. Hard, firm, or difficult to pass stools, even when regular, are considered as constipation. The Bristol Stool Chart can help identify stool types, with types 1 - 2 indicating constipation and type 3 considered as tending towards constipation. 

Headaches, haemorrhoids, rectal bleeding, brain fog and mood disturbances can accompany constipation. Patients who also have IBS or SIBO may also experience fluctuating diarrhoea, masking an underlying natural tendency to constipation.

Causes of constipation

Numerous factors can affect the transit time of a stool. Healthy digestion relies on all parts of the digestive system working well together, from chewing food properly, good saliva production, adequate hydrochloric acid in the stomach, and healthy digestive enzyme production, to the wave like constrictions of peristalsis moving food through the intestines. 

Another stronger wave-like muscular constriction called the migrating motor complex (MMC) occurs around every 90 minutes (when we’re not eating/digesting) and is a necessary ‘cleaning cycle’ ensuring the mucosal lining is maintained, and pushes all food particles out of the small intestine into the large intestine for elimination. 

The microbial species in the large intestines also seem to play a role in the movement of faecal matter through the bowel. A disturbance in any of these factors can cause constipation.

Stress and constipation

Playing an important part is the gut-brain axis, or the interaction of the nervous system and digestive system. During stress, either acute or chronic, our sympathetic nervous system slows down digestion, inhibiting production of digestive enzymes and hydrochloric acid, and processes such as peristalsis and the MMC. It does this to divert the body’s resources to respond to an emergency (real or imagined) in the fight or flight state.

Common causes of constipation can include:

  • Low fibre intake
  • High intake of refined carbohydrates, sugar and trans fats
  • Poor hydration/inadequate water intake
  • Laxative abuse/long term use
  • Lack of physical activity (often due to illness, injury or travel)
  • Food allergy/intolerance
  • SIBO (small intestinal bacterial overgrowth)
  • IBS (irritable bowel syndrome)
  • Stress, anxiety, depression
  • Microbiome dysbiosis, lack of diversity, species overgrowth
  • Poor/sluggish liver function
  • Structural abnormalities, tumours, haemorrhoids, anorectal fissures
  • Hypothyroidism, diabetes, hyper/hypokaelaemia 
  • Pregnancy
  • Medications: anti-histamines, opioids, NSAIDs, antacids, PPI’s, anticholinergics, sedatives, diuretics, calcium channel blockers, some iron or calcium supplements, narcotics, tranquilisers, sedatives and antidepressants
  • Smooth muscle/connective tissue disorders e.g. scleroderma, amyloidosis
  • Neurological disorders: Parkinson’s disease, dementia, cerebrovascular disorders, spinal injury, Alzheimers’ disease
  • Congenital conditions: neuromuscular bowel impairment, Hirschsprung's disease (aganglionic megacolon)
  • Concern of lack of privacy when passing a bowel movement

Underlying medication conditions should first be ruled out, such as:

  • Heavy metal poisoning
  • Diverticular disease
  • Intestinal obstruction
  • Colorectal cancer
  • Depression
  • Thyroid disease/dysfunction
  • Inflammatory bowel disease

What causes eczema?

There isn’t one single cause of eczema but a range of potential contributing factors that are unique to each person. These include:

Genetics

Research has found people with the ‘atopic triad’ have a defective barrier of the skin and upper and lower respiratory tracts.

These genetic alterations cause a loss of function of filaggrin (filament aggregating protein), which is a protein in the skin that normally breaks down to create natural moisturisation and protect the skin from penetration by pathogens and allergens.

Filaggrin mutations are found in approximately 30 percent of people with atopic dermatitis, and also predispose people to asthma, allergic rhinitis (hayfever), keratosis pilaris (dry rough patches and bumps on the skin), and ichthyosis vulgaris (a chronic condition which causes thick, dry, scaly skin.)If one parent carries this genetic alteration, there is a 50 percent chance their child will develop atopic symptoms. And that risk increases to 80 percent if both parents are affected. 

Food allergy and sensitivity

Food hypersensitivity has been found to cause or exacerbate atopic dermatitis in 10-30% of cases, and 90% of these are caused by eggs, milk, peanuts, soy and wheat.

Compromised gut health

The connection between the gut microbiome and skin health is complex, however, research has found the microbiota contributes to the development, persistence, and severity of atopic dermatitis through immunologic, metabolic and neuroendocrine pathways.

