Is Constipation Ruining Your Health?
As a Nutritional medicine practitioner, the digestive system is one of the primary focuses of any treatment. Its proper function is linked to every other system in the body and without proper management, it can be the downfall of any treatment.
Therefore we find ourselves talking about stool, feces or poop a lot. So not deviate from this topic, I would like to focus on constipation. This condition is something that many people see as very simple, however it is one of the most multifaceted issues you can have in the digestive system.
Medically constipation is defined as fewer than three stools per week and severe constipation as less than one stool per week. However from a more naturopathic understanding we know that our stool is one of the 4 major detoxification pathways of the body (the others being urine, breath and sweat). An accumulation of these toxins lead to the reabsorption into the blood stream and a subsequent increase in tissue toxicity.
Therefore as a holistic practitioner constipation is considered as any or a combination of the below:
- Passing stool every 2nd day or more
- Difficulty in emptying the bowels
- Hardened stool
- Frequent incomplete evacuations
- On a Bristol Stool Chart type 1, 2 and 3
So why is constipation so bad?
Constipation leads to the reabsorption and build up of toxins which can re-enter the blood stream negatively affecting liver function, nervous system health, immune function, hormonal health, sleep and energy levels.
Some of the most common symptoms associated with chronic constipation are
- Lack of appetite
- Leaky gut
- Foggy thinking
- Concentration issues
- Poor memory recall
- Disrupted menstrual cycle
- Sleep disturbances
- Toxic build up
- Overburdened detoxification pathways
- High blood pressure
Before we go into what causes constipation lets first quickly delve into the digestive system and see what’s actually going on.
So food and drink enters our mouths and digestion starts. After chewing our food we swallow and the bolus (mass of food) travels down the esophagus into the stomach. Here super strong acids churn around like in a washing machine, breaking down protein and fat compounds releasing minerals and vitamins.
Following about an hour the spin cycle is complete and the stomach empties into the small intestine. Here the real magic happens as enzymes, bile acids and bacteria come into the mix and begin further breaking everything down. Once everything is disassembled into its individual components it can be absorbed through the lining of the small intestine. Most of the nutrients in our food are absorbed in the small intestine, which is covered in small protuberances called villi that increase its surface area. If you were to flatten out the entire small intestine it would be about the size of a tennis court!
Once everything easy to digest has been absorbed the remaining food (largely comprised of fiber) is sent into the large intestine. The large intestine or colon has two major roles; to draw liquid out of the remaining food and to house a zoo of different bacteria which help the body break down any nutrients remaining. When the stool first enters the large intestine it has a very high water content as the small intestine is more or less filled with liquid. However as the food travels along the colon it becomes drier as more liquid is drawn out. All the time bacteria are hard at work eating away and producing byproducts we need for our health.
There are so many bacteria in our colon that our stools weight is actually over half made up of dead bacteria. Although this may seem kind of gross we are learning so much about our microbiota and its affect on our health. Having these critters unhappy is one of the major contributors to disease.
So the finale of the digestive miracle ends with a trip to the toilet where, if everything went to plan, well-formed stool, made up of waste and indigestible material is evacuated.
So what causes constipation?
This is where it gets interesting as there are at least 8 independent reasons that can cause constipation.
The cause that one everyone thinks of first is fiber. We know that a high fiber diet increases stool quantity and thereby pushes things along in the digestive system gathering all the waste and neatly depositing it into the toilet. Fiber is split into 2 major types. Soluble fiber and insoluble fiber. Soluble fiber can be broken down in our body, however it is still very hard to do so, therefore we rely heavily on our bacteria in the colon to do this job. They love soluble fiber as its one of their major food sources. However too much soluble fiber can cause the bacteria in your gut to have a party leading to gas, cramps, diarrhea, constipation and other unpredictable digestive complaints. Insoluble fiber cannot be broken down in the body and therefore makes up the bulk of our stool. The best way to visualize insoluble fiber is as a big sponge, which grabs and brings along all the toxins and waste products we don’t want hanging around in our digestive system. It also holds water which keeps our stool nice and soft.
