This episode is Part 1, about causes of constipation in IBS. Helping to understand what might be maintaining your slow bowel is important to know where to start in treating.

• 🤔 The Constipation Conundrum: Unravelling the complexity of tackling constipation, beyond the common advice of drinking more water.
• 🤯 Types of Constipation: From slow transit time to pelvic floor dysfunction - different constipation categories.
• 🚺 Gender Disparity: Discover why women are more than twice as likely to experience constipation compared to men.
• 🤰 Hormonal Influences: Understand how hormones, especially during menstruation and menopause, can affect gut transit time.
• 🍽️ Dietary Causes: Explore the impact of low-fibre, high-fat diets, and the surprising connection between under-eating and constipation.

Part 2 next

Relevant episodes

• Ep 24 - Abnormal eating pattern
• Ep 23 - Dietary fats and IBS
• Ep 7 - Periods and IBS
• Ep 1 - Normal Digestion

Work with me

• Group Gut Reset - https://www.goodnessme-nutrition.com/group-course-ibsc/
• 1:1 Gut Reset - https://www.goodnessme-nutrition.com/consultations/

Why is it so hard to tackle constipation?

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Especially when you're trying to eat

more fibre, but it just leaves you

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feeling bloated and even more stuck.

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That's exactly what I'll be sharing in

this episode of The Inside Knowledge.

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Constipation can be a real challenge

to shift, and it is not just

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as easy as drinking more water.

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You'll learn in this episode of the

different types of constipation from slow

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transit time to pelvic floor dysfunction

I'll be covering common causes of

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constipation from different medication

diet and other health conditions And I'll

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share why women are more than twice as

likely to get it compared to men part

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two will cover diet and treatments.

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But for now, let's get into the causes.

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Welcome to episode 33

of the Inside Knowledge.

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I'm Anna Mapson.

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So today's episode all about constipation,

IBSC, as it's sometimes referred to.

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This is a big challenge

for a lot of my clients.

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I tend to have a lot of

constipation clients, people who

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have really struggled for years

and with slow digestion, painful.

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bowel movements, hemorrhoids, bloating,

irritation when you eat certain

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foods, like this is quite common

presentation and pattern in constipation.

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I thought I'll just start explaining

whether it's IBS or the doctors might

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consider it functional constipation.

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So functional gut disorders are

slightly different from IBS, but really

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the only main difference is that In

IBS, you get a lot of abdominal pain.

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So if you've had a diagnosis of IBS

C, that's constipation predominant

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IBS, then you're more likely to

have recurrent abdominal pain.

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But, apart from that, the

definitions are pretty much similar.

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So, you probably have less Then

three bowel movements per week.

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And it involves straining, or hard stools

more than quarter of the time you go.

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And also that sense of incomplete

evacuation, so a sense of like a blockage.

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That's really common as well.

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And also what is common, but really

not talked about a lot is using

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your hand or your So, um, how

to help you extract the poo out.

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This is something that can happen

when it is so hard, but people

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don't like to talk about it because,

yeah, sounds a bit embarrassing.

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However, I just want to reassure you

that, if that has happened to you, and

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you've had to do that, it's not unheard

of, and it is actually quite common.

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In fact, It's part of the diagnostic

criteria to the extent that, you

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know, it's recognised that a lot

of people will have that problem.

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So if you think back to episode 1 where

I talked about normal digestion and

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what we're aiming for with a normal

bowel movement, the difference with

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constipation is that you've got type

1 or type 2, so either very hard,

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small, pebbly poos or very large,

hard, poo that is difficult to pass.

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Those are both signs of

constipation and also the frequency.

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So less than three times a

week is considered constipated.

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Now, if you're going only every other

day, you could still be constipated.

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And that's the other thing is you can

have constipation and be passing stool

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every day, but still be constipated

because they're small pebbles.

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Just a little bit each day.

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That means you're still constipated.

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Only apply to people who are

not going for days and days.

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There's three kind of categories,

that I divide constipation up into.

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So, there's a normal transit time,

that food is passing through you,

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you know, roughly 24, 36 hours.

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But, it is getting to that point that it's

straining, you're maybe having a lot of

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problems with bloating, a lot of abdominal

pain, discomfort, and very hard stools.

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So, It might be coming through you at

the correct speed, but when it gets to

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going to the toilet, it's difficult,

or you might have a really slow transit

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time, and that could be down to a

couple of things, slow motility due to

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The smooth muscles of your intestine

and your bowel working slowly, so

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they're not pushing things through.

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And then a third type is

pelvic floor dysfunction.

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So this is where potentially

your muscles are not cooperating.

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They're not coordinated to open

and close at the same time.

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There's a pelvic floor basket

that holds you from hip to

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hip and holds everything up.

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If these muscles don't all open and

close at the right time and let the stool

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out, even when you get an urge to go,

that can lead to you being constipated,

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and it can lead to reduced sensation of

the urge to want to go, and sometimes

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it's, that you just can't get it out.

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So, a number of ways that

you can be constipated.

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It's a number of different types that

helps in a way, because we're trying to

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see how to fix it, and we need to really

understand what these different types are.