Nutritional deficiencies

Deficiency of Omega-6 essential fatty acids (EFA) has been linked with the increased incidence of atopic dermatitis, along with the inability for the body to efficiently metabolise EFA’s to gamma linoleic acids (GLA) and arachidonic acids (AA).

Weather and environment

Changing weather conditions can certainly aggravate eczema symptoms, but the triggers are subject to change among individuals.

Hormones

Hormones also play a role in the course of atopic dermatitis, including the stress hormone cortisol which triggers an inflammatory immune response affecting all organs of the body, including the skin.

Mould exposure

Mould exposure and susceptibility to mould can cause Chronic Inflammatory Response Syndrome (CIRS), of which dermatitis is a manifestation.

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Constipation treatment - the conventional approach

Conventional medicine treatments usually involve pharmaceutical medicines for laxation, or recommendations for over the counter laxatives from pharmacies. 

Laxatives can take the form of:

  • Bulking agents - which draw water into the stool, usually in the form of psyllium husk (Metamucil) or methylcellulose, with added colours and flavours
  • Emollient laxatives/stool softeners - draw fats and water into the stool
  • Osmotic/hyperosmolar laxatives - also draw water from surrounding tissue into the stool 
  • Stimulant laxatives - stimulate the lining of the gut for stool propulsion
  • Prokinetics, also known as GCC receptor agonists - stimulate frequency and strength of intestinal contractions, and are generally only prescribed where other methods have been ineffective

Other treatments may include colonic irrigation and enemas. Suppositories for constipation are also used for delivering medications, particularly for children and the elderly.

These can be effective for short term treatment and suppressing symptoms, however they don’t address the root cause and are therefore ineffective long term solutions. 

It is also possible to become reliant on laxatives for long-term use which can result in electrolyte imbalances, mineral deficiencies, dehydration, chronic constipation, and damage to nerves and muscular structure of the intestines and cardiac function. 

Taking a holistic approach to constipation to address the underlying factors that contribute to the condition is a long-term and effective alternative.

Constipation - functional testing considerations

Our constipation specialists use state-of-the-art pathology testing in conjunction with detailed case taking involving your personal health history to determine the factors contributing to your constipation, and any other health problems you may be experiencing. 

Testing might include:

  • Gut microbiome testing
  • Food allergy, intolerance or sensitivity testing
  • Serum calcium and potassium
  • Digestive function and nutrient absorption assessment
  • Thyroid profile
  • Cortisol awakening response to assess the stress response
  • Other tests, as required for your specific symptoms

The gut is the seat of all health and so our team are all constipation specialists, versed in assisting patients with all types of digestive disorders.

Functional medicine treatment for constipation

A natural, functional medicine approach to treating constipation provides effective long-term relief, restoring healthy digestive function and reducing other health problems that constipation can lead to. 

One of our functional medicine constipation specialists will first identify the cause of constipation with testing and comprehensive case taking. This deeply comprehensive, investigative approach helps create a plan for how to treat constipation naturally. Once the root cause is established, your practitioner will walk you through a holistic understanding of your health concerns, as well as your personalised treatment plan.

Natural remedies for constipation treatment, may include:

  • Increasing dietary fibres from whole plants, grains, fruits and vegetables
  • A specific diet, eliminating food intolerances, allergies or sensitivities
  • Supplementing with specific fibres  such as psyllium husk, PHGG, and/or slippery elm powder which absorb water to  increase bulk of the stool, and also feed the microbiome that can promote motility
  • Strategies to increase daily water consumption
  • Specific lifestyle strategies to ‘retrain’ the bowel, and to improve stress resilience or reduce stress
  • Micronutrient supplementation to ensure the body has necessary cofactors for robust and healthy digestion, such as magnesium, zinc, Vitamin C and Vitamin A
  • Probiotic supplements to support microbiome health, with strains such as  as L. plantarum LPO1, L. plantarum 299v, B. breve BR03, B. lactis BS01, L. rhamnosus GG, and L. acidophilus LA02
  • Digestive enzymes to enhance digestion and encourage the easier passing of stools if poor digestion is indicated
  • Treat any other conditions that may be contributing to constipation
  • Herbal medicines to increase digestive tone, soften stools, support/increase microbial make up and diversity, improve the strength of contraction of peristalsis, produce healthy mucosal linings, and reduce inflammation
  • Chamomile, green oats, valerian, passionflower, lemon balm, verbena, gotu kola or bacopa as nerve tonics/relaxants
  • Yellow dock, St. Mary’s thistle, dandelion, black walnut, and turmeric to stimulate bile production and support liver detoxification
  • Rhubarb, licorice, aloe and butternut as short term herbal laxatives
  • Peppermint, cinnamon, chamomile and fennel to treat flatulence 
  • Artemisia, barberry, gentian, ginger, centaury and dandelion root to stimulate digestive secretions
  • Fennel, chamomile, lemon balm, peppermint, anise and ginger to reduce abdominal spasms / cramping

