Episode 10: Why You Don’t Poop
Constipation and Bloating: Definitions, Myths, Causes, and Practical Strategies
Why do you feel bloated even when you’re pooping every day? Is constipation always caused by not drinking enough water or eating enough fiber? In this episode of the Gut Girls Podcast, naturopathic doctors Dr. Dominique Vanier, ND, Dr. Whitney Baxter, ND and Dr. Christina Carew, ND unpack the surprising causes of constipation, bloating, and digestive discomfort.
Learn why daily bowel movements don’t always mean healthy digestion, how hidden constipation can contribute to abdominal bloating and distension, and why common advice about fiber and hydration doesn’t work for everyone. The team explores the Bristol Stool Chart, gut motility, the gut-brain connection, pelvic floor dysfunction, probiotics, hemorrhoids, medications that can slow digestion, and the many factors that influence bowel health.
Whether you’re struggling with chronic constipation, IBS-C (irritable bowel syndrome with constipation), incomplete evacuation, gas, abdominal pressure, or persistent bloating, this episode provides practical insights to help you better understand what’s happening in your digestive system.
In this episode, you’ll discover:
• The connection between constipation and bloating
• Why you can be constipated even if you poop every day
• Common myths about fiber, water, and digestive health
• How probiotics may help support bowel regularity
• Red flags and symptoms that should be investigated further
• The role of the nervous system, stress, and the gut-brain axis
• Lifestyle habits and toileting strategies that can improve bowel movements
• Common medications and health conditions linked to constipation
If you’ve ever felt frustrated by digestive symptoms, overwhelmed by conflicting gut health advice, or unsure why your bloating won’t go away, this episode will help you ask better questions and understand your body more clearly.
Because Better Gut Health Changes Everything.
00:00 10: Why You Don’t Poop
01:01 Constipation and Bloating Intro
01:58 Bloating vs Distension Explained
02:58 Bristol Stool Chart Basics
03:44 Real World Constipation Cases
06:22 Myths About Fiber
08:47 Daily Poop Myth and Overflow
11:21 Water and Hydration Myth
13:55 Do Probiotics Help
14:49 What to Assess in Clinic
17:00 Red Flags and Testing
22:47 Lifestyle and Toileting Habits
25:21 Tools and Laxative Options
28:02 Root Causes and Types
29:25 IBS C vs Functional Constipation
32:54 Practical Takeaways and Wrap Up
10: Why You Don’t Poop
Constipation and Bloating Intro
Dr. Dominique Vanier, ND: Welcome back, listeners. I’m joined by my Team Gut Girls co-hosts, naturopathic doctors, Dr. Whitney Baxter and Dr. Christina Carew, and our honorary baby member on my lap today. today’s topic is all about constipation and bloating. So in this intro, we’re first gonna define what constipation actually is.
and so it’s clinically defined as infrequent, difficult, or incomplete bowel movements. Constipation, as we know, is actually a major cause of abdominal bloating, so up to 90% of constipated patients experience bloating. In one multi-center study of about 2,200 patients with functional constipation or IBS constipation, bloating prevalence was really high.
Over 90% of the participants with either functional constipation or IBS constipation reported bloating. So there is a really strong connection there.
Bloating vs Distension Explained
Dr. Dominique Vanier, ND: We also want to [00:02:00] distinguish that constipated people are more likely to have both bloating and distension. So we’ve talked about this in previous episodes, but we’ll redefine it here.
It’s a quick… It’s a, it’s a subjective feeling when we talk about bloating. So that means that we feel like there is, for example, a balloon in the abdomen, whereas distension is more like an increase in physical girth. So for example, patients will describe, like, looking in the mirror and saying that they feel like they look six months pregnant.
And often, people will have both bloating and distension present together. And so there are many reasons why somebody who is constipated is more likely to experience bloating, and one of the main ones is because they actually have retained stool. and that’s gonna increase a few different things, so that will lead to an increase in colonic volume, an increase in luminal distension.
It’ll change the stretch signaling, and all of these can contribute to feelings of fullness, pressure, and bloating in somebody.
Bristol Stool Chart Basics
Dr. Dominique Vanier, ND: And so some of our [00:03:00] listeners may know what something, it’s like an objective tool that we use in practice called the Bristol Stool Chart. So constipated people are typically at the type one or type two on the Bristol Stool Chart.