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So, before I jump into any more

detail on this, just to flag

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some red flags with constipation.

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So, some things that you should

look out for if you feel like you've

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got constipation, you haven't.

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seen a doctor about it.

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So one would be unexplained weight loss.

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If you are losing weight unintentionally,

if you're seeing a lot of blood in

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the stool, and I will come back to

this because hemorrhoids are very

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common with people who've got IBS

and have been straining frequently.

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So it's not uncommon to see fresh

red blood, but if you see any dark.

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kind of coffee granule type black blood.

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If you see frequent amounts of high

bleeding, then these should all

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definitely be checked out by a doctor.

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If you've got unexplained iron

deficiency anemia, then also go to your

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doctor and make sure that they know

that you've got constipation problems.

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If this suddenly started after

you're age 50, this is a red flag.

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Uh, and then the significant pain.

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So I'm talking about not feeling

just discomfort and a bit upset, and

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bloated, but significant pain where

you're needing to take painkillers,

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you're needing to lie down.

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Again, this should be, checked out

by your doctor also if you have

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a family history or you have your

own history of colon cancer or IBD.

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These are all red flags for someone

who suffers with constipation.

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Just make sure you've been to your

doctor and get them checked out.

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Now food travels obviously from your

mouth all the way through your stomach.

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Stomach, small intestine,

and then the large intestine.

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During processing through the small

intestine, a majority of absorption

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happens there, and that's where we're

getting all the goodness out of our

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food, and it's really a lot of waste

that gets to the large intestine.

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However, There's a lot of key activity

that happens in the large intestine

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as well that's really important.

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One of them is fermentation of

the fibers by our gut bacteria.

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You'll have heard me talk a lot

about gut bacteria if you're a

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regular listener to the podcast.

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Um, the large Undigestible fibres

that reach the gut bacteria from

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our food, so from vegetables, whole

grains, fruits, pulses, nuts and seeds.

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These are all really important

to eat regularly because if we're

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eating a diverse set of fibres,

it's going to feed a diverse set

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of gut bacteria and that is good.

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Good for our immune system, for

our general overall well being

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and regular bowel movements.

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The other thing that also happens in

the large intestine is there is some

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absorption of nutrients but really

critically water is reabsorbed.

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I think it's quite astounding that

up to one to two litres of water

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or liquid is reabsorbed from the

stool content back into the body.

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Now this is key when you hear people

say, oh have you been drinking

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enough water when you're constipated?

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And one of the reasons is if your

body doesn't have enough water in the

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tissues, it will start reabsorbing more

and more from the large intestine and

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that will lead you to have a hard bowel.

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stool.

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So we want to try and make sure we've

got sufficient water from drinking

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so that we're not reabsorbing lots

of water in the large intestine.

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And then the other thing that's really

happening a lot in the large intestine

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that is Important for constipation

and regular bowel movements is the

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peristalsis, so that's like the

movement of food through the large

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intestine as it's moving up and

across and down, like across around

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our tummy, ready to be excreted.

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This peristalsis, this movement, is

affected by So when we eat certain foods,

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or when we eat a meal, the gastrocolic

reflex kicks in, and that can sometimes

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cause you to want to go to the toilet.

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There's something called 5 HT, which

is, a precursor to serotonin, that

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also Influences motility, and then our

gut microbes and the gases that they're

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producing can also affect the speed of

transit through the large intestine.

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I'll come back to this in the next

episode, but that's particularly methane.

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There is a type of microbe that

can produce methane gas and it is

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known to slow down the transit time.

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the more methane gas that you have.

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So that is also something to be

aware of, that gut health is key and

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making sure you've got a good mix of

microbes can help you protect against

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constipation, but also to treat it.

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If we think about now the causes of

constipation, I'm going to start off

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with a common one, which is dehydration.

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It's really important that

you are drinking enough water.

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And especially during the winter.

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It can be hard to meet those

fluid targets because it's cold.

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And you don't want to drink cold water.

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You can drink hot water.

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You can drink herb teas.

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And actually Tea and coffee

are diuretics but they do count

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towards your fluid intake.

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So aim for around 2 litres of

water a day and try and space it

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out throughout the day as well.

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Not just downing like 2 pints of water

in the middle of the day and then

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not drinking for the rest of the day.

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If you're worried about fluid intake and

needing a wee before bed, then definitely

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try to preload your fluid intake, so

drink as much as you can in the morning

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and try and get your liquid intake then.

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In terms of dietary patterns that

typically cause the most constipation,

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it's a low fibre, high fat diet.

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Fibre is known to promote regular

bowel movements by adding in

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the mix of different fibres.

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So you've got bulk forming fibre

which helps you create an urge to

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want to go as well as soluble fibres

that's more gel forming that helps

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to create a softer stool that creates

a nice easy motion through your gut.

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So low fibre diet is going to put you

at danger of constipation, and then

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also a very high fat diet, because we

know that when you're eating very high

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fat foods, it slows the body down.

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If you listen to my episode on fats,

episode 23, that explains a lot more about

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how different fats affect our digestion,

but generally We are known to slow down

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transit time when we have high fat foods

because the body wants to try and get

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as much energy from it as possible.

