How To Treat Functional Constipation Using Natural Therapies

Health Is PowHer Podcast Episode 56

With Dr. Anna Esparham-Evans, MD

Constipation is one of the most frequent disorders seen by gastroenterologists worldwide. 

What is Functional Constipation?

And there are several types of constipation but today we’re going to focus on functional constipation which means having two of the following for about 6 months having infrequent stools (conventional medical diagnosis is < 3 per week), straining to stool, hard/lumpy stools feeling like you haven’t completely evacuated - and sometimes this means still feeling bloated, full, or you can still palpate stool in the left lower corner of the abdomen/pelvic area. 

Typically, functional constipation is caused by changes in colonic motility and of course pelvic floor disorders or anorectal dysfunction, like not coordinating the anal and rectal sphincters to actually go #2. 

What Doctors Do to Diagnose?

Typically, your thyroid function has to be assessed b/c hypothyroidism even subtle changes can lead to constipation, calcium levels need to be checked, cancer or anatomical issues, if there are red flags, need to be ruled out, celiac disease and non-celiac gluten sensitivity has to be ruled out (most associated diarrhea with celiac but constipation can occur in about 10% of patients). 

What Can Change the Colon’s Motility?

Some people can be diagnosed slow transit constipation which means their stool movement throughout their intestines is slowed down and this is typically diagnosed by gastroenterologist. 

Otherwise, it’s typically normal transit constipation or defecatory disorders, which we’re going to explain:

The Gut Microbiota

Some changes in the gut’s flora can increase bile acid metabolism and that subsequently increases methane (gas) production that ultimately can cause constipation. 

Diet

Food sensitivities (dairy is a common one that people report causes constipation)

Foods high in certain types of carbohydrates or starches (that’s why some people feel better on certain FODMAP foods)

Stress, anxiety, depression and anything that affects the brain can affect the gut (BRAIN-GUT AXIS)

I’m going to emphasize STRESS here…

Lifestyle 

Sleep changes, health issues, and prescription medications that can affect serotonin/norepinephrine levels like antidepressants, pain medications, antihistamines. 

Lack of movement and physical activity

Changes in routine

Traveling!!

Defecation Disorder

The abnormal coordination of rectal sphincter, abdominal wall muscles, and anal sphincters and the pelvic floor muscles is a very common disorder of constipationt has to deal with incomplete evacuation. 

Pelvic floor dysfunction is common in us women who have this type of functional constipation because all our pelvic floor muscles can be so incredibly tight or relaxed depending on what type of dysfunction. And then we fail to relax the anus or generate an adequate force in the abdomen and rectum to deliver the stool to the anus. So, the contraction and relaxation of the different muscles and sphincters involved in pooping is thrown completely off and totally uncoordinated. 

So How Do We Manage and Treat Constipation?

Prebiotics and Probiotics:

I have experimented so many times with different prebiotics and probiotics, and it is soooo personalized that the research is really tough to piece together which types of probiotics are going to work for you.  

After I had a bout of peritonitis (super infection in the belly after an undiagnosed appendix that had burst for about 3 months) being on IV antibiotics and then developing subsequent non-celiac gluten sensitivity, I have played around with quite a few. 

The spore-based probiotics seem to be a bit more powerful when it comes to regulating the gut flora and communicating with our current microbiome immune system, but still more evidence to come on this. 

Fiber:

The whole fiber thing is also pretty individualized while a lot of the studies have been done on the soluble fiber - psyllium husk, more recently one study found that FLAXSEED actually performed better than psyllium at improving constipation. 

However, flaxseeds are extremely oxidized when milled into “flaxseed meal”, so it’s preferred that one buys organic flaxseeds and “mills” them in a blender/bullet themselves before it oxidizes within an hour. I use flaxseed on my paleo muesli in the mornings (seeds, nuts, blueberries, and coconut flakes with almond milk). 

Acacia fiber on the web has been advocated to improve irritable bowel syndrome, but there’s not a ton of research on this yet.  I personally tried it, and had more bloating with it even when titrating up pretty slow.  I might try it again, but I’m loving the flaxseed fiber!

Hydration:

Increasing water intake for those who are dehydrated may help constipation, but otherwise not so much unless you’re eating more fiber to help bulk the stool and if you’re eating more healthy fats, like on a ketogenic diet where you need extra hydration.

Exercise:

The research studies have had some shortcomings, but that doesn’t mean exercise doesn’t help constipation. 

In general, exercise, movement, physical activity all may help people with constipation.  I know it does for me (especially walking and running and doing some plyometric/jumping exercises in my HIIT workouts).

Anorectal Biofeedback and Pelvic Floor Therapy:

Biofeedback is amazing for those with functional constipation that can’t coordinate their defecation (rectum, anus, abdominal and pelvic floor muscles).  This retrains your nervous system and muscles to recoordinate and have proper bowel movements. 

Pelvic Floor Therapy also helps to release any pelvic floor muscle tension (including bladder!) or strengthen certain muscles that are the culprit.  Physical Therapists trained in pelvic floor therapy are the way to go and typically takes about 6 weekly sessions with you doing the home exercises consistently. 

Osmotic Laxatives:

Magnesium citrate is a common osmotic laxative for those who don’t have kidney issues.  One has to drink a lot of water because it pulls water from your tissues into the colon to have smoother and faster motility. 

Stimulant Laxatives:

Senna is a common natural form that many pediatric gastroenterologists recommend as well. Apparently, the consensus among gastroenterologists now is that stimulant laxatives when used correctly don’t cause rebound constipation necessarily.  Senna comes in all different forms, like tea, chocolate chews, and pill form. It can cause moderate and uncomfortable intestinal cramping about 6-10 hrs later (so women with pelvic pain/severe menstrual cramps - WATCH OUT! b/c it can release a lot of prostaglandins which can be pain inducing substances), so there is a fine line about how much one can take and that also is individual. 

Abdominal Massage:

There is some evidence for abdominal massage in a clockwise direction with an organic oil. Typically this is done daily for 10-15 minutes (I can never get up to this long of a treatment and that’s the reason why it didn’t work for me....), but that’s what some of the research study interventions did and probably why it worked so well. In addition, someone was usually doing the abdominal massage to the participants which is much better than one doing it to oneself. 

Acupuncture

So excited to report that the current evidence shows that acupuncture is SAFE and EFFECTIVE for treating functional constipation. However, we still need more high quality trials. 

Foot Reflexology

I had gone to a reflexologist several years ago for relaxation. And the certified practitioner warned me that I will likely have to go to the bathroom right after. She said that’s the usual side effect from reflexology. I said “great, I could use some extra flow”. And sure enough, I did have to go the bathroom several times afterward, which is VERY UNUSUAL for me.  

When I reviewed the research, it looks like 7 research studies have been examined and finds that foot reflexology is indeed effective for treating functional constipation (though many of these studies were small). So go get your feet rubbed :)

Well that’s not an exhaustive list of therapies, but it’s a start for now and we can continue with more episodes on this as new research comes out!!!