Constipation, bloating and IBS are among the most common “gut issues” people experience on a regular basis, affecting more than 1 in 4 people (1-4).

Here’s what you need to know about why constipation, bloating and IBS happen and what to do about them.

The Real Cause of Constipation, Bloating & IBS

man with constipation holding stomach

Constipation, bloating and IBS are not diseases, they are symptoms and syndromes often indicating something is not right. The two most common causes of constipation, bloating and IBS include:

(a.) A gut pathology (like SIBO, dysbiosis, leaky gut) and/or

(b.) Stress (such as a food sensitivity, lack of water, poor quality sleep, mental stress, etc.).

Regardless of the cause, constipation, bloating and IBS can all affect your quality of life—from running to the bathroom, feeling awful after you eat or feeling “stuck” inside.  Sometimes symptoms can even occur so frequently that they become your “norm” or you stop questioning what it could be like to feel differently.

Constipation Overview

Constipation is impaired colonic function and alterations in gut transit of feces, that includes two or more of the following:

  • Lumpy hard stools
  • Sensation of incomplete evacuation
  • Sensation of anorectal blockage
  • Manual manoeuvres to facilitate defecation
  • Loose stools rare without the use of laxatives
  • Insufficient for IBS with constipation

How it Happens

Some common triggers for constipation include:

  • Altered gut microbiota—such as dysbiosis or SIBO;
  • Food sensitivities/intolerances;
  • Low stomach acid or digestive enzymes;
  • Liver/gallbladder congestion;
  • Hormonal imbalances;
  • Poor thyroid function;
  • Low water intake or poor water absorption;
  • Low fiber intake or digestion of the fiber;

  • Poor sleep quality;
  • Intestinal permeability;
  • Straining
  • Medications;
  • HPA Axis Dysregulation (stress; inflammation);
  • Altered gut motility (low 5HT, serotonin);
  • Altered gut signaling and/or gut reflexes
  • Structural abnormalities

 

 

What’s Going on “Under the Hood”

Constipation is a byproduct of altered colonic and/or defecation function (elimination) which often goes hand in hand with an altered gut microbiota, digestion and gut function.

Although some cases of constipation involve obstruction or structural abnormalities in the GI tract (such a Megacolon or sphincter dysfunction), the majority of constipation cases are “functional disorders” in nature—disorders of gut–brain interaction. Functional GI disorders are classified by GI symptoms related to any combination of the following: motility disturbance, visceral hypersensitivity, altered mucosal and immune function, altered gut microbiota, and altered central nervous system (CNS) processing.

Underlying Triggers of Constipation

Some of the key mechanisms underlying constipation include:

  • Poor Water Absorption

A healthy colon receives approximately 50 ounces (about 6 cups) of liquid daily from the small intestine alone, which helps is absorbed then transported, along with waste, to the rectum, where it is expelled or stored until elimination is convenient. If we are low on water intake or our colon absorbs too much water at once, then overly dry stools and constipation can arise.

  • Poor Motility & Nerve Signaling

Poor colonic motility is common in constipation. Motility of the GI tract helps propel and contract food, wastes and feces through the system. Motility is primarily driven by the nervous system, and is greatly influenced by serotonin (“feel good” brain chemicals produced in our gut). Low serotonin production from a disrupted gut microbiota can decrease GI motility.

In addition, stress and HPA Axis interruptions can stall the normal elimination process. In a healthy colon, large, coordinated contractions (known as high-amplitude propagated contractions [HAPCs]) bring poo forward in mass movements from the ascending colon down to the left colon. HAPCs typically occur in the morning soon after awakening, as well as around meals for some people, when we exercise or after eating something that doesn’t agtree with us. When stool enters the rectum, it causes GI distension and a conscious realization of the urge to poo. If the timing is not appropriate (such as the body senses stress or a threat), the rectum accommodates to store the stool temporarily, resulting in the dissipation of the urge and propagating contractions. Normal colonic transit in adults ranges from 20 hours to 72 hours, but in those with constipation it can be longer—anywhere from 48 hours to 120 hours.

  • Disrupted Gut Microbiota

Gut bacteria can have an inhibitory or supportive affect on our elimination patterns. Gut bacteria produce deconjugated bile salts that may promote colonic motor responses. Other (unhealthy) or dysbiotic bacteria may produce gases (such as H2 and S) and organic acids in excess that may contribute to the symptoms of slowed motility, constipation, gas and abdominal distension.

Additionally, short chain fatty acids (SCFA’s)—nutrients produced by gut bacteria—have been shown to stimulate intestinal contractions and the intestinal release of 5-hydroxytryptamine (5-HT)—necessary for pushing food and waste through out system. In addition, SCFAs may directly stimulate the intestinal and colonic smooth muscle contractility.