So type one is described as, like, those, you know, tiny rabbit pellets, and type two is just a little bit larger than that, and both of them are seen in constipation. and if you don’t know what this chart is, it’s great, so look it up online. But one major myth we want to go over is that if you’re having a bowel movement daily, this means you can’t be constipated, and that’s not true.
So stay tuned, because we’ll talk a little bit more about how we can still be constipated when we are actually having a bowel movement daily. and constipation can be any of the varying degrees that we just described above.
Real World Constipation Cases
Dr. Dominique Vanier, ND: So with that intro, maybe we can dive into, Christina and Whitney, have you seen any difficult constipation cases recently?
Dr. Christina Carew, ND: Yeah, for sure. I would say it’s like an every day someone is constipated of some level. and it [00:04:00] doesn’t mean that you couldn’t be constipated and have another reason for bloating, and I think that’s a piece that, listeners need to realize is that, So I have, I have one patient, she’s still with me, like four years of working through constipation.
but one of the things we recently figured out is that she has a lot of internal hemorrhoids, and so when her internal hemorrhoids are really flared, she has a really hard time getting the stool to pass through because the passageway is decreased in volume. And so one of the ways that we figured out that was part of it is, and I think we’ll probably talk about this later, is doing a transit timing test, and it was like several days before her stool passed, so we knew that she was, like, not only backed up, but there was, because she was getting blood on the stool, it was like sort of this combination sort of situation.
So keep in mind that constipation alone may not be your bloating problem, but part of it.
Dr. Dominique Vanier, ND: Yeah, that’s really helpful. It’s, it’s incredibly common to see hemorrhoids in constipation, [00:05:00] and interestingly, even the patients that have, like, a mixed presentation, so, like, they go back and forth between constipation and more the loose end diarrhea, even the diarrhea or the, or the loose bowels is enough to aggravate the hemorrhoids.
So we don’t always need to be constipated to have an aggravation of our hemorrhoids. what about you, Whitney? Any tough cases lately?
Dr. Whitney Baxter, ND: Yeah, I’m like you both where the majority of my bloated patients were talking about constipation or this hidden constipation, and a lot of it is my, my busy mamas. So they get up, and their whole morning routine is dictated by their kiddos and getting them out the door, so they don’t have that slow intro to the day.
Even me, I try to wake up at 5:00 in the morning to have a moment to myself, but whose little door opens when they hear the coffee machine turn on? It’s my five-year-old. So we do our best, but if we’re, we don’t have a ritual and a slow, calm ritual sometimes, then the nervous [00:06:00] system just switches into go, go, go mode, and it’s hard to have that, like, full complete feeling of a bowel movement.
Dr. Dominique Vanier, ND: Yeah, that’s definitely really helpful. We… And we do talk a little bit more about this, which is we need our nervous system to be in more of, like, a calm state to really allow for that gut-brain connection to happen and then to, to support the motility. So we’ll dive into that a little bit in a moment.
Myths About Fiber
Dr. Dominique Vanier, ND: but let’s talk maybe a little bit about some myths and misconceptions.
So we have four that we wanna go over, and, I can go over maybe the first one here. So, a very common misconception is that more fiber helps with constipation and bloating, and this actually isn’t true for some people. So we know that fiber increases stool bulk and can help in mild or occasional constipation, but in more severe or chronic constipation cases, sometimes fiber can backfire.
and that has to do with the type of fiber, and I know we’ve gone over this a little bit in, I think, the FODMAP episode that [00:07:00] we recently recorded. But it has to do with, like, for example, high-brand cereal. Often patients will feel worse depending on their type of constipation, and that’s because it’s more of an insoluble fiber that they’re reacting to, and that can lead to more gas and bloating.
But interestingly, we also know that a low-fiber diet should not automatically, be assumed to be the cause of chronic constipation. So what the research shows is a lot of patients with chronic constipation will have normal or even high fiber intake. So they’ve already taken care of this. Like, people, people wanna solve their constipation, and one of the first things they’re gonna think about is, like, “Do I have enough fiber or water in my diet?”
And often they’ll take care of that before they come to see us. so constipation is really, like, multifactorial and such as motility disorders, pelvic floor dysfunction, medications. There’s, there’s a lot of other things beyond fiber and water that can be leading to issues i- in the bathroom. some other misconceptions or myths that you guys [00:08:00] have, come across in conversations?
