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Top 10 root-causes of constipation

Wouldn’t life be easy if you could figure out that one thing that’s causing your constipation issues?

Unfortunately, that typically isn’t the case and if you clicked on this blog post, chances are you’re having trouble figuring out what’s really causing your bowel irregularities.

Up to 19 percent of Americans (about 63 million people) suffer from constipation, which is astounding! Having healthy digestion and eliminating stool at least once a day (optimally twice a day) is critical to flushing out toxins in your body. If you have fewer than 3-4 bowel movements per week, well then, we have a serious problem!

We’ll review the top 10 root-causes of chronic constipation and what to do about it. These are the best kept secrets and I hope you’ll find some insight and things to consider moving forward.

A Word Before We Get Started

Before we get started, it’s worth mentioning you’ll want to make sure you’ve had a colonoscopy and a regular work up by your doctor to rule out more serious causes of your constipation before moving onto the suggestions I’ve listed below.

Also as a reminder, my Digestive Reset Program addresses root-causes to your chronic constipation by providing an individualized program designed just for you. No more cookie-cutter recommendations or WebMD guidelines, we look at your entire picture to get you on the fastest path to healing.

If you’re looking for accountability and direction to send your on your path to freedom from digestive discomfort, then book a complimentary call with me to get started now.

Without further ado, here are the top 10 root-causes of chronic constipation.

1.) Micronutrient Imbalances

In my Digestive Reset Program, I utilize micronutrient testing to address nutrient imbalances contributing to gut issues.

There are imbalances of a few key micronutrients you’ll want to investigate if you’ve been struggling with chronic constipation, here’s a few of the most commonly overlooked ones.

Low Magnesium

The bowel effects of magnesium deficiency are 2-fold.

First, magnesium draws water into the stools, softening them and making them easier to pass. Most of you have heard of taking magnesium citrate to temporarily relieve constipation. While this is a good temporary fix, often that isn’t enough to get you back on track in the long term.

Second, magnesium is a master electrolyte that helps drive potassium into your cells to promote optimal muscle contraction and relaxation. Once magnesium drives potassium into your cells, your brain signals can communicate with the muscles in your digestive tract.

If there’s not enough magnesium to help drive potassium into the cell, then the neuo-muscular activity in your body becomes diminished leading to impaired contractions of the smooth muscle in your colon leading to constipation.

I recommend getting your magnesium levels tested before supplementing. Long-term daily magnesium supplementation could unknowingly throw other nutrients off balance like vitamin D and calcium, further complicating your issues with constipation as we’ll see below.

My motto is always “test before you guess” to make sure you’re optimally supplementing all micronutrients.

Excess or Insufficient Vitamin D

Vitamin D is a hot topic these days. I see many people supplementing in large doses without even knowing what their actual vitamin D levels are.

On the flip side, I’ve seen people with chronically low levels of vitamin D that their doctor overlooked and never even addressed.

Excess Vitamin D

If you’re one of those people supplementing high doses of vitamin D without even knowing what your levels are, you could end up with high blood calcium levels. Why is this important in the constipation picture? We’ll see in the next section that high levels of calcium can lead to constipation.

Insufficient Vitamin D

Motility disorders are a common reason people experience chronic constipation. We mentioned earlier how magnesium affects intestinal motility, but insufficient levels of vitamin D has also been implicated as a cause.

How it causes constipation is still to be fully determined but studies have hypothesized that low vitamin D causes damage to the neuromuscular structures of the gut.

Excess Calcium

I can’t tell you the number of women I’ve seen supplementing with high doses of calcium, especially those in the peri-menopausal and menopausal stage of their life.

The effect of supplementing with too much calcium can actually lead to and exacerbate constipation.

The reason for this is as your body’s levels of calcium go up, the muscle contractions that keep stool moving in your bowels start slowing down. High levels of calcium also dehydrate you, leaving your stool hard and dry.

Some considerations if you’re supplementing with calcium is to note calcium carbonate (also found in antacids like TUMS) is more likely to cause constipation than other forms of calcium.

You’ll want to properly balance out calcium supplementation with magnesium and vitamin D. Be sure to take calcium in smaller more manageable doses as you can’t absorb more than 500mg at a time.

Again, I always recommend testing before you guess! Balancing out calcium supplementation with magnesium and vitamin D in addition to using the proper form and dose of calcium can help you avoid constipation.

2.) Hypothyroid

One in 8 women will develop a thyroid disorder in her lifetime. When the thyroid fails to produce enough hormones it can have a drastic effect on metabolism. A sluggish metabolism can result in a slowdown of the entire digestive process, leading to constipation.