Bloating Overview

The term “bloating” refers to the sensation of abdominal inflation or swelling and trapped gas in the upper GI tract. It is often accompanied by visible distention (an increase in abdominal girth), gas and/or belching.

Bloating is most often experienced following meals.

How it Happens

Some common triggers for bloating include:

  • Altered gut microbiota—such as dysbiosis or SIBO;
  • Food sensitivities and impaired digestion;
  • Poor food quality (old, rancid, difficult to digest);
  • Low stomach acid or digestive enzyme production;
  • Carbohydrate malabsorption;
  • Impaired motility;

  • Hormone imbalances (often also intertwined with altered gut microbiota);
  • Impaired gut signaling or “GI reflexes;”
  • Increased stress and inflammation;
  • Extra swallowed air and/or poor chewing (eating too fast);
  • Poor sleep quality;
  • Intestinal permeability;
  • HPA Axis Dysregulation (stress; inflammation);

 

 

Since optimal digestion happens in the parasympathetic (“rest and digest”) state, if the gut is at “unrest,” then this creates a more hospitable environment for bloating

 What’s Going on “Under the Hood”

Gut bacteria play a key role in bloating and flatulence through carbohydrate fermentation and gas production. Higher intestinal gas or imbalances in intestinal gas levels [particularly Nitrogen (N2), oxygen (O2), carbon dioxide (CO2), hydrogen (H2), and methane (CH4)] account for more that 99 percent of bloating and expelled intestinal gas.

If your gas has an odor, it may also contain higher amounts of sulfur-containing compounds such as methanethiol, dimethyl sulfide, hydrogen sulfide, as well as short-chain fatty acids, skatoles, indoles, volatile amines, and ammonia—often byproducts of unhealthy gut bacteria.

 IBS Overview

IBS is a diagnosis of exclusion when other functional gastrointestinal diseases (such as IBD, GERD, or diverticulitis) that have a structural effect on the gut are ruled out in conventional medicine.

It is characterized by symptoms of recurrent abdominal pain or GI discomfort associated with two or more of the following:

  • Improvement in symptoms with stool elimination
  • Inconsistent or altered stool patterns (i.e. loose, hard/difficult to pass, etc.)
  • Onset associated with a change in frequency or consistency of the form of stool

IBS is typically referred to as either “IBS-D” (with diarrhea) or “IBS-C” (with constipation), depending on which symptom one experiences more frequently.

To officially be diagnosed with IBS, symptoms must be present for at least three months, with onset at least six months previously. Constipation and bloating are also common symptoms. Unfortunately, many cases of IBS often go undiagnosed due to patients thinking their symptoms are “normal” or frustration from being bounced around the medical field for many years with varying diagnoses because of the lack of interest in treating IBS and its underlying cause(s).

How it Happens

Some common triggers for IBS include:

  • Altered gut microbiota—such as dysbiosis or SIBO;
  • Food sensitivities/intolerances;
  • Food Poisoning;
  • HPA Axis Dysregulation (stress) and hormone imbalances (cortisol);

  • Environmental toxin exposures;
  • Immune dysfunction;
  • Low stomach acid;
  • Intestinal permeability;
  • Temporomandibular disorders (TMD)
  • Genetic Polymorphisms (gene alterations)

 

 

What’s Going on “Under the Hood”

IBS is poorly understood in conventional medicine. It is viewed as a disorder resulting from an interaction among a number of factors and no single abnormality has been found to be specific for the syndrome.

Some research reports that visceral hypersensitivity (increased sensation in the gut) is a frequent finding in irritable bowel syndrome (IBS) patients. Perception in the gastrointestinal (GI) tract results from stimulation of various receptors in the gut wall. These receptors transmit signals via afferent neural pathways to the brain, consequently perpetuating the ongoing cycle of IBS symptoms—especially when stress is present.

However, this explanation does little to define why this hypersensitivity happens in the first place.

Given the strong ties between IBS and its symptoms to other underlying pathologies, it is a safe assumption that IBS is primarily a group of symptoms with different ideologies and underlying pathologies, including things like gluten or food intolerance, SIBO, disrupted gut microbiome, gut infections, low stomach acid, gut-brain axis dysfunction, toxin exposures (heavy metals, mold), immune dysregulation, leaky gut, and genetic polymorphisms (alterations).In short: To address IBS, you actually must first identify your gut pathologies.

