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What is Constipation?

Constipation refers to having infrequent bowel movements (typically measured as less than 3 per week) that are usually hard to pass. What is considered to be a ‘normal’ bowel movement schedule differs for everyone, so an individual that typically passes a stool every day might actually be experiencing constipation if they start to only pass 3 per week, even if this would be a higher frequency than normal for some. Constipation can cause very strained and difficult to pass bowel movements that may consist of dry, hard, and/or lumpy stools. It can feel like something inside is blocking the stool from coming out, or that the bowels haven’t been completely emptied even after a long time on the toilet. Constipation may also cause bloating and feelings of distention in the abdomen if there are elongated periods of time in between bowel movements. 

What causes Constipation?

There are many potential causes of constipation, ranging from simple issues like dietary habits to more serious health conditions. Constipation has been linked to diets that are too low in fiber or lack enough fluid, and it is possible that diets that don’t take into account how certain foods may affect an individual’s unique gut microbiome may lead to constipation. Low physical activity, alcohol consumption, and certain medications have also been linked to constipation. More complicated causes of constipation can include hormonal conditions affecting fluid balance such as thyroid issues, color and abdominal cancers, and even certain neurological or muscle issues that can affect the movement of stool such as multiple sclerosis. Gastrointestinal conditions like IBS and SIBO can also cause constipation. 

Is Constipation tied to Gut Health?

Bowel movements can be very revealing about the state of a person’s digestive health. A healthy and properly functioning gut microbiome should ideally help produce normal bowel movements, as research has shown a clear relationship between gut bacteria and intestinal transit time. It is thought that the presence of certain bacteria activates a gene in intestinal nerve cells that regulates peristalsis (the muscle contractions that move food through the digestive tract). Healthy peristalsis is a sign of a healthy digestive process, so it makes sense that gut dysbiosis could upset this relationship and lead to the abnormal bowel movements experienced with constipation. Studies have shown that the gut microbial composition of those suffering from constipation differs from that of a non-constipated gut, and usually contains a higher percentage of methane-producing bacteria. High levels of methane may adversely affect peristalsis by over-amplifying the muscle contractions, which in turn may slow the intestinal transit time of stool and lead to constipation. This mechanism may be plainly illustrated in a condition of the small intestine, methane-dominant SIBO, as constipation is one of the most commonly reported symptoms. IBS-C, a type of irritable bowel syndrome that involves chronic constipation, is also thought to be caused by a dsturbed balance of intestinal microbiota. 

Can Antibiotics cause Constipation?

They certainly can. When antibiotics were first discovered, the phrase “magic bullets” was used as a way to describe how they harm the pathogen but not its host- but we now know this concept is not necessarily true. Antibiotics fight bacterial infections by killing all bacteria in their path, which usually results in some beneficial bacteria being killed along the way. It is thought that a more diverse gut microbiome is generally a healthier microbiome, and antibiotics can severely wreck this diversity. This can result in a disturbed microbial balance that can lead to gastrointestinal issues like IBS and SIBO that cause constipation. Antibiotics may wipe out bacterial strains that positively regulate digestive processes, such as those associated with healthy peristalsis, with constipation as a repercussion. Conversely, antibiotics may allow for methane-producing bacteria strains to dominate an altered microbial composition, potentially leading to constipation due to the dysregulation of the intestinal transit process. 

How do you Treat Chronic Constipation?

Unfortunately, many commonly suggested treatment options either do not help relieve constipation symptoms, and may actually cause other adverse effects. An example would be laxatives and stool softeners, as they only temporarily relieve constipation by treating the symptoms and not the root cause. Laxatives can also result in painful stomach and intestinal cramping, gas and bloating, and even nutritional deficiencies if used too often. Broad, one-size-fits-all advice you may find on the internet on how certain dietary and lifestyle changes may relieve constipation doesn't take into account the unique role an individual’s microbiome may have in the cause and treatment of constipation. While simply increasing fiber and drinking more water may work for some, this may not help individuals that are experiencing constipation due to certain microbial imbalances in their digestive system. However, diet and lifestyle changes that work towards a healthier gut and digestion may simultaneously resolve constipation. 

Can Protiotics Help with Constipation?

More research is needed, but it is thought that probiotics may help induce the growth of beneficial bacteria needed for a healthy gut microbiome and healthy digestive system. Studies have shown that certain probiotic strains help shorten gastrointestinal transit time, and positively affect stool frequency and consistency. However, it is important to note that not all probiotic strains may be favorable for each person. Depending on the makeup of an individual’s unique gut microbiome, certain strains may help with a healthy digestion while others may have the opposite effect and further promote constipation. Therefore, using personalized probiotics is the smart option to make sure you are only consuming helpful probiotics that may have a positive effect on overall your gut and digestive health.