The symptoms of low thyroid functioning develop slowly over time and you may notice other symptoms that accompany it, such as:

If you think you could be suffering from low thyroid functioning, it’s important you advocate for yourself and request your doctor order you a full thyroid panel. Most doctors will only order TSH, which doesn’t give us a full picture of your thyroid functioning. A full thyroid panel, at a minimum, will include:

If you have low thyroid functioning and address it appropriately, then we’ve addressed your underlying cause. Get your thyroid checked if you’re not sure about your levels, it never hurts to test.

3.) Intestinal Dysmotility

Although a more severe cause of constipation, it’s worth noting that intestinal dysmotility is a condition which impacts the muscles and nerves of the digestive system affecting its speed, strength and coordination.

Dysmotility can happen in the stomach (gastroparesis), small intestine, or the large intestine. Large intestine dysmotility is associated with symptoms of constipation.

There are many causes to intestinal dysmotility which can be characterized into 2 groups:

Nerve and muscle abnormalities may be genetically inherited and it’s common to find family members with intestinal motility problems as well.

Some underlying causes of intestinal dysmotility could include:

Bacterial over-growths can develop because of poor motility, exacerbating symptoms such as constipation. Symptoms of intestinal dysmotility could include:

Not all of the above mentioned signs and symptoms are present in all cases. The exact signs and symptoms present in an individual depends on the underlying cause of bowel motility disorder. Even for the same cause, signs and symptoms may vary between individuals.

Diagnoses typically involves blood work, x-ray studies, motility-transit studies, and intestinal biopsies.

4.) SIBO

Small Intestinal Bacterial Overgrowth (SIBO) is characterized by an increase in number or a change in the type of bacteria growing in the small intestine.

The symptoms of SIBO can include:

Additionally, risk factors that predispose one to SIBO include:

Interestingly, SIBO can be tested and categorized as either hydrogen or methane dominant. Hydrogen dominant sufferers often experience diarrhea, whereas methane dominant sufferers experience constipation. The treatment parameters will differ depending on the type of SIBO you have.

If any of the above symptoms and risk factors fit your profile, then you’ll want ask your doctor for the methane SIBO breath test to rule out methane dominant SIBO as an underlying cause to your constipation.

5.) Food Sensitivities

Food sensitivities are often culprits to causing issues with constipation as foods can cause an immune reaction in the gut. This immune reaction releases pro-inflammatory cytokines leading to slowed digestion.

The most common food sensitivities I’ve seen associated with constipation are dairy and gluten, so this is always a great place to start. Be sure you’re reading labels very carefully to be sure you’re fully eliminating any unintentional ingredients.

However, there could be any number of foods or ingredients triggering your constipation. The best way to pin-point these is with Mediator Release Testing (MRT), which is the most accurate food sensitivity test available on the market.

With MRT testing, we have a tried and true protocol for your elimination diet so we can easily identify your food triggers. This test has been life-changing for my clients struggling with digestive issues.

6.) Dietary Insufficiencies

By dietary insufficiencies, I’m referring to actual dietary components you may be lacking in such as fiber, hydration, and fat, which can greatly contribute to your constipation issues. Let’s look at each of these factors in detail.

Fiber

A lack of high-fiber foods can lead to reduced bulk in your stool causing constipation. If you eat a diet high in processed foods and added sugars, you may want to consider switching to a whole food, real-food diet instead.

Back in the day, as hunter-gatherers, we humans ate 100 to 150 grams of fiber a day. Today most modern humans are lucky if they get just 8 grams daily.  Guidelines suggest women get about 25 grams and men get about 30 grams of fiber daily.

If you’re following a Low FODMAP diet for your constipation, you’ll want to reconsider that. I wrote an extensive article about why the Low FODMAP diet is actually compounding your digestive problem in the long run.

Fiber comes from plant foods (including FODMAP foods), so you’ll want to be sure to get plenty of colorful fruits and vegetables each day. You can also add “super fibers” like freshly ground flax seeds and whole chia seeds.  Try adding 2 tablespoons a day to your smoothies or salads for an easy fiber boost. 

Nuts, seeds, and beans also contain high amounts of quality fiber. If you have trouble consuming beans or other cruciferous vegetables, I always have clients add Bean Assist with these foods to help cut down on gas.

If you begin increasing your fiber intake, be sure to do it slow and drink plenty of water….which brings me to the next suggestion, hydration!

Hydration

I can’t tell you how many clients I’ve worked with who’re under-hydrating. You might not even be aware of it yourself but by under-hydrating you’re actually compromising your bowel habits.

