Constipation

Bowel regularity is an important aspect of wellbeing, yet it is often overlooked. While occasional constipation is common, nearly 33 million Americans live with chronic constipation, making it a frequent concern among healthcare providers.(1-3)

What is Constipation?

We define constipation as a stool frequency of fewer than three, organic or unprovoked bowel movements per week.(1-3) 

Constipation is often accompanied by symptoms such as bowel discomfort, lumpy or hard (Bristol Type 1-2) stools, difficulty in passing stool, straining during more than 25% of defecation attempts, partial or incomplete evacuation, abdominal cramping, and a sensation of blockage. These symptoms can significantly impact quality of life.

Constipation is a multifactorial condition that can come in two key forms: acute & chronic.

• Acute constipation often comes on quickly and is short lived. Common triggers include travel, temporary dietary changes, or medication use. 

• Chronic constipation occurs when constipation persists for 6-months or longer. This can further be broken down into either primary or secondary constipation. 

  • Primary constipation is caused by gastrointestinal motility issues or pelvic floor dysfunction.

  • Secondary constipation: results from external factors affecting gut function, such as dehydration, low fiber intake, immobility, medications (pain relievers, antihypertensives, antidepressants), hormone imbalances (e.g., diabetes, hypothyroidism), pregnancy, neurological disorders (e.g., MS, stroke, TBI, neuropathy, dementia), mental health conditions (e.g., anxiety, depression, eating disorders), or structural abnormalities like masses or obstructions in the GI tract. (1-3)

Treatment of Constipation

Standard first line treatments for constipation aim to soften and bulk the stool to move it along. This could include increasing hydration, using laxatives, and boosting fiber intake. 

Laxatives:

• Osmotic laxatives are those that draw water into the lumen of the intestine to soften the stool. Osmotic laxatives include Miralax (polyethylene glycol), magnesium, lactulose, vitamin C, etc.  

• Stimulant laxatives such as senna or bisacodyl (Dulcolax) irritate the bowel to induce evacuation. These are best for short-term use due to risks of dependence, electrolyte imbalance, and bowel dysfunction.

• Bulk-forming laxatives (soluble fibers such as psyllium husk or wheat dextrin) increase stool mass, which is beneficial when transit is normal but stool volume is insufficient. Foods like artichokes, asparagus, and kiwi are natural sources of soluble fiber, but there are many more!

Physical Activity

Although literature is mixed on the benefits of exercise in constipation, regular physical activity can promote peristalsis or contractions in the bowels, as well as ease stress that can affect bowel signaling. It also has a positive effect on the gut microbiome which can play a key role in how quickly stool moves.

Prokinetics:

If we break this word down, pro- means “in favor of, or to proceed with” and kinetics means “movement”. These agents help move stool along, but they do so a bit differently than a stimulating laxative. Prokinetic agents promote GI motility not by irritating the colon, but by stimulating the stomach and small intestine’s migratory motor complexes, thus improving transit. They may also alleviate symptoms of functional dyspepsia. Some of my favorite natural prokinetics include ginger & artichoke. 

Pelvic Floor Therapy

For those with secondary constipation related to neurological dysfunction, pelvic floor therapy can help retrain and strengthen muscles crucial for healthy bowel movements.

A Deeper Dive

If bowel movements remain inconsistent after these changes, a deeper investigation into the root cause is warranted. 

Stool testing 

Stool testing can shed light on the microbial balance of the colon. Not only only is this helpful in determining if species such as candida or methane producing bacteria are overgrown but it can also show whether or not beneficial bacteria status is sufficient. Often I see that those with low beneficial microbe status live with either frequent diarrhea or constipation, as these bacteria are responsible for producing key signaling molecules such as serotonin, short chain fatty acids or bile acids, which also act as a pro-kinetics.

Food Sensitivity Testing

Sensitivities to certain foods can contribute to altered bowel motility. A classic example is dairy consumption for many people, but others could be at play such as grains, eggs, etc. See my article to learn more about food sensitivities here. 

Thyroid & Hormone Testing

As multiple endocrine imbalances can affect one’s metabolism and elimination processes, it would be worth while to screen for:

• Thyroid Function (TSH, free T4, free T3)

• Blood sugar control (Insulin)

• Reproductive hormone status (Progesterone & Estradiol)

• Stress Hormone (Cortisol)

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References:

• Diaz S, Bittar K, Hashmi MF, Mendez MD. Constipation. In: StatPearls. StatPearls Publishing; 2025. Accessed November 17, 2025. http://www.ncbi.nlm.nih.gov/books/NBK513291/

• Sadler K, Arnold F, Dean S. Chronic Constipation in Adults. Am Fam Physician. 2022;106(3):299-306.

• Constipation: practice essentials, background, pathophysiology. Published online October 17, 2021. Accessed November 17, 2025. https://emedicine.medscape.com/article/184704-overview?icd=login_success_email_match_norm