Constipation, Bloating & IBS Busters

Experiment with these busters to east bloating symptoms while you address the underlying root cause:

  • Drink (enough) water. Hydration is key for easing digestive symptoms. Add lemon.
  • Boost Stomach Acid. Swig an Apple Cider Vinegar Shot (in water) or take HCL Tablets with meals
  • Enzyme Up. Look for a blend in you enzymes, including: Protease/pepsin, amylase, glucoamylase, lipase, ox bile, etc.
  • Cook, Sautee, Puree & Mash Veggies. Raw veggies are much more difficult for your body to break down.
  • Drink Ginger Tea. Ginger in food, or ideally as a strong tea, helps stimulate saliva, bile and gastric juice production to aid in digestion.
  • Make Fat Your Friend. Add healthy fats to meals. Work like a “slippery slope” for moving food through your GI system
  • Move Your Body. Get up and move throughout the day with short walks, a set of squats, or yoga poses. Don’t stay in one position for too long (i.e. stuck at your desk).
  • Sleep (Enough). Just like your energy levels and brain cells need sleep to restore and function at their peak, so do gut bacteria. Gut bacteria have “intestinal rhythms” similar to circadian rhythms. Sleep disruptions and deprivation negatively impact the gut microbiota, releasing proinflammatory cytokines in the body (inflammation) and activating the “stress response” when we don’t get enough (7-9 hours).
  • Take Your Time. Do you ignore the urge to go? Make time in the morning to sit down and try to go. If it’s a strain, consider using a Squatty Potty that supports the natural squatting position. You can also mimick this position by leaning back when you are sitting in the loo and pulling your knees towards your chest into a squat-like position.
  • Take a Quality Probiotic & Eat Fermented Foods (1-2 per day as tolerated). Refuel the gut microbiome with probiotics to help balance out the GI. Start with soil based organisms and 1-2 condiment sized servings of probiotic rich foods.
  • Supplement Smart. Some natural remedies include:
    Bloating

    • Peppermint Oil Capsules
    • Digestive Bitters (Such as dandelion, chamomile, licorice root and aloe vera)
    • Liposomal Curcumin
    • Vitamin B Complex
    • Apple Cider Vinegar Capsules
    • Atrantil (a formula with peppermint, quebracho, horse chestnut) or other natural herbs (ginger, garlic/allicin, mint)

Constipation

  • Peppermint Oil Capsules
  • Digestive Bitters (Such as dandelion, chamomile, licorice root and aloe vera)
  • Liposomal Curcumin
  • Vitamin/Electrolyte Blend (Vitamin C, Magnesium, Vitamin K, Calcium)
  • Vitamin B Complex
  • Magnesium Glycinate
  • Prokinetics (specific supplements that help GI motility)
  • Prebiotic Fiber (such as Partially Hydrolyzed Guar Gum & Glucomannan)
  • Probiotics: Lactobacillus plantarum, Bifidbacteria infantis, soil based organisms, transient commensals, E. coli Nissle

Loose Stools/Diarrhea

  • Activated Charcoal
  • Saccharomyces boulardii
  • Prebiotic Fiber (such as Partially Hydrolyzed Guar Gum & Glucomannan)
  • Probiotics: Soil based organisms, transient commensals, E. coli Nissle, quality lactic acid probiotic (with clinical research behind it, such as VSL#3 or Seed Probiotic)
  • Limit FODMAP Foods (stick to 1-2 servings per day) FODMAPs are a list of several types of carbohydrates that are easily fermented by gut bacteria and subsequently produce gas, bloating, constipation and IBS symptomsFODMAPs is an acronym for:
    • Fermentable
    • Oligosaccharides (eg. Fructans and Galacto-oligosaccharides (GOS))
    • Disaccharides (eg. Lactose)
    • Monosaccharides (eg. excess Fructose)
    • and
    • Polyols (eg. Sorbitol, Mannitol, Maltitol, Xylitol and Isomalt)

Not every FODMAP will affect you, but of the ones you eat regularly, it’s worth an experiment to see what cutting back can do for improving how you feel. See the FODMAP Cheat Sheet.

foodmap cheat sheet, constipation, bloating, IBS

 

Low FODMAP Food List

foodmap list, constipation, bloating, IBS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

  1. Sanchez, M. I., & Bercik, P. (2011). Epidemiology and burden of chronic constipation. Canadian journal of gastroenterology = Journal canadien de gastroenterologie, 25 Suppl B(Suppl B), 11B-15B.
  2. Jiang X, Locke GR, 3rd, Choung RS, Zinsmeister AR, Schleck CD, Talley NJ. Prevalence and risk factors for abdominal bloating and visible distention: a population-based study. Gut. 2008;57:756–763.
  3. Nagari M, Thomas L. Diagnosis and management and of irritable bowel syndrome. Prescriber. 2014;25(6):17-23.
  4. Zhao, Y., & Yu, Y. B. (2016). Intestinal microbiota and chronic constipation. SpringerPlus, 5(1), 1130. doi:10.1186/s40064-016-2821-1