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Constipation: Causes, testing and natural treatment options



"A gastroenterologist once told me that I was going to have to live with chronic bloating and constipation. I left that appointment feeling hopeless." Dr. Mary Pardee

In this video, Dr. Williams and Dr. Mary from modern med dive into the causes and integrative treatment options for constipation. 


Dr. Mary’s Personal Experience with Constipation

I first dealt with constipation as a child, and when I became a teenager, it progressed to bloating and gas in addition to constipation. I was really uncomfortable; I felt full all the time, and my stomach looked distended.


I was having two bowel movements a week, constantly burping, experiencing reflux, and I didn't feel well.


As a teenager, I was really self-conscious about my stomach sticking out, and I spent a lot of time researching home remedies. I saw gastroenterologists, and they prescribed me the normal list of medications for constipation. I was diagnosed with SIBO (small intestinal bacterial overgrowth), but the conventional treatment did not resolve anything. Most of the medications they put me on either did not help or had side effects that made me nauseous. After I exhausted the conventional route, I explored other treatments and saw acupuncturists, chiropractors, and tried A LOT of supplements. I was always buying the newest supplement from the latest health influencers that were podcasting.


I spent thousands of dollars on supplements, and they never fixed my issue. At best, I would feel a little better for a few days or weeks, then it would just go back to where I started.

And to top it off, I was already eating super healthy. I had cut out all of the things the influencers had told me were “inflammatory” and “bad for my gut”. But I still felt bloated and backed up.


All I wanted was to forget about my stomach issues. I wanted to feel like I could wake up, eat a salad for lunch, and not feel nine months pregnant. I wanted to be able to go out with friends and not stress about what to eat or what clothes to wear so I didn't look bloated.

What I really wanted was my quality of life back. At its worst, I would think about my gut symptoms all day long. It took up so much of my mind space I had a hard time getting other things done, and it made me miserable. I wanted to free up my thoughts for things I was passionate about.


I left that gastroenterologist's office hopeless, but it was also a key point in my life—I knew I wanted to become the doctor that I never had and help people find solutions to their gut issues.


Understanding Constipation

The prevalence of constipation varies, with studies indicating that 12-19% of the population experiences it. The perception of constipation can differ among individuals, making diagnosis challenging. Factors like age contribute, with over 65-year-olds experiencing a higher incidence, possibly due to reduced caloric intake, decreased fluid consumption, and lower fiber intake.


People seek help for constipation because they want to have daily bowel movements but more importantly, it significantly impacts their quality of life. Common complaints include discomfort, bloating, gas, and anxiety-related issues.


Diagnosing Constipation

Diagnosing constipation involves assessing bowel movement consistency and, frequency. The diagnosis of functional constipation is based upon the presence of the following for at least three months (with symptoms starting at least six months prior to diagnosis).

  • Must include two or more of the following:

  • Straining during more than 25% of defecations.

  • Lumpy or hard stools (Bristol Stool Scale Form 1 to 2) in more than 25% of bowel movements.

  • Sensation of incomplete evacuation for more than 25% of bowel movements.

  • Sensation of anorectal obstruction/blockage for more than 25% of bowel movements.

  • Manual maneuvers to facilitate more than 25% of defecations (eg, digital evacuation, support of the pelvic floor).

  • Fewer than three spontaneous bowel movements per week.

The other criteria that have to be met are that loose stools are rarely present without the use of laxatives and the person does not have irritable bowel syndrome (IBS). 


"The mind-body connection often plays a crucial role in addressing constipation, a realization that some may resist due to preconceived notions or reluctance to address mental health."

Case Study: Lauren’s* Journey

Meet Lauren*, a 35-year-old woman who is determined to overcome constipation and bloating. She struggled with constipation for 13 years, experiencing only three bowel movements per week. Her journey began during grad school and persisted after giving birth.  Recently, bloating emerged, adding to her discomfort.


Lauren explored elimination diets (taking out gluten, dairy, even grains and legumes), hoping to find relief but with no success. Alongside constipation, she grappled with eczema, fatigue, and intense PMS. She underwent tests and a SIBO breath test revealed methane levels at 65, which is considered very high. 


Her path to healing began with herbal antimicrobials coupled with motility support. Initially promising, her symptoms, especially gas and bloating, improved significantly, offering a glimmer of hope, yet regressed despite her efforts. Bowel movements remained at a scant 2-3 times weekly, and her stools were hard. 


She experimented with low FODMAP, but to her dismay, her condition worsened. She took rounds of antibiotics and a prescription medication for constipation. This resolved her symptoms for a short period of time but then symptoms returned weeks later. 


Dr. Williams and Lauren finally identified that stress was a big contributing factor to her symptoms. Recognizing the pivotal role of stress management and nervous system regulation, Lauren embarked on a new journey. Collaborating with a mental health specialist, daily bowel movements became her new norm. She now manages her condition with magnesium, fiber, and ginger and is very happy with her results. 


Potential Causes of Constipation

Several organic causes of constipation need to be ruled out as well. Potential causes of constipation include diabetes mellitus, multiple sclerosis, pseudoobstruction, hypothyroidism, anorexia, medications such as opiates, antihistamines, antidepressants, and iron supplements, colorectal cancer, irritable bowel syndrome (IBS), small intestinal bacterial overgrowth, and celiac disease.


Alarm Signs

It's crucial to recognize alarm signs, such as blood in stool, significant weight loss, and family history of colon cancer. 


Testing

Dr. Williams emphasizes the importance of thorough testing, including the lactulose breath test, blood work (thyroid panel, CRP, SED rate, celiac serology) and potential referral for a colonoscopy or imaging studies.


Advanced Testing

For persistent constipation, advanced tests like manometry studies and motility studies may be considered.


Treatment:

Constipation treatment encompasses various strategies targeting emotional, physical, and social health. Retraining the bowel and regulating the nervous system for improved colonic function is beneficial. Practices like using a Squatty Potty, maintaining a consistent routine, adhering to regular meal patterns, and gradually increasing fiber intake to 35 grams per day have shown efficacy. Additionally, considering magnesium and medications like Motegrity, Linzess, or Amitiza might be recommended after consultation with a healthcare provider.



*Names and identifying factors have been changed to protect the identity of our patients.


Disclaimer: 

The information in this blog is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this blog is for general information purposes only. Modrn med and Dr. Mary Pardee make no representation and assume no responsibility for the accuracy of information contained in or made available through this blog, and such information is subject to change without notice. This blog does not provide medical services, diagnosis or counsel. You are encouraged to confirm any information obtained from or through this email with other sources, and review all information regarding any medical condition or treatment with your physician. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this information.


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