Today’s post is for those of you looking to dig even further into the causes of constipation. If you’ve tried everything from fiber, probiotics, hydration, and food elimination diets and nothing has worked, you’re in the right spot. These are the potential root causes behind constipation that are often overlooked. However, suspecting one of them is only part of the battle. The next step would be for you to work with a doctor or functional medicine practitioner who can formally diagnose you. From there, you’ll be able to resolve your issues effectively. With that disclaimer out of the way, let’s get right to it! These are the hidden causes of constipation that you need to know.

Hormones:

Our hormones play a role in the regularity of our stools. This is referred to as motility, which describes the muscle contractions in the bowel that move stool. Hormones can either slow down or speed up motility. [1]]

·     Thyroid

The thyroid, which is a small, butterfly-shaped gland resting at the front of our neck, tightly regulates several metabolic processes, from our metabolism to our body temperature. When it’s no longer functioning at optimal levels, it affects the speed of our motility. Constipation is often the result of an underactive or hypothyroid. A good way to remember it is if constipation is slow, then so too is the thyroid. Slow thyroid, slow motility. [2]

Test Don’t Guess: Don’t go on a google binge and self-treat. Work with a medical practitioner who can properly test you. For labs and what to look for, I recommend checking out this post from Dr. Izabella Wentz, Pharm. D.( aka, the Thyroid Pharmacist).

·     Progesterone

Estrogen steals the spotlight when it comes to hormones, but there’s another one that deserves some attention, too. Progesterone is one of our reproductive hormones; it’s important for prepping and maintaining pregnancy (also prevents miscarriages), regulating menstrual cycles, sleep, raising body temperature, and building stronger bones (stimulates osteoblast activity). [3] [4] [5]

 However, when progesterone levels start rising, several side effects can occur. These include anxiety, increased appetite (potentially leading to overeating), bloating, and, notably, constipation. These symptoms typically happen around menstruation and during pregnancy. [6] [7] [8]

So, if your constipation happens to get worse around your period, you have progesterone to blame. In this case, check out my list here on different ways to relieve it in the short term. If you’re pregnant, talk to your doctor about how to safely ease constipation. Finally, if you suspect your progesterone levels are too high, then request a blood test from a healthcare practitioner.

Motility Disorders

Our GI tract is made of four parts, each separated by a sphincter muscle. The sphincter muscles play a significant role in motility, opening or closing at specific times and affecting the speed of digestion

• GERD (gastroesophageal reflux disease): This is the dysfunction of the lower esophageal sphincter (LES). The LES either relaxes or fails to properly close, resulting in stomach acid to flow back up the esophagus and cause the familiar chest pain and reflux after eating. [9] (By the way, many doctors often prescribe medications that can lead to digestive-related side effects, including constipation.) [10]

• Fecal Incontinence (FI): To put it plainly, this is when you no longer have control of your bowels. While it most famously is known for causing you to soil your underwear (aka, poop your pants), it also causes stool to overfill the rectum and grow stiff. FI is typically caused by weak sphincter muscles in the muscles, either in the nerves or muscles themselves. A physical exam and further diagnostics will be used for diagnosis and treatment. [11] 
• Hirschsprung’s Disease: A rare birth defect resulting in missing nerve cells in the colon. While symptoms happen immediately at birth, they can later manifest in life. Aside from constipation, it also causes watery stools, diarrhea, and loss of appetite. Diagnosis involves x-rays or a biopsy, with treatment often being surgical. [12] 
• Pelvic Floor Dysfunction: Pelvic floor disorders like dyssynergic defecation (DD) involve either damage, weakness, or dysfunction in the nerves or muscles in the pelvic floor. The pelvic floor is a special group of muscles in between the hip bones, right below the abdomen. Its function is to support the rectum, uterus, and urinary bladder in the pelvis and maintain healthy bowel movements. Half of patients with chronic constipation often have DD. [13] Symptoms include trouble “squeezing” or defecating, fullness, incomplete BM’s, and chronic constipation. Diagnosis involves a series of physical exams and tests. With treatment, strengthening the pelvic floor is essential. Biofeedback therapy (neuromuscular training) and bowel re-training are considered the first-line treatments before laxatives and medications. [14] 
• Gastroparesis: A type of disorder where food “sits” in the stomach or takes too long to be digested. Aside from feeling uncomfortably full even after a few bites, symptoms include constipation, extreme nausea, vomiting, bloating, reflux, and pain. Think of it as “paralyzed” or “frozen” digestion. While most cases are considered idiopathic (meaning the cause is unknown), others are either due to diabetes, surgery, medications, or damage in the vagus nerve. Treatment may involve medication, surgery, feeding tube, and diet changes. [15] [16]

Infections and Overgrowths

Finally, chronic constipation may be the symptom of either an infection or overgrowth, such as:

• SIBO (small intestinal bacterial overgrowth)
• SIFO (small intestinal fungal overgrowth)
• Yeast infections (candida Albicans)
• Parasites (helminths, giardia) [17] [18]
• H. Pylori [19]
• Clostridium Difficile (C. diff) [20]

To get rid of these unwanted guests, you’ll need to get tested not only for confirmation but for how severe your case may be. In cases like C. diff, you’ll need to be hospitalized. Others require you to take antibiotics or herbal supplements over a period of time. Like constipation, overgrowths can be a symptom, not a cause. For instance, in cases like hypothyroid, motility slows down, which increases your chance of bacterial overgrowth in the small intestine (SIBO). [21] Testing and fixing the overgrowth is just the beginning. You’ll need to dig deeper into root causes, like thyroid imbalances, autoimmune disease, poor lifestyle, chronic stress, etc.

Over to You

I hope this list gives you some direction with your constipation! Don’t ever give up. Sometimes, you need to keep questioning and searching for answers. As you can see, there are many, many reasons why constipation may be happening. And way it’s a sign of a more significant issue at hand. As always, be sure to share your thoughts with me down in the comments!

Sources:

[1] https://www.iffgd.org/gi-disorders/motility-disorders.html
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985619/
[3] https://forevher.healthywomen.org/facts-to-know-questions-to-ask/progesterone/
[4] https://academic.oup.com/jcem/article/96/4/E614/2720877
[5] https://www.ncbi.nlm.nih.gov/pubmed/2194787
[6] https://www.sciencedirect.com/science/article/abs/pii/S0018506X17303847
[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2885896/
[8] https://www.webmd.com/baby/bloating
[9] https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940
[10] https://www.healthline.com/health/gerd/constipation#medications
[11] https://www.drugs.com/health-guide/fecal-incontinence.html
[12] https://www.aboutkidsgi.org/lower-gi/hirschsprung-s-disease.html
[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4930297/
[14] http://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm16060
[15] https://www.iffgd.org/upper-gi-disorders/gastroparesis.html
[16] https://my.clevelandclinic.org/health/diseases/15522-gastroparesis
[17] https://www.ncbi.nlm.nih.gov/pubmed/20962736
[18] https://www.medicalnewstoday.com/articles/167079.php
[19] https://www.mdedge.com/infectiousdisease/article/137748/gastroenterology/constipation-implicated-indicator-helicobacter
[20] https://www.mdedge.com/infectiousdisease/article/137748/gastroenterology/constipation-implicated-indicator-helicobacter
[21] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056127/