constipation

Constipation is one of the most common digestive complaint that involves infrequent bowel movements, straining, hard stools, difficulty passing stools, or a feeling of incomplete evacuation. While bowel habits vary from person to person, in functional medicine constipation is generally characterised by having fewer than one bowel movement per day, passing hard or dry stools, excessive straining, bloating, abdominal discomfort, or the sensation that the bowel has not fully emptied. Some people may also experience fatigue, reduced appetite, or increased abdominal distension when constipation persists.

There are many potential causes of constipation, and often several factors contribute at the same time. Common causes include inadequate fibre intake, insufficient fluid consumption, a sedentary lifestyle, chronic stress, and changes in routine such as travel.

However, addressing these factors does not always resolve constipation. In my practice, I often see people who do everything "right"- they drink plenty of water, eat a high-fibre diet, and exercise regularly - yet they continue to struggle with constipation. In some cases, the healthier they eat and the more fibre they add to their diet, the more constipated they become. This can be both frustrating and confusing.

The reality is that the common advice to drink more, move more, and eat more fibre is often not enough, and for some people, increasing fibre can actually make symptoms worse. That is why, in my practice, we dig deeper to understand what is driving stubborn bowel problems. Functional testing, such as comprehensive stool analysis, can provide valuable insights into the health of your gut microbiome, while a SIBO breath test can help identify bacterial overgrowth in the small intestine.  In both cases, dysbiosis in either the small bowel or colon can drive constipation. Assessing thyroid function is also important, as an underactive thyroid can slow gut motility and contribute to chronic constipation.  

These investigations can reveal the underlying causes of constipation and help guide a more targeted and effective treatment plan, beyond simple advice to eat more fibre. 

Identifying and addressing the root causes is important, as long-term constipation can contribute to a wide range of health concerns, including impaired detoxification, liver issues, increased intestinal permeability ("leaky gut"), chronic inflammation, hormonal imbalances - particularly oestrogen excess - and even mood disorders. 

Effective treatment often requires addressing the underlying drivers of constipation rather than simply managing the symptom itself.