Sluggish gut? Here are 5 tips you can implement starting now to improve constipation
29-Dec-2021
I recently came across a funny meme about constipation which described the condition so perfectly: “GTG, BRB/LOL JK.”
In basic terms, it means when nature calls, it may be playing a cruel joke. The “urge” can resolve as soon as you sit down for a bowel movement, just for you to stand up and again feel like you could “go.” It’s this constant dance of “should I go or not go?” and a lot of time spent in the bathroom unsuccessfully on the toilet.
If you’re reading this, you have probably tried to increase your fluid and fibre intake. If you are constipated due to irritable bowel syndrome, the increase in fibre likely made your symptoms worse. And sometimes the increase in fluid causes more bloating — an uncomfortable side effect.
What causes a “sluggish gut”?
A “sluggish gut,” or chronic constipation, is most commonly due to a secondary cause. These include irritable bowel syndrome (IBS), hypothyroidism, diabetes, depression, anxiety, conditions or diseases that affect blood vessels and nerves, medications, and some vitamin and mineral deficiencies.
Constipation has classically been defined as having three or less bowel movements per week. However, incomplete evacuation — which is the feeling like you’re not passing all the stool — is a hallmark symptom of constipation. So, too, is having difficulty passing stools, passing stools that are hard or dry, and sitting on the toilet for long periods of time.
How can I improve my constipation?
I want to spend a little time here on the actions that can improve constipation. There’s a lot of information online about the causes of constipation as well as conventional approaches to improving constipation, but less information available about what to do when the typical fibre, water, and laxatives don’t work, and when secondary causes like hypothyroidism and diabetes have been ruled out.
Since a primary focus in my clinical practice is irritable bowel syndrome, the 5 tips below can be helpful for individuals suffering with IBS constipation but also apply to those with chronic constipation without IBS.
1. Dietary changes.
It’s important to recognize that individuals with IBS constipation will experience a worsening of symptoms with certain aggravating foods. These foods increase intestinal gas production which causes changes in colonic pH, leading to changes in gut bacteria. This, in turn, causes location inflammation and activation of the immune system, changes to colonic function, and finally results in gastrointestinal symptoms including excessive gas, bloating, and changes to bowel patterns [1]. There are well-researched diets like the low-FODMAP diet that can lead to significant improvement in symptoms, however, this is meant to be a short-term diet and should be done under the supervision of a qualified practitioner.
2. Supplements.
There are several evidence-based supplements that may help patients with IBS constipation. I do want to note that individuals with IBS have a high placebo response to supplementation, meaning that in clinical trials, they tend to respond positively to the placebo or “fake treatment.” Supplements that have shown to benefit IBS patients in randomized, placebo-controlled trials are enteric-coated peppermint oil, melatonin, and vitamin D. Probiotics remain a highly recommended supplement by naturopathic doctors, MDs, and GI specialists, however, I find not all probiotics work equally, as certain species, like Lactobacillus plantarum, outperform other species specifically for patients with constipation. Much like dietary interventions, supplementing truly does require the help of a qualified practitioner, as there are many nuances in the implementation and monitoring of supplementation.
3. Support mental health to improve gut health.
You may have heard me talking about the “gut-brain” connection. Patients with IBS have significantly higher levels of anxiety and depression compared to non-IBS patients, regardless of IBS subtype [2, 3]. There is considerable evidence that an array of mind-body and other psychological therapies can be an effective treatment for IBS symptom severity [4]. In my clinical practice, I find that when patients implement stress- and anxiety-reducing activities, such as mindfulness-based therapies, their symptoms improve. Similarly, I also find that lack of implementation or attention to mental health is a barrier to symptom improvement.
4. Bowel retraining.
I am a big proponent of pelvic floor physiotherapists and osteopathic practitioners, both of which use manual therapy to work on the muscles and fascia of the digestive system. Dyssynergic defecation, which is an acquired behavioural problem due to the inability to coordinate the abdominal and pelvic floor muscles to evacuate stool, occurs in up to 50 percent of individuals with chronic constipation [5]. Retraining the bowel with manual therapy and biofeedback therapy can be tremendously helpful.
5. Exercise.
Bowel movements are more frequent and colon transit is more rapid in physically active individuals compared to sedentary individuals [6]. Additionally, exercise stimulates the release of “feel-good” hormones like dopamine and serotonin, leading to improvements in mood and stress (see: mental health section above on why this is important for constipation!).
In summary, the good news is that there are many other interventions that can improve constipation beyond increasing water and fibre intake. To save time, money, and headache, I recommend working with a qualified practitioner who has a special focus on digestive health, with a legal scope of practice and medical training (such as a registered naturopathic doctor) in order to rule out other conditions that cause constipation.
Did you find the above information helpful? Stay tuned for my digestive health program “Getting to the bottom of IBS” being released in spring 2022. Sign up for my newsletter for notifications on my program launch!
Dr. Dominique Vanier is a naturopathic doctor in Burlington, Ontario with a focus on digestive health and hormones. As a regulated health provider, she is registered to see patients in Ontario both virtually (online) and in person.
References:
[1] Werlang ME, Palmer WC, Lacy BE. Irritable Bowel Syndrome and Dietary Interventions. Gastroenterol Hepatol (N Y). 2019;15(1):16-26.
[2] Fond G, Loundou A, Hamdani N, et al. Anxiety and depression comorbidities in irritable bowel syndrome (IBS): a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci. 2014;264(8):651-660. doi:10.1007/s00406-014-0502-z
[3] Lee C, Doo E, Choi JM, et al. The Increased Level of Depression and Anxiety in Irritable Bowel Syndrome Patients Compared with Healthy Controls: Systematic Review and Meta-analysis. J Neurogastroenterol Motil. 2017;23(3):349-362. doi:10.5056/jnm16220
[4] Shah K, Ramos-Garcia M, Bhavsar J, Lehrer P. Mind-body treatments of irritable bowel syndrome symptoms: An updated meta-analysis. Behav Res Ther. 2020;128:103462. doi:10.1016/j.brat.2019.103462
[5] Rao SS, Patcharatrakul T. Diagnosis and Treatment of Dyssynergic Defecation. J Neurogastroenterol Motil. 2016;22(3):423-435. doi:10.5056/jnm16060
[6] Zhou C, Zhao E, Li Y, Jia Y, Li F. Exercise therapy of patients with irritable bowel syndrome: A systematic review of randomized controlled trials. Neurogastroenterol Motil. 2019;31(2):e13461. doi:10.1111/nmo.13461