Dr. Christina Carew, ND: Yeah, I would add to the fiber one just saying that lots of times people will be taking tons of fiber or those fiber gummies or fiber- Yes … pills, but they’re just not taking enough water with it, and so they definitely, like, make the constipation worse, because all the hydration is kind of getting sucked into that area.
So being mindful- Yeah … of that, for sure.
Dr. Dominique Vanier, ND: That’s a great point, and also knowing that there, like, there’s different fibers too, and so it’s not always, like, so the, the Metamucil powder or the psyllium husk powder is not the same as, like, fiber gummies. That’s often a different type of fiber, and some people may react to those more than such as, like, in the, the powder, which is a different type of fiber.
So helpful information there. What are some other misconceptions?
Daily Poop Myth and Overflow
Dr. Whitney Baxter, ND: I think what you talked about, Dawn, with the Bristol Stool Chart is helpful to show people what a bowel movement should typically, what’s, what’s normal versus more on the constipated side. ‘Cause sometimes they say, [00:09:00] “Yeah, I’m having a movement every day.”
But if we show them and they, they say, “Actually, it is a little bit firmer.” And if we ask more questions to get this more detailed about it as we do, then yeah, they start to notice, “Oh, maybe it is more incomplete,” or, “I am straining more than I thought I was.” So this misconception of having a bowel movement every day, that you can’t be constipated is a good, myth to just highlight because a lot of people notice that.
So we can be having a bowel movement every day, but if it’s not complete, it can give you that sense of, like, still bloating or sluggish or, like a sense of incomplete evacuation is what it talked about in the literature. but yeah, just that feeling of not feeling fully empty. so you can think about a water in a bathtub analogy.
So if the water isn’t flowing through the drain well, it will result in more and more backing up into the top of the bathtub. So we want that drain to be emptying [00:10:00] fully every day, otherwise we are getting this backup of fluids and foods, and it will just lead to bloating and then obviously distension ’cause it needs somewhere to go.
Dr. Christina Carew, ND: Yeah, I think of this also, like, when I describe it to patients a- about a tube, right? Or, like, we think about it as a pipe. And so the assumption is that there’s nothing blocking the pipe, and so it- when it comes out hard, it’s because the entire pipe is hard. And that’s why sometimes we’ll get that diarrhea and then constipation is because it’s not fully blocked, but something needs to kind of like slide by.
It’s like a, a sink that’s a little bit stuck in the s- in the kitchen. Like, some water still gets through, but maybe it trickles down the drain, instead of it, like, whooshing out into the, into the pipe. And so just thinking that, like, just because your stool sometimes is more loose does not mean that you still couldn’t have constipation even with those bowel movements every day
Dr. Dominique Vanier, ND: We have a lot of good house infrastructure analogies today.
Yeah. The [00:11:00] bathtub, the kitchen and the pipes. that’s really helpful. It’s, it’s, I believe it’s known as loose stool overflow. So we can get, like, this hard stool, but then we’ve got loose stool that slides around it, and still the approach is that we need to support the constipation. And ideally just make sure that stools are more like a type four on the Bristol Stool Chart more regularly.
No, go ahead.
Water and Hydration Myth
Dr. Christina Carew, ND: I was gonna say, misconception number three is, like, drinking more water relieves constipation. I actually have a, a great case about this. So I’ve got a woman who, … she’s like, “Oh, I’m drinking lots and lots of water.” she’s one of my regularly constipated patients, and I asked her to show me the water bottle and, and she brought it into the screen, and it was crazy.
It was like two liters, and she was drinking, like, three of those a day. And she was getting really, like, swollen and, like, c- and, I was like, “I think you’re over-hydrating.” And she’s like, “Yeah, but I’m still constipated.” And so one of the strategies we worked on [00:12:00] was, like, the water actually wasn’t, moving into her body.
She still felt really thirsty. It was, like, passing through because she had diluted so much of the minerals that her body needed. So, drinking more isn’t always better. There’s, like, sort of a finite amount of how much do you need to drink based on, you know, heating, air conditioning, sweating. You know, what else are you consuming?