To calculate your water needs, a good rule of thumb is to take your weight in pounds and divide it in half. For example, if you weigh 160 pounds you’d want to drink 80 ounces of water per day, or 10 x 8oz glasses.

You can also look at the color of your urine, the darker yellow it is, the more dehydrated you are and the more water you need to consume. Aim for a straw colored urine for optimal hydration

Choose filtered water as your primary beverage. I personally like sparkling water, and if you want a little flavor you can add sliced fruit to it. Sugary drinks, diet sodas, and caffeinated beverages should be limited or avoided completely.

Fat

Despite being touted as “healthy”, low fat diets can actually contribute greatly to constipation. Consuming adequate amounts of fat in your diet will actually help normalize intestinal motility and aid in lubrication of the bowels. Be sure you’re choosing healthier fats like:

If you’re consuming a low fat diet and experiencing constipation, you’ll want to gradually begin adding healthy fats back into your diet. Those who’re missing their gallbladder or have gallbladder issues will want to add fats in small quantities at each meal and snack and consider supplementing with ox bile at higher fat meals.

7.) Medications

Your constipation may not actually be caused by your health status but from side effects of pharmaceutical medications you’re taking.

I always investigate the medications my clients are on, as it’s super important to factor in how these drugs may be impacting their digestive capacity and overall health status.

An easy way to do that is to visit Drugs.com and type in the drug name you’re taking with the words “side effects” to see a complete list.

A brief list of common drugs that can cause constipation include:

If you struggle from chronic constipation and your medication lists “constipation” as a side effect, discuss it with your doctor so you can find alternative treatment options. This is a very important step in addressing root-cause constipation issues.

8.) Low Stomach Acid & Dysbiosis

Low stomach acid and microbial balances (aka dysbiosis) in the gut can greatly impact constipation as we’ll see below.

Low Stomach Acid

For those experiencing constipation, low stomach acid can be a common root-cause. It can delay bile and pancreatic enzyme output which are important in breaking down foods while promoting gut motility.

Proton Pump Inhibitor (PPI) use such as prilosec, prevacid, nexium, protonix, dexilant, etc can lead to low stomach acid. If you don’t already know about the risks of using these medications read about it here and here.

Other causes of low stomach acid include:

Microbial imbalances in the gut can actually be caused by low stomach acid, as we’ll see next, referred to as dysbiosis.

Dysbiosis

Dysbiosis is basically an undergrowth of healthy bacteria and an overgrowth of unhealthy bacteria. These microbial imbalances can be a root-cause to constipation.

For example, if you have low levels of Bifidobacterium, Lactobacillus, and Bacteroides you’ll experience constipation because pathogenic organisms like Pseudomonas Aeruginosa are allowed to proliferate.

This reduces gut motility and reduces gut secretions important for digesting foods. These pathogenic bacteria can also release endotoxins which additionally contribute to slowed digestion.

Having adequate levels of healthy bacteria in the gut, while also providing enough fuel to feed these bacteria is super important.

Carbohydrates, like FODMAPS, help feed your gut bacteria. If there isn’t enough fuel to feed your healthy bacteria then you’ll miss out on a healthy by-product of their breakdown called Short Chain Fatty Acids (SCFA’s). These SCFA’s, if depleted, can also contribute to slowed digestion.

As you can see there are a number of direct and indirect ways in which dysbiosis contributes to slowed motility in the gut.

If you’re a frequent anti-biotic user, eat a low carbohydrate diet (like Low FODMAP), or take medications (which can alter your gut microbiome unfavorably) you’ll definitely want to investigate dysbiosis as a source of your constipation.

The best way to detect dysbiosis is to get a comprehensive DNA stool analysis. These cutting-edge tests are not offered at your regular doctor’s office because insurance companies don’t cover them.

As a convenience to clients I include DNA stool analysis as part of my exclusive Digestive Reset Program. The results of these tests have been an invaluable resource in helping clients get to the root of their digestive issues.

9.) Hormonal Imbalances

There are a number of ways hormonal imbalances can contribute to constipation, we’ll review two major ones here.

Serotonin

Serotonin is an important neurotransmitter with about 95% of it produced in your gut. Lowered serotonin levels can reduce gut motility and intestinal secretions important for digestion of foods leading to constipation.

How and why is serotonin lowered?

Well there are a number of reasons for this. First, having a negative mood will actually lower serotonin. The interaction between serotonin and mood are 2-way, with serotonin influencing mood and mood influencing serotonin. So working to create a more positive out-look on life will actually help boost serotonin levels naturally.