Chronic constipation can contribute to  more significant health conditions, so seek the help of constipation specialists like the trusted practitioners at Melbourne Functional Medicine. Our functional medicine constipation approach is designed for long-term success. We team you up with your specialist constipation practitioner, and a health coach, giving you all the support and guidance you need to implement your plan with ease and get the results you’re after. 

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FAQs

How to relieve constipation, what is the best natural treatment?

Natural methods are best, as the long-term use of laxatives can be harmful.

Increasing water consumption to at least 2 litres per day, and increasing the daily intake of whole, unprocessed fruits and vegetables can often provide relief.

Natural fibre supplements such as psyllium husk or slippery elm powder can also provide relief when taken in conjunction with an increase of water.

Foods such as artichokes, asparagus, garlic, onions, potatoes, root vegetables, leeks, barley, and whole oats can all be beneficial.

Eliminating any food intolerances or sensitivities can also help, as can eliminating highly processed foods, refined carbohydrates, sugar, and trans fats.

Where is constipation pain felt?

Constipation can be felt anywhere in the abdomen, with symptoms of bloating, distension, burping, reflux, heartburn, flatulence, cramping and griping.

Painful passing of hard stools may result in rectal pain and bright, red blood if haemorrhoids are present.

Why am I constipated? What is chronic constipation?

There are a variety of reasons for chronic constipation.

A diet high in processed foods, refined carbohydrates and sugar can cause constipation, as can a diet low in fibre from fruits, vegetables and whole grains.

Food intolerances and sensitivities, medications, anxiety, stress, depression, low thyroid hormones, other medical conditions, lack of exercise, and poor hydration can also be responsible. When constipation occurs regularly for more than 3 months, it is considered chronic.

What to do for constipation?

Ensuring a daily diet of whole, unprocessed fruits, vegetables and grains will increase fibre intake which helps stimulate the movement of digested food through the digestive tract.

Leaving skins on vegetables wherever possible can help increase the fibre in your diet.

Make sure to drink at least 2 litres of water to maintain hydration, which is essential for ensuring stools are soft enough to move easily through the large intestines.

As stress and anxiety can inhibit digestive processes, and contribute to constipation, practising techniques to reduce stress such as mindfulness and meditation, or even regular walks in nature can help.

If these suggestions don’t resolve constipation, get the advice of a constipation specialist such as a constipation naturopath or functional medicine practitioner to help determine and resolve other constipation causes.

How to fix constipation, naturally?

The best natural treatment for constipation is to ensure that your body has sufficient fibre to bulk the stool and to feed the microbiome, and enough water to ensure the stool can be soft enough to pass easily.

Minerals such as magnesium are important in forming and passing stools, and most people are deficient in magnesium - particularly, if not consuming whole fruits and vegetables, such as leafy greens. Magnesium citrate can help relieve bowel spasms, is non-addictive and can provide other health benefits, however speak to your constipation naturopath to ensure this is right for you.

Fibre supplements such as psyllium husk, PHGG and slippery elm powder can provide relief, if taken with plenty of water. At least 2 litres of water per day is enough to help soften stools.

It is also important to rule out other medical conditions and factors that may be causing constipation.

High fibre foods for constipation

All whole, unprocessed fruits, grains and vegetables, especially with skins left on are all helpful for relieving constipation.

Rather than focusing on particular types, variety that is best, so aim to eat a variety of fruit and vegetables of all colours each day.

However, foods such as kiwi fruit, plums, banana, apple, onion, leek, garlic, asparagus, artichoke, nuts, seeds and whole grains are all high in fibre.

Increasing water to at least 2 litres per day is also necessary to soften stools. 

Are laxatives good for relieving constipation?

Laxatives don’t address the root cause of the problem, hence the constipation can persist which can have long term health impacts.

Long-term laxative use can even cause constipation and other health issues, and it is possible to become reliant on them. 

Speak to a functional medicine constipation specialist or constipation naturopath who can help prepare a personalised plan that helps to address the root cause rather than rely on laxatives.

Can’t find what you’re looking for? Reach out to the team directly – we’ll be happy to assist.