A Root-Cause Approach to Constipation

Struggling with constipation can feel frustrating, especially when your daily bowel movements aren’t satisfying. Healthy stools are crucial, yet often overlooked. In my practice, I frequently discuss stool patterns with clients, covering everything from frequency to shape, color, and consistency. After all, we’re all aware when something feels “off.”

A helpful tool we use is the Bristol Stool Chart, a clinical resource for identifying stool types. Types 1 and 2 indicate constipation, types 3, 4, and 5 are healthy (with 4 being optimal), and types 6 and 7 indicate diarrhea. Let’s focus on the constipated types and explore root-cause solutions.

What is Constipation?

The traditional medical definition of constipation is:

“Constipation is generally described as having fewer than three bowel movements a week.”

But who feels good only going three times a week? From a functional medicine perspective, constipation refers to incomplete or infrequent bowel movements on a daily basis. You’re functionally constipated if you:

• Don’t have daily bowel movements.
• Struggle or strain to eliminate.
• Have hard, painful, or incomplete stools.
• Need to use your hands or fingers to help pass stool.

Ideally, a bowel movement should be like any healthy animal: sit, relax, gently push, and you’re done in under five minutes. If this doesn’t sound like you, you may be functionally constipated.

Constipation can impact your health by allowing waste products to sit too long in your colon, which may lead to toxin reabsorption, gut bacteria imbalances (dysbiosis), altered pH levels, and even colon cancer.

First Steps to Address Constipation and Improve Gut Health

Start by consulting a doctor to rule out any physical colon or rectal issues. Next, check your hormone levels, as imbalances—especially low thyroid—can contribute to constipation. Pregnancy and certain medications can also cause constipation.

You can test your transit time—the time it takes for food to move through your system. Ideal transit time is 12-24 hours; more than 24 hours is slow, and over 48 hours means waste is sitting in the colon for too long. To test, consume ½ to 1 cup of red beets or take four charcoal tablets. Red stools mean the beets have passed, and black stools indicate the charcoal. This will show how long your food takes to move through.

Use Functional Medicine to Check for SIBO or Dysbiosis

If you have slow transit time and experience significant abdominal bloating, you may have small intestine bacterial overgrowth (SIBO). This occurs when bacteria grow in the wrong part of your gut. Constipation can be both a cause and an effect of SIBO, and this condition typically leads to bloating that worsens throughout the day.

To test for SIBO, try following a low-FODMAP diet. If your symptoms improve, SIBO may be the issue. Consult a gastroenterologist or functional medicine practitioner for a breath test to confirm.

Dysbiosis, on the other hand, refers to an imbalance in your gut bacteria, which can include yeast, viruses, and parasites. A GI-MAP functional stool test can help identify which microbes are out of balance, so you can address the problem accurately.

Checklist for Gut Health Deficiencies

Constipation can also result from deficiencies. You might lack movement, fluids, fiber, stomach acid, digestive enzymes, beneficial gut bacteria, or magnesium. These factors are key to achieving a healthy stool score of type 4. Here’s how to identify and address possible deficiencies:

• Movement: Aim for a brisk 15-30 minute walk daily.
• Fluids: Drink half your body weight in ounces of non-caffeinated fluids each day (e.g., 75 oz for a 150 lb person).
• Fiber: Use an app like MyFitnessPal to track your intake and aim for at least 30g of fiber daily. You can also add a fiber supplement, which helps feed beneficial gut bacteria.
• Stomach Acid (HcL): Test by drinking 4 oz of water with ¼ tsp baking soda first thing in the morning. If you don’t belch within 5 minutes, you may have low stomach acid. Try a betaine HcL supplement with meals to see if it helps.
• Digestive Enzymes: Take a pancreatic enzyme supplement (1-4 capsules) with meals and monitor the difference.
• Probiotics: Opt for a high dose of bifidobacteria, which won’t exacerbate SIBO (unlike some lactobacillus strains). Track any improvements.
• Magnesium: Magnesium citrate or oxide are the most effective forms for relieving constipation.

Find Your Personalized Solution

Constipation often stems from a combination of root causes. It’s best to implement these changes one at a time and observe how your body responds. For more complex cases, ordering a GI-MAP stool test can help uncover deeper imbalances in your gut. Once your test results are available, we can work together in a new patient consultation to interpret them and create a personalized treatment plan to resolve your constipation for good.

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