Dr. Ann-Marie Regina, ND
Chronic Constipation: Answers Beyond Fibre
Updated: Dec 1, 2021
Have you been suffering from long term constipation? Maybe you've tried metamucil or have been told to just increase your fibre intake but even still it doesn't seem to work or makes it worse. Constipation can be caused my multiple underlying issues and when not assessed and treated appropriately may exacerbate and cause other conditions. Long term constipation can lead to hernia's, diverticulitis, haemorrhoids, fissures, rectal prolapse hormonal imbalances, gas & bloating, changes to weight, contribute to skin issues, joint pain and many more.
What are some of the underlying causes of constipation?
It is important to make sure that your constipation is assessed appropriately as there are multiple benign and serious conditions that can be causing your symptoms.
Hypothyroidism and Hashimoto's thyroiditis
Irritable Bowel Syndrome
Anxiety and Depression
Weak pelvic muscles
Parkinson's, Dementia and MS
Scleroderma and amyloidosis
Cancer, scar tissue, strictures and impaction
Higher risk populations: pregnant women, seniors and children
If all of the above conditions have been ruled out, the following criteria for primary chronic constipation may be met:
Must include two or more of the following:
straining during more than one-fourth (25%) of defecations
lumpy or hard stools more than one-fourth (25%) of defecations
sensation of incomplete evacuation more than one-fourth (25%) of defecations
sensation of anorectal obstruction/blockage more than one-fourth (25%) of defecations
manual manoeuvres to facilitate more than one-fourth (25%) of defecations (such as digital evacuation, or support of the pelvic floor)
2. fewer than 3 spontaneous bowel movements per week. Loose stools are rarely present without the use of laxatives
3. Insufficient criteria for irritable bowel syndrome (IBS)
*Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis.
Does this sound like you? If so, let's look at how we can begin to treat it!
What is happening with the gut bacteria in constipation?
When you have a bowel movement you are expelling many things from your body including the good and bad gut bacteria. This acts as an outlet to help maintain a balance within your digestive system. When you don't have regular bowel movements, there is an accumulation of this biomass (total mass of organisms) resulting in dysbiosis. Dysbiosis is an imbalance of the good and bad bacteria in your gut which can cause a wide host of symptoms.
Why Fibre doesn't work
Research does not support fibre as a first line treatment for chronic constipation. If you have chronic constipation, it's likely that you've tried increasing your fibre. So you know that it doesn't typically work. This is because it's the type of fibre that matters. Fibres that are more effective increase stool water content so that they are soft, easy to pass and increase stool bulk. These fibres should also resist fermentation, which typically causes gas and bloating. The most evidence based fibre for chronic constipation is psyllium husk which is an insoluble fibre. Fibres such as inulin, FOS/GOS and wheat bran typically worsen symptoms and cause gas and bloating.
The Naturopathic Approach to Treating Constipation
So what does your treatment plan look like when treating chronic constipation?
Let's get things moving. Stimulating a normal bowel movement is the primary course of action. Osmotic laxatives that draw water into the bowel are non-habit forming and are the first line care to stimulating a natural bowel movement. If an osmotic laxative doesn't work, we can try some herbal laxatives that are more stimulating. These herbs can be more habit forming and should be prescribed by a practitioner so that you can be monitored effectively.
The Kill-off phase. Natural antimicrobials are used in order to help balance the bacteria. In chronic constipation bacteria and stool are stagnant in the bowel. We need to kill off the "bad" bacteria that has accumulated. Encouraging other lifestyle factors like exercise, stress management, proper sleep is also recommended here.
Flood the gut. Adjusting diet to feed the good bacteria. An individualized dietary plan will be made for you to address your specific needs. Prebiotics, probiotics and fermented are other options considered.
Maintenance. Heal and repair the gut, lower inflammation, address any other nutrient deficiencies, continue with dietary management. Ultimately focusing on preventing future episodes of chronic constipation and improving overall quality of life.
If you have been struggling with chronic constipation or other digestive concerns, please seek care from a professional. Dr. Ann-Marie Regina, ND can help you understand your triggers, see what's possible and feel comfortable in your body. If you would like to learn more about how she can assist you in your health care journey, please book a free meet and greet appointment (online or in person) here.