How much caffeine are you having? So it’s not that there’s a universal amount for every person. I think that’s sometimes one of the things that, we are like, “Oh, well, I drink eight, eight cups,” or, “I drink eight glasses.” And a cup and a glass is very different. and then there’s also people that are just drinking those Stanley mugs like they’re going out of town.
And so, that’s a lot of water. And so maybe part of what you’re need to consider is if you’re having a lot of hydration and still having constipation, that it’s best to talk to someone about how much water should you be drinking and, you [00:13:00] know, should some of that maybe be electrolytes or other types of fluids so that you’re getting some of those minerals in.
Even, like, herbal teas can sometimes really help. And so we can be dehydrated even if we’ve consumed a lot of water
Dr. Dominique Vanier, ND: Yeah, certainly if people don’t put salt on their meals, or, and, and also don’t, don’t eat out, so they’re, it’s all home-cooked food, but they’re not adding really any minerals into their food is…
And they’re drinking a lot of water, they may be, they may be more likely to be dehydrated. I do get a question often in clinic, which is, you know, how much water should I be drinking? How much water, means that, you know, I would, could be dehydrated? So it seems that falling below about four glasses a day or under one fluid a- from drinks would make somebody mildly dehydrated.
But we also have to keep in mind we get a lot of fluid from our foods, like fruits and certain vegetables. So it needs to include that as well.
Do Probiotics Help
Dr. Dominique Vanier, ND: Okay, and then more, I’ll call this one a myth, but myth number [00:14:00] four is that probiotics don’t work for constipation. and so we wanted to chat about this a little bit because the evidence has evolved pretty considerably in this area.
There was a 2022 meta-analysis that found probiotics and synbiotics significantly increased stool frequency and improved stool frequency in chronic constipation, outperforming placebo. But what, you know, what’s interesting, too, is that not all probiotics will work. If one probiotic doesn’t help, it doesn’t mean that the next one is not going to help.
There’s multiple strains, there’s different doses, there’s different forms. So probiotics is a little bit like of a dog’s breakfast, and so working with a practitioner to, to really figure out if probiotics are helpful is, is a key part of this, this part here Okay, so I have a question for both of you.
What to Assess in Clinic
Dr. Dominique Vanier, ND: what are some of the things we wanna discuss or assess when someone comes to us needing support for constipation?
Dr. Whitney Baxter, ND: Well, we’ll, we’re diving into when this [00:15:00] all started for them. For some people, they can say, “Oh, I’ve always been this way.” so we’re getting really clear about how long it’s been going on, and then all about the bowel habits. Right. So how frequently are you going throughout the day? How many… I like to ask, how many days are you going without a bowel movement?
Yes. So is it one day, two days? ‘Cause sometimes it can be more on the normal side versus we are actually calling this more constipation. So getting really clear about that. Bristol Stool Chart we talked about, so we’ll show this in clinic. One day I will get it framed as a beautiful addition to my clinic, my clinic walls.
And then asking things like, “Are you straining? Do you see blood in your stool? Are you, do you feel like it’s incomplete? Is it hard stools? Are you using any laxatives? Are you needing to get this, like, through in other ways, when this, when this is, like, really uncomfortable?” ‘Cause [00:16:00] some people don’t even notice that they are anymore.
“Oh, yeah, I have Smooth Move tea every weekend,” or, “I need this a lot more than I realized.” So kinda getting clear about that. And then any triggers. Sometimes after, like, a stomach bug, we’ve talked about this before, but any alteration to the microbiome ecosystem, so after antibiotics, stomach flus. Do you remember when this happened for you?
what you’ve tried in the past. So have certain laxatives worked? Have certain probiotics worked? Has anything made it worse? so getting clear, but have you tried adding in more water? What types of fiber are you adding in? What’s on that fiber, nutrition label? What other types of fiber? Sometimes things like…
And you might talk about this soon, but, certain types of fiber like inulin can be really, really, like, flaring for a lot of people. It can just, feed the microbiome and cause a lot of gas and discomfort. So we’re trying to just look for any things that help speed things up or are maybe contributing to the [00:17:00] slowdown.
