The Health Consequences of Chronic Constipation
Constipation isn’t something often discussed.... But given it affects up to 25% of the population (and mostly women) it means a lot of us are suffering in silence.
In fact, almost all of the individuals who reach out to me for a gut health consultation are struggling with constipation.
In 2020 OTC revenue of laxatives in the United States alone reached around 1.54 billion. Clearly, constipation is a problem.
While most people think of constipation as just an annoying symptom, rather then a factor that both causes and results in damaging health consequences, the truth is, constipation is much more then a mild annoyance. It can be the root cause of other symptoms and conditions as well. Hormonal imbalances, fatigue, weight gain, anxiety, mood disorders are just a few.
If you’ve ever battled chronic constipation you know how debilitating it can be, not just physically but mentally and emotionally as well.
Pooping is a basic human function, something our bodies should be able to do naturally, but for many this sadly is not the case.
Before I go further let me preface by saying we all can get a little backed up after travel, or a few days of poor nutritional choices. That happens, and can be easily fixed by cleaning up your diet, hydrating, and getting some exercise to help move things along.
This blog is specifically meant to address chronic constipation, the kind that carries on for months and years, leaving you feeling fatigued, moody, bloated and toxic. The kind of constipation you’ve maybe even seen a doctor for, only to be told it’s “normal”, “in your head”, or to just take some Miralax and move along.
If that sounds familiar, then I’m here to tell you that constipation is actually a HUGE health risk, something you need to address and clear out ASAP.
In this blog I’ll define what constipation is, explain how chronic constipation is much more then “tummy troubles”, and explore ten side effects of constipation.
WHAT IS CONSTIPATION, EXACTLY?
Constipation can mean different things to different people so I want to start by defining what chronic constipation is.
There are different ways to tell if you have constipation.
The first is to use the Rome III diagnostic criteria which identifies people as having functional constipation when 25% of bowel movements are associated with at least two of the following symptoms:
• hard or lumpy stools
• a sense of incomplete evacuation
• a sense of anorectal obstruction
• the need for manual maneuvers to remove or dislodge stool or stimulate a bowl movement
• having fewer than three bowel movements per week in the previous three months, with an onset of symptoms longer than six months
Another way to look at constipation would be to use the Bristol Stool Chart. This is a visual aid designed to classify ones poop by placing it into one of seven categories.
Frequently eliminating stool that matches Type 1 or 2 in the chart generally indicates a problem with constipation that should not be ignored.
I have an entire blog post dedicated to understanding the Bristol Stool Chart here.
I personally believe a healthy bowel should produce a healthy stool at least once a day, and when I work with clients who have ongoing issues with constipation this is my goal.
HOW CONSTIPATION HARMS YOUR HEALTH
Most people think of constipation as a symptom of, rather than the cause of their health problems. For many gastrointestinal conditions like gut pathogens, dysbiosis, leaky gut and food sensitivities, this is definitely the case - which is why you might need to get tested and uncover the root cause of your constipation.
But, constipation itself can also be the root cause of other symptoms and conditions.
Constipation can cause whole body health problems, stemming from one of three main issues;
1. Toxin reabsorption in the colon, including excess hormones, that would normally be excreted in the stool. 2. Imbalance of intestinal flora, including a reduction in healthy species and overgrowths of unwanted bacteria or pathogens. While dysbiosis can cause constipation, constipation and poor motility can also be the cause of dysbiosis.
3. Structural and physical effects of large hard stools and the straining that commonly accompanies them. This can lead to fecal impaction, internal or external hemharroids, or anal fissures.
It’s these mechanisms that often are the catalyst for a whole range of unwanted symptoms. I’m going to get into ten of the more common side effects of constipation below.
TEN SIDE EFFECTS OF CONSTIPATION
Constipation and fatigue go hand-in-hand, with strong evidence for a connection between the two.
A dysbiosis caused by constipation can increase the fermentation of carbohydrates and the production of various gases, including super smelly hydrogen sulphide thought to cause dysfunction of the mitochondria - the energy producers within our cells.
And when you don't eliminate regularly or properly, you don't naturally detoxify properly. Toxic substances you should be expelling from your body then get reabsorbed and can enter the bloodstream, impacting energy levels and causing fatigue.
Do not, for one second think constipation is not a contributing factor to weight gain. I do not just mean in the sense that you're (literally) carrying around waste in your body, I mean actual bodyweight gain. Constipation and the systemic inflammation it causes can literally cause an increase in body fat through several mechanisms.
Science is just starting to understand how dysbiosis can cause or contribute to weight gain and obesity but the link is definitely there.
Hormone imbalances, particularly those relating to oestrogen have also been linked with obesity. So if you’re backed up and your body is unable to clear out excess estrogens, this means they get reabsorbed back into the body, causing body fat to go up.