Getting outside and exposing yourself to natural sunlight daily can also boost serotonin, as well as regular exercise and an optimal diet.

High tryptophan foods (pumpkin seeds, soy foods, cheese, meat, chicken, fish) combined with complex carbohydrates can optimize serotonin production in the body. Yet another reason why avoiding complex carbs, as found in FODMAP foods, could be working against you.

We discussed how dysbiosis (see #8) can be a root-cause to constipation. Having imbalances in gut bacteria can also inhibit serotonin production in the gut. Getting your microbes balanced appropriately seems to be two-fold in getting your constipation under control.

Progesterone

Elevated progesterone levels, as seen in pregnancy and in the luteal phase (2nd half) of your menstrual cycle, have been associated with slowed gut motility. Although not abnormal, hormone surges of progesterone in these phases can have a an effect in slowing your gut.

One theory is that progesterone slows bile secretion from the gallbladder. As bile secretions slow, the ability of your body to break down fats in foods and promote gut motility also slows.

If you’re pregnant, well there’s not much, hormonally, we can change. If you’re in the luteal phase of your cycle, there could be hormonal imbalances that need to be optimized. Sometimes progesterone can be elevated in relation to estrogen (this is common in peri-menopause). Taking a look at hormonal balance throughout your cycle could be incredibly helpful in getting to the root of hormonally induced digestive issues.

Women experiencing peri-menopause or menopause who’re on progesterone therapy will obviously want to investigate hormone supplementation (too much progesterone) as a potential root-cause to their constipation. Check with your doctor to make sure they’re routinely evaluating your hormone levels in response to hormone replacement therapy (HRT).

In addition, recent research suggests that hormonal imbalances in peri-menopause and menopause may not be the culprit to digestive issues after all, but rather, stress, tension, anxiety, and cortisol levels may be the real underlying cause…..which brings me to my next root-cause of constipation, STRESS.

10.) Stress

Whether you’re experiencing stress due to natural hormonal shifts in peri-menopause and menopause or if you live a high stress lifestyle, then you’ll want to seriously consider stress as a root-cause to your constipation.

There are several ways in which real or perceived stress can lead to constipation.

First off, when you experience a stressful situation or a stressful thought, your body releases a hormone called cortisol into the blood stream. Cortisol causes blood flow to divert away from your digestive tract and into vital organs to prepare you for “fight or flight”.

When blood flow is diverted away from your digestive tract, digestive secretions and hormones diminish and as a result you end up with constipation.

Stress also causes an inflammatory processes in the gut that is two-fold.

First, inflammatory cytokines are released in response to stress which can contribute to a slowing of the gut. Second, stress causes dysbiosis in the gut leading to reduced levels of healthy gut bacteria. As we discussed earlier in #8, dysbiosis can eventually lead to slowed digestion.

What can you do? It’s important you have a regular and daily practice, such as meditation, to help you cultivate a more relaxed and positive mindset. Read more here about why cultivating a positive mind-body connection is such an essential piece to your healing journey. Learn the science behind it and get a free guided meditation too!

In Conclusion

We reviewed the top 10 root-causes to constipation that you and your doctor could be over-looking, these root-causes include:

  1. Micronutrient Imbalances
  2. Hypothyroid
  3. Intestinal Dysmotility
  4. SIBO
  5. Food Sensitivities
  6. Dietary Insufficiencies
  7. Medications
  8. Low Stomach Acid & Dysbiosis
  9. Hormonal Imbalances
  10. Stress

Often these root-causes are intertwined and related to one another. For example, dysbiosis can eventually cause slowed digestion. However, slowed digestion could also be caused by: stress, a low fiber diet, medications, an autoimmune condition, or reduced stomach acid.

It’s important to remember to look at the WHOLE picture of your specific health scenario to come up with a protocol that will send you on the fastest path to healing.

I hope this post has shed some light into your considerations around conquering your constipation. However, if you feel more confused than ever, let me help! Enroll in my Digestive Reset Program to get a tried & true protocol and get on the fastest path to healing & relief!

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Sarah Neumann Haske, MS, RDN is a Women’s Health Functional Dietitian and owner of Neumann Nutrition & Wellness, LLC. Her practice helps women heal their gut, regulate their hormones and balance their thyroid using a root-cause approach to their health. As a result of her program her clients are able to come off medications, feel more energized, and be more confident in their bodies again. If you’re interested in being a partner in your own health journey and finding the direction and accountability you need to reach your health goals, then schedule your complimentary call with Sarah now.

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