The perfect combination of soluble and insoluble fiber promotes proper stool formation and bacteria health. The recommended daily fiber intake is 30grams with the ratio being about 30% soluble fiber and 70% insoluble.
Luckily foods naturally contain a balanced quantity of soluble and insoluble fiber. Whole grains are the highest followed by fruits and vegetables, then nuts and seeds and finally potatoes.
Reading the above you may have noticed how the amount of water in your stool affects its consistency. The colon draws water out of our stool and the two major factors that affect how much it draws out are: the length or time stool stays in the colon (transit time) and if the body is dehydrated overall.
The transit time of stool in the colon is affected by a number of the other factors however dehydration is a completely independent factor. I commonly see patients taking fiber supplements however not drinking enough water. When the body is dehydrated it will draw this water from wherever it can and one of the most common places is the colon. Therefore ensuring you are drinking 2 liters of water per day not including any extra water you may need to replace following exercise/sweating. This will make sure that your body is adequately hydrated and won’t overly dry out your stool.
The digestive system takes food all the way from the mouth to our anus, this is a long way, approximately 30 feet (9m) in adults. To facilitate this long trip the digestive system is lined with muscles, these muscles perform an action called peristalsis which is a rippling contraction that pushes food further along. Although this action occurs in the esophagus, small intestine and colon, we will focus on its action in the colon. As our stool dries out in the colon it relies almost exclusively on peristalsis to move through the 5 feet of colon. When peristalsis is not as active or correctly stool can build up in the colon and get stuck. This is very toxic to our liver and negatively affects our bacterial balance in the colon. Peristalsis is triggered by a molecule called 5-HT which is a precursor of Serotonin, our make happy neurotransmitter. When there is an abundance of serotonin our smooth muscles contract and make the stool travel at a speed through the colon that is perfect both for absorbing the necessary water out of our stool and for the bacteria to do their magic. Magnesium, Calcium and Potassium are minerals that cause muscles to contract and relax, something that happens over and over again in the action of peristalsis. When we are deficient in magnesium, calcium or potassium, our muscles get exhausted very easily and are not able to continually perform the peristaltic function. Other factors that can affect peristalsis are the bacteria that live in our gut, medications, structural afflictions and if the stool is lacking in fiber. Exercise is another big factor in motility. Our colon also uses gravity and body movement to push stool further along the colon. Therefore regular moderate exercise supports healthy stool transit time.
We have approximately 37 trillion cells in our body and we have approximately 38 trillion bacterial cells living within us. These collectively are called the microbiome. Although these only make up for about 1-3% of our body weight we can safely say that, cell for cell bacteria outnumber ours. Until about 10 years ago we didn’t think too much about these bacteria except when we got sick. However more recently we’re finding out that our personality, mood, habits and health is affected if not governed by our Microbiome.
Knowing that the majority of the mirobiome resides in the colon gives us an indication that their presence also affects conditions such as constipation.
Probably one of the most profound ways that the microbiome affects constipation is that 90% of the serotonin in our bodies is produced in the lining of the colon and the production is triggered by specific bacteria in our colon. This serotonin or 5-HT stimulates peristalsis thereby facilitating the movement of stool through the colon. The microbiome can also negatively affect motility when there is an overgrowth of bad bacteria. These bacteria produce toxins (lipopolysaccharides) that can hinder peristalsis. The health of the microbiome relies strongly on our diet with adequate soluble and insoluble fiber and is very easily negatively affected by antibiotics, antacids, pesticides, other environmental toxins and psychological stress. Therefore the correct diet with plenty of pre-biotics (soluble fiber) and the addition of probiotics (live bacteria) in the form of a supplement or fermented food is required.