Red Flags and Testing
Dr. Whitney Baxter, ND: and then of course, any– we’re always searching for red flags, so ruling out things like unintentional weight loss, any bleeding that you’re noticing in the stool or when you’re wiping on the toilet paper. Or if you’ve had any testing done, it’s called a FIT test, so where you, like, collect your stool and you send it back to Life Labs.
and then we’re always looking at your blood work. Is there, is there ev- other evidence of blood loss even if you’re not seeing it? So iron deficiency or iron deficiency anemia, especially if you eat meat and your periods are not particularly heavy, we wanna be more curious about where that iron is going.
if you have fevers, even if they’re coming and going, that can be a pattern that we’re thinking about. Any pain in your rectum or lower abdomen, any pain with that bloating, pain passing your stool. and then we’re really getting more concerned if this is happening all of a sudden in older adults, so in our fifties, sixties, even forties.
We’re starting to kinda [00:18:00] screen more for, colon cancers, really recommending those FIT tests or even referring for colonoscopy. So just really covering our bases. We do a really comprehensive overview of, this whole presentation for you
Dr. Christina Carew, ND: I would add to that, is the constipation when you do have a bowel movement, does the bloating go away?
‘Cause that can help us when we’re thinking about this, piece of bloating. also, has their thyroid been checked, or is that an issue? Because we see lots of people when their thyroid medications get changed, sometimes the constipation is a result of that, and they don’t even realize it, or they’ve, you know, forgotten to take it, or their dose changed.
and also, a lot of… I have a lot of people that will come in as newly constipated after traveling or after hot weather. so there’s a lot of, like, that dehydration. And so even though they’ve, like, come back to their regular habits, there’s sort of this cemented stool stuck inside, and part of our job is [00:19:00] to get the old stuff out so the new stuff can flow again.
and so it might be even a temporary constipation situation where you’re having it, but maybe it’s only been a short period of time, and that may be as a result of something that happened. You got a flu or a cold. Yeah, you’re in menopause, and you’re getting a ton of hot, flashes and night sweats. so thinking about, like, there’s a lot of reasons why people might be getting, um, more stuck stool.
And we talked a little bit about the fiber, and so, you know, maybe too much fiber, or the wrong type of fiber, or too little fiber. so people who are pursuing, like, low FODMAPs because they think that that might be a relationship to their bloating often have such a little amount of fiber that they’re actually also not getting enough stool formation.
And even things like, um, gluten. So I always call gluten glue. And so lots of people that have, um, gluey stools will sometimes have [00:20:00] a harder time getting them out, and they’ll, they’ll notice, um, sort of those patterns if you can get them to recall, like, oh, what did you have the night before for food, things like that.
Um, sometimes people have other food sensitivities like dairy or things that cause them more inflammation. Um, and so it’s not necessarily that you’re sensitive to that food. You might be, but you may also be struggling with how to break it down in your body, and so it’s creating more of, like, stuckness.
Dr. Dominique Vanier, ND: Interesting point about the travel too is if somebody comes back saying that their constipation improved when they are traveling is we want to look at things like qu- quality of food, but also if they were more relaxed, if they were moving more. So travel can be an interesting test for some people. and we’ve talked about, you know, fluid and the amount of fluids.
The goal that I will usually s- give to people that I discuss this with is about at minimum a liter and a half a day. But again, it depends on the person and adjusted for body weight, activity, climate, et [00:21:00] cetera. and medication discussion is also important too. So this is often, like, a critical, possibly a missed step.
There are many ca- medications that we know can possibly cause constipation in some people, so those are the opioids, tricyclic antidepressants, your antipsychotics, anticholinergics. Even iron supplements can do it, and that even can depend on a few other factors like the dose of iron, often higher doses or the type of iron may be more constipating than lower doses.
things like antacids, diuretics. So there’s a few, a few medications. Not everybody who’s on a particular medication may have a bowel response to it, but it’s certainly something that you wanna discuss with, with your practitioner What else?
Dr. Whitney Baxter, ND: And a lot of the times, like, these medications can’t be changed or adjusted.
I used to work in cardiac rehab, and so it’s like after a cardiac event and they’re kind of put on this list of medications to stabilize them, and they need them, [00:22:00] right? They’re important medications to be on long term, but not a lot of people are asking about their bowel habits. You know, these gastroenterologists are making sure they’re stable, and then they’re, um, you know, admitting them to, like, an outpatient setting, so they have exercise therapists, dieticians, which is a great program.