Another side-effect of toxicity associated with constipation is acne and skin breakouts. This happens when toxins and waste are re-absorbed back into the bloodstream via the colon, rather than being eliminated.
From the bloodstream, these toxins can exit the body by way of the skin, which is the largest detoxification organ.
The other mechanism by which constipation can impact skin is through the alteration of gut bacteria.
I read an IG post once that said “beauty begins in the bowel” and it’s true. For more on the gut/skin connection check out my blog here "Common Gut Related Skin Conditions"
Constipation is one of the highest risk-factors and most common causes of small intestinal bacterial overgrowth (SIBO) .This condiiton (and its subtypes) happens when bacteria from the large intestine are allowed to colonize in the small intestine where they don’t belong.
In fact, SIBO is thought to be responsible for up to 80% of IBS cases. While the most common symptoms associated with SIBO are constipation, diarrhea and extreme bloating, it has also been connected with fatigue, weight gain and many of the other issues discussed in this blog.
One SIBO subtype, methane SIBO is both caused by, and can actually cause, constipation too, so this can be a vicious cycle.
Brittle nails & thinning hair
Excess toxins being reabsorbed into the bloodstream also contributes to poor nail and hair health.
Poor immune health
Our intestinal flora is responsible for much of the body’s immune response, including the removal of cell debris, viruses, bacteria, and cancerous cells. Most of your body's immune system is in the gut.
As constipation is often associated with missing or damaged bacteria (intestinal flora), the impact on your immune system can be significant.
The toxic buildup and inflammation associated with constipation can also impair the immune system and leave you vulnerable to illness and infections.
In clients who have constipation, I commonly notice low IgA levels (signaling poor immune function) correlate with dysbiosis or overgrowth of pathogenic bactiera in the gut on a stool test like the GI MAP.
I see this- ALOT. Constipation can inhibit the excretion of unwanted estrogen from the body and promote its reabsorption.
We are exposed to a lot of environmental sources of estrogens through toxins such as plastics, medications and hormones in the animal proteins we consume. This means that most people have excess oestrogen coming into the body that then needs to be excreted each day. (for more on endocrine disruptors you may want to read my blog here)
If you are constipated excess estrogens can be re-absorbed in the colon and cause elevated estrogen levels relative to testosterone and progesterone. This can in turn cause things lie allergies, weight gain and fatigue,
Beyond functional and chronic disease, constipation can also cause physical or structural problems that may require surgical intervention.
Straining during bowel movements, sitting on the toilet for extended periods, or passing hard stools can result in hemorrhoids, rectal prolapse, and anal fissures.
Hard stools and increased intra-abdominal pressure are thought to add extra pressure to the veins around the anus and increase the risk of hemorrhoids .
The connective tissue around the anus can also weaken, leading to rectal prolapse, a condition in which the rectum protrudes through the anus. And, passing hard or large stools can cause anal fissures, which are small tears in the skin of the anus.
These are very real issues that can have consequences.
Faecal impaction is the result of chronic or severe constipation and is basically a bowel obstruction caused by poop that has hardened in the colon to the point that it is causing a solid blockage.
This doesn't necessarily mean you will cease to eliminate, as liquid stool can bypass the impacted poop, causing overflow incontinence, often mistaken for diarrhea. This is common in the elderly.
In severe cases, fecal impaction can cause ulcers or bowel perforation. This is definitely one of the more severe side effects of constipation.
Anxiety and Depression
Mood and anxiety disorders have long been linked to, and correlated with constipation and other gastrointestinal disorders.
And while constipation is often thought to be the symptom, recent neuroscientific research has begun to show the importance of microbiome balance in the development of brain symptoms. I discuss the gut-brain connection more here.
But there is a clear connection between what happens (or doesn't happen) in your gut, and your mood. While anxiety and stress can cause slower transit time and dysfunctional motility, chronic constipation, can actually in and of itself, cause anxiety and depression.
This study found that constipated patients had higher psychological distress than healthy subjects and that of the psychological distress, anxiety, depression and pain disorders were the most prevalent
The Bottom Line:
Constipation (chronic) is not healthy, nor “normal“. Do not let anyone make you feel otherwise.
If you are battling with chronic constipation, it's not something you should leave unaddressed
While you may have never made the connection until now, it's important to realize that constipation can actually cause a variety of additional health issues.
It is important to simultaneously work at uncoverMing the root cause of your constipation while supporting your body through it. Diet adjustments, lifestyle changes, stress management, herbs, and prokinetics can all be helpful in alleviating constipation
Reach out for support! It can help to work with a qualified professional, someone experienced with GI issues and constipation who can guide you through proper testing, support your efforts, and ensure you don’t go through the process alone.
I recently graduated from the Institute for Integrative Nutrition where I completed additional coursework in gastrointestinal health. If you’d like expert guidance and one-on-one support approaching your chronic constipation, I’d love to talk to you about how I can help! Allisonmoyer@live.com