There are hundreds of interactions that can cause constipation to one degree or another. Therefore always take a close look at the medication your are taking and see if any could be linked to constipation. This does not mean you should stop the medication but instead look for the specific reason the medication is causing constipation. Is it reducing motility? Is it affecting the microbiome? Is it affecting hydration? Some medications can cause constipation even when you are no longer taking them, for instance overuse of laxatives can cause a dependency. Once we know the specifics we can then find a workaround. Remember to always consult your health care professional before stopping, changing or adding another medication or supplement.
Now this may seem obvious, however its more common than you might expect. By obstruction I don’t necessarily mean a mass blocking the colon or a physical abnormality. This also includes scar tissue in the colon from surgeries, diverticulitis, Crohn’s or pathogens such as worms. Furthermore I also include posture when going to the toilet into the category of obstruction. Unfortunately the shape of our bowels hasn’t much changed in hundreds of thousands of years and we originally went to the bathroom in a squat. As such our bowels is shaped so that when we squat the lower part of our colon and rectum straightens out allowing easy passing of stool. Therefore using a stool beneath your legs on the toilet corrects the posture and supports the complete elimination of your stool. Besides the posture, most obstruction related causes of constipation need to be investigated by way of a through case history and if required subsequent testing or scans.
For the most part people prefer to use their toilets at home rather than public toilets or even the ones at work. This stigma/fear/habit can lead to our mind overruling what our body is telling us. As such we hold onto stool longer than we need to, reabsorbing more water and the toxins held within the stool. It is not uncommon for a patient to forgo using the toilet till he/she arrives home and then being too constipated to go. Beginning a downward spiral where the quantity of feces in the colon accumulates, microbiota changes, mobility reduces and a patient begins suffering from chronic constipation. The gut-brain connection is immensely strong so therefore must always be taken into account when any condition is related to either the gut or the brain. There can also be damage to the nervous system that stops the brain from properly receiving the stimuli to evacuate its bowels or is not able to sense when it is fully evacuated. Certain diseases or medications can contribute to this. Asides from nervous system damage the best way to encourage healthy bowel motions is creating habits. We are very habitual beings. Everything in our body and even our lives goes around in cycles. Our hormones, heart function, sleeping cycle and eating habits are all in a cycle. Our body thrives off routine; therefore trying to create a bathroom routine can also be very beneficial.
Natural laxative treatments
Sometimes we need to nudge the colon along and support the emptying of our bowls. This is where a natural laxative or even fiber supplement can be extremely beneficial. In extreme cases medication is most definitely required. Keeping toxic feces within is often worse than the side effects of a medication.
However even natural laxatives such as high dose magnesium or vitamin C have negative affects on the gut and are therefore not long-term solutions. Both magnesium and vitamin C can be very irritating to the gut exacerbating existing conditions or causing inflammation. Likewise, clays and other indigestible stool fillers bind minerals and long term can cause nutrient deficiencies.
Fiber supplements rarely substitute the health benefits of a balanced diet and are also not a long term solution in most cases. Although it is much harder to form dependency on natural laxative treatments, it is very common to find that higher and higher doses are required over time to perform the same function. Aloe Vera is an excellent natural laxative however when patients need higher and higher doses Aloe Vera can be toxic to the gut causing irritation and inflammation. Please don’t interpret this section as ‘natural laxatives are bad’ but nothing replaces finding the underlying cause of constipation and addressing them.
Seeing a practitioner
I hope this article has shed some light onto your relationship with your bowel motions. Seeing that treating the symptom of an issue never replaces addressing the underlying cause of a condition. However you may have realized that when it comes to constipation there are no direct answers. It’s complicated and messy requiring an in-depth look into current health, lifestyle, diet and history. Although the internet is great for self diagnosing serious conditions (sarcasm), nothing replaces an objective view of a health professional who not only know what signs to look for but can also follow up the investigation with personalized support to remove the underlying cause of the issue.
If you don’t currently have a practitioner the ‘Truly Heal Cause Evaluation’ is a great way to get to the bottom of your condition.