But this is an example of, like, not everybody’s following up on your, your digestion and your bowel habits, and you could be uncomfortable for years and no one said, like, “Oh, this medication that you need actually has this unfortunate side effect.” So I think it’s always nice to have a second set of eyes and kind of reviewing your list of medications and t- of course, if you’re taking it properly and then the side effects.
That can be pretty straightforward, but we can really help with diet adjustments, exercise, movements.
Lifestyle and Toileting Habits
Dr. Whitney Baxter, ND: and then this too is bowel habits and toileting behavior. So we can help you, kind of plan your day and your positions to have a more comfortable and complete bowel movement. So our bodies [00:23:00] love a routine.
I have one-year-olds. Dom has a little baby too, so we can see how much they need these routines, but these timed, bathroom breaks. So the mornings, attempts in the mornings after a meal, for example, to really leverage something called the gastrocolic reflex. So every time that food enters our system, our guts are gonna feed back to the brain and the, the whole, like, m- mechanism of having a bowel movement to say, “Okay, it’s time to go.”
So if you feel that urge, just really encouraging people to go, to not hold it, ’cause that, that, that urge will go away. so just like, yeah, morning routine discussions is something we’ll dive into, and then posture, the squatty potty or supported squat. So feet elevated on a stool for a while there.
It’s really popular to get these high toilets, but actually we need to be a little bit lower with our legs up. So [00:24:00] putting your feet up on a stool, to… and then to really get into that posture, leaning forward, that really helps strengthen… It straightens the anorectal angle and reduces straining effort.
So it’s, it’s an an- anatomic position that can be really helpful
Dr. Christina Carew, ND: I would say, one thing that we didn’t ask about in the history that might be really relevant is sometimes people are told if they have had a colonoscopy that they have a torturous colon or, like, a longer colon. And so that generally means for people that they have more feet of colon, and so they have more dehydration because there’s more water absorption.
It’s just in there for a longer period of time. I have a growing list, I think I’m almost at a dozen of these people now. And so some of their struggle is, like, that things are never normal for them because of, because of that. The hemorrhoids would be also one. People have varicose veins, so we know there’s, like, more pressure in the lower part of the [00:25:00] body.
And people without gallbladders. so we know that bile is a big part of the, the m- motility, cascade. And so if you don’t have a gallbladder, you’re sometimes not getting that reflex that, Whitney, related to in order to get the idea of, like, food in, food out or making space.
Tools and Laxative Options
Dr. Christina Carew, ND: we also see that sometimes people, are using, tools to be able to help them to get their stool out, and so we wanna ask about, you know, what are the tools that they’re already using, and those might include medications.
So sometimes people are prescribed medications from their, primary care. Things could be like prucalopride or Constella. they work on different receptors in the small intestine to push stool forward. There’s also lots of herbs that work in this area. So some people might say, “Oh, I use ginger tea,” or, “I use, other, like, herbal formulations,” or, “I use things that support my gallbladder, and those seem to help.”[00:26:00]
Or not help. and then that’s sort of like upper GI, so that’s below the stomach and before the large intestine. In the large intestine, a lot of the tools that we always think of classic constipation movers are things that we wanna learn about, you know, are the patients using. So would that be something, um, like PEG, um, which is called Restorlax i- in where we are, uh, magnesium citrate or magnesium oxide, which work as these like they pull more water into the colon to help basically loosen.
I always say it’s like a Slip ‘N Slide. If there’s no water on the Slip ‘N Slide, you’re not going anywhere. bulk-forming laxatives, so that’s the things like this Metamucil or the psyllium fiber. we might have stimulant laxatives, so someone talked about Smooth Move tea already or Senna tea or, Ex-Lax, those types of like things that are kind of creating more, urgency or more urge.
there’s stool softeners that people may be using, or [00:27:00] also other types of, medications that are more laxative-inducing. And so sometimes, people who struggle with constipation for a long time may have been given some of these, and maybe they didn’t feel good. So they’re like, “Oh, I went from constipated to having like really runny stool, and that didn’t really help my bloating,” or, “Maybe the runny stool did help my bloating, but then it aggravated my hemorrhoids or it made it difficult for me to leave the house.”
So there’s often like a longer story of, you know, what are the things that people have tried. And so not just knowing, you know, what they tried, but did it help? Did it not help? Did they have to increase the dose? Did it help for a while, and then it stopped helping? all of that can be helpful to understand more about what’s going on ’cause as you started to realize, there are lots of reasons for constipation, similar to like there’s lots of reasons for bloating.
And if constipation is triggering the bloating, we wanna make sure that we’re dealing with the right reason why there’s constipation, or else we won’t actually know that that’s part of the [00:28:00] problem.
Dr. Dominique Vanier, ND: Yeah, that’s really helpful.
Root Causes and Types
Dr. Dominique Vanier, ND: And yeah, we can maybe go into the causes right now because as I think our listeners have determined, it, it is, it’s multifactorial.
So when we talk about constipation, we wanna think of it in really two more simplistic ways. So it’s, it’s either one of the following: it’s an obstruction of the luminal content movement, or it’s poor colonic propulsive activity. And we can have primary functional constipation, or we can have more secondary, which means it’s due to something else.
So if it’s primary, we’re thinking of maybe normal transit constipation, which actually accounts for at least half of cases. We can have slow transit constipation, so that’s more about a quarter to 30% of chronic constipation cases. Or we’ll have something called defecatory or pelvic floor disorders. And we didn’t go into that too much, [00:29:00] but that’s more like a dysenergic defecation, where we seem to have, like, lost kind of that brain pelvic floor connection, causing issues with that rectocolic reflex.
So when it comes to secondary constipation, we’re not talking too much about that today, but that’s more due to other conditions, so, like, things like uncontrolled diabetes, neurological issues like Parkinson’s, uh, et cetera.
IBS C vs Functional Constipation
Dr. Dominique Vanier, ND: So maybe, um, you guys can help me dive a little bit into more of the primary functional causes, and we’ll start with IBS constipation.
maybe we can talk a little bit more about that.
Dr. Whitney Baxter, ND: So yeah, we’ll dive into IBS constipation, and we’ve talked about this a lot in other episodes, but it’s one of those disorders of gut-brain interaction, so there’s a lot of causes to this. But essentially, the definition is, and the key, differentiator is that there’s pain or discomfort that’s associated with the constipation.
and there’s a [00:30:00] lot of underlying factors, so we’re screening for these things, but one of the main things is visceral hypersensitivity. So it’s where the gut is over-sensitive to normal levels of, like, food and gases and fluids moving through your, your digestive tract, any expansion or distension happening.
so it’s generating pain and urgency without anything wrong or anything abnormal. It’s driven by gut-brain axis signaling, and they’re just yelling at each other inappropriately, and there’s a lot of, like, causative factors that go into this that we’ve talked about more in the Disorders of Gut-Brain Interaction podcast, so tune into that one.
but other things that can be going on are mast cell activation, low-grade mucosal inflammation. So that’s a whole other podcast that we have as well. there’s a lot of histamine involved there and other chemical mediators in the immune system, so more immune-driven. Another thing is gut microbiome dysbiosis.
So we need, like, a good [00:31:00] ecosystem of a, a number of different species to help move the gut, and, and that can contribute to a slowed down gut. increased test- intestinal permeability, leaky gut. So things moving through what should be a tight gut lining, but instead they’re leaking through into our bloodstream and showing the immune system that something is up.
So again, it’s like immune-driven, like inflammation, low-grade inflammation going on there. And then the central nervous system processing. So, so for anxiety or catastrophizing, these things can really play into this irritable bowel syndrome picture
Dr. Christina Carew, ND: And then there’s the other side, functional constipation, which is, more of a structural or mechanical potentially driven. So that’s the pelvic floor. This is tight diaphragms. This is, where we’re not getting the gallbladder firing, motility, [00:32:00] so things along those ways. they generally have slower transit, but not always that pain or hypersensitivity, although you could still have pain because you’re overfull, right?
And so this might be someone who has an X-ray that says that they’re, just like full of stool or backed up. and so remembering that like even if you have one thing or one cause, it can trigger other causes, and so it’s like a domino kind of falling over. It doesn’t mean that every single one needs to…
reason needs you to have a treatment for that reason. It just means that over time, these accumulate and kind of snowball. And so we wanna make sure that we’re thinking about all of the reasons and not just, just the easy reason why someone is experiencing this.
Dr. Dominique Vanier, ND: Yeah, that’s really helpful.
Practical Takeaways and Wrap Up
Dr. Dominique Vanier, ND: Okay, so to maybe start to conclude this podcast, let’s maybe talk about some [00:33:00] key practical takeaways, and I’ll maybe just rapid fire through this.
So things to think about, low fermentable fiber with enough water, and we talk about the fermentability of fiber. We’ve talked about that in a few other episodes, so we can link to those. Easy lifestyle tweaks, using a Squatty Potty or elevating feet, allocating enough time in the morning, trying not to be rushed.
There are some really cool constipating supporting fruits, like kiwis have some interesting research behind them, but there’s also dates, figs, prunes, papayas. We wanna keep the bowels moving. that, that… well, for most people, that, that is a goal, so discussing this with your practitioner on ways to help to do that.
Talking about this with your doctor. If blood tests have not been done, then maybe that’s a good idea to look in if there’s more of a secondary cause of constipation here. There’s a lot of really great gut-brain therapies, like cognitive behavioral therapy, gut-directed hypnotherapy. I know we’ve talked about those in a few other episodes, but [00:34:00] really focusing on the gut-brain connection, which can help with motility.
And then there’s always the refractory cases, where sometimes people just don’t respond to anything, and certainly working with family doctor, naturopathic doctor, GI specialist is really important here. And then considering maybe more imaging through their provider, like an ultrasound of the abdomen, possibly a colonoscopy, FIT test, or even motility testing, ’cause sometimes it’s truly an underlying motility issue.
to take away here, if someone has constipation, how can they discuss this with their practitioner? And maybe you guys can help answer some of these questions here
Dr. Christina Carew, ND: Yeah. So starting at the beginning of the podcast, like thinking about all those questions we wanna ask our patients, bringing that information into your practitioner can be really helpful.
So when did it start? You know, what helps? What doesn’t help? Is there pain? Is there discomfort? What have you figured out? What did you, what have you tried already that didn’t help? Because anything [00:35:00] that you can help to narrow down prevents you from getting drink more water, have more fiber, take a probiotic as a recommendation, ’cause you can say, “Well, I’ve already tried those things.”
so being upfront with that can be really helpful. and we have a long list of those in this podcast, so make sure that you go to the website ’cause the transcript’s on there. You can always go through and, write them down very easily. also things like a symptom diary or a tracking chart. This is Brittany…
Or as Whitney discussed, the Bristol Stool Chart if you’re having straining or bloating. Which, laxatives have helped in the past? And, what are your actual goals? Like, how often do you actually want to have a bowel movement, need to have a bowel movement? If a, a patient that only wants to have his bowel movements in the morning, that is his goal, not always a realistic goal and then making sure that if you, want to or need to have a referral to a gastroenterologist or a [00:36:00] pelvic floor physiotherapist, depending on, you know, how your insurance or your s- your, province or state works, that you’re asking about those other practitioners that can help you gather more information so that you’re getting a bunch of different people looking at your situation.
Dr. Whitney Baxter, ND: I always, I work with a pelvic floor physio for all of my constipation cases, and it’s so helpful just to have them focus on, like, their, even, like, their exercise patterns and, like, that component so we can really dive into all the other pieces and blood work and dietary approaches. But, yeah, they can be really helpful.
And then we talked about this, the transit time test. So tracking your transit time. There is a handout in the show notes for you called the Blue Muffin Poop Challenge. How exciting. You get to eat a blue muffin and see when it comes out, and that’s your transit time. So there is a normal range, so we’re looking at that compared to what, when you see the blue, and seeing how your stool is moving.[00:37:00]
Dr. Christina Carew, ND: And if you see it more than once.
Dr. Dominique Vanier, ND: Yes.
Dr. Whitney Baxter, ND: And if you see it more than once.
Dr. Dominique Vanier, ND: Yeah. And what’s cool about this is there’s actually a few research papers to, to back up this, this method of the blue poop challenge. So very… It’s a, it’s a fun at home, uh, at home activity that we can do with the family if needed. so let’s recap- Sweet
uh, three main take home points here. It’s not always about having more fiber and water. There are multiple causes of constipation, so it’s important to figure out if the constipation is primary or secondary. And as you can tell based on this podcast, it is multifactorial, so working with a qualified practitioner is important.
And lastly, it’s usually not just one thing that will make a difference. It’s often a combination of approaches and even a combination of practitioners. So thanks for joining us today to discuss constipation and bloating because, as you know, better gut health changes everything.
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