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The other episode that will be

really helpful for you is listening

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to episode 24 about abnormal eating

patterns because under eating is

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a common cause of constipation

and people are surprised by this.

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Not eating enough food.

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Slows down your transit time and

can lead you to be more constipated.

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I know that the majority of people who

come and see me are not eating enough food

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because you're worried about the symptoms.

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I completely understand you're worried

about the bloating, the pain, the gas.

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However, unless you're having

three meals a day, you are going to

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struggle to get enough movement coming

through to kick start that process.

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So, those are the main sort of

dietary things that are, oh, I say

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easy to adjust or easy to address.

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They're not necessarily easy because it,

if you're eating a low fibre, high fat

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diet now, it could be massively difficult

to change to a high fibre, low fat diet.

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However, those are the dietary

triggers that you can think about.

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Then there's also like another whole

section around the gut brain connection

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because stress, anxiety, and Psychological

distress, really, just can influence your

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gut through the gut brain connection,

the vagus nerve that travels from your

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brain into your digestive system, and

can transmit a lot about how we're

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feeling and can cause physical symptoms.

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So it can definitely create

this sensation of holding on.

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And I've worked with quite a few clients

recently who have noted throughout

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our work and just other times they've

been in therapy, that they may have a

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predisposition to kind of emotionally

hold on to things and not want to let go,

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they're afraid of losing control, they're

afraid of What happens when you stop,

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so they're always busy busy busy These

things, although it might sound a bit odd,

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they can actually really contribute to

someone's bowel habits and constipation

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and there are a number of other

conditions that also affect constipation.

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For example, Parkinson's, multiple

sclerosis, these are neurological

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conditions, but also there's

Ehlers Danlos Syndrome, which is

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where the smooth muscles of your

body don't work as effectively.

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And this can just lead to reduction

in the movement of the gut.

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And often people who have

this are like hypermobile,

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Then other medication that may cause

constipation includes morphine.

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So we know That morphine slows down

the gut, but also things like codeine.

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So they're two painkillers,

some antidepressants and some

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blood pressure medication may

also be affecting constipation.

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Think about when your symptoms

started in relation to other

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medication that you're taking.

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Of course.

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Stopping any medication should only be

done after a conversation with a doctor,

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so if you feel like there's a link, go

back and speak to your doctor and check.

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Then the last couple of things, that

can also slow down our gut transit

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time include, ignoring the urge to go.

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So this is actually something people don't

think about much, but if you're one of

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those people who only likes to go to the

toilet in your own home and if you get the

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urge to go outside the house you just will

ignore it and you wouldn't be able to go.

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Do consider revisiting that because

if you constantly ignore the messages

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from your gut up to your brain saying,

I need to go, I need to go to the

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toilet, then what happens is those

messages become a little bit ignored.

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And so you can sometimes lose that urge.

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And so you.

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Don't feel a sensation there where you

should and so it's really important

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to go when you need to Other things

that you might not really think

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are connected is like having a very

sedentary lifestyle So for example

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people who are bed bound in hospital

if you've Just don't move very much.

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You sit at your desk all day,

and you maybe just watching telly

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in the evening, and you just

don't do much physical activity.

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That can also lead to constipation.

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And then finally, hormones.

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These can also affect, gut transit

time, so a low functioning thyroid,

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because the thyroid is, involved

in the metabolism and the speed

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of a lot of Processes in our body.

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And so when that is low in hypothyroid,

you might find you get more constipation.

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And also, just before your

period, sometimes people get

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a week of constipation or

constipation becomes worse.

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just before the period, and

that's down to progesterone.

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Actually, on that note, women

tend to experience constipation

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twice as much as men.

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I think the ratio is 2.

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2 to 1, so it's much more likely

that women will be constipated.

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However, obviously it

does affect men as well.

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It's around that slowing down of

the gut to prepare for a pregnancy,

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to extract as much nutrients

out of your food as possible.

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You can listen to episode 7 for more

information about periods and IBS, and how

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hormones may be affecting your digestion.

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But there are also a couple of other

factors why women may be experiencing

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constipation more than men.

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One of them is really about

the positioning on the toilet.

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So sometimes we need to get

a really good position on the

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toilet to relax your pelvic floor.

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Now when you're learning to go to

the toilet, Little boys, when they're

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sitting down, they put them right

far back on the toilet in order that

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they don't wee all over the floor.

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So when they're sitting down, they

want to put the boys further back.

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But actually, girls sometimes will balance

quite near the front of the toilet and

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so maybe don't have the best positioning.

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So you might learn to sit

differently on the toilet, and

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I'll come back to that in a moment.

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Um, also, women tend to

have a weaker pelvic floor.

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or damage from childbirth, tears,

prolapses, and the impact of fluctuating

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oestrogen has also got an impact on

the strength of the pelvic floor and

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so sometimes during menopause this

can change and may be contributing

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to symptoms like constipation.

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So there's a lot of reasons

why women might be getting

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constipation more than men.

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Now, our pelvic floor muscles need

to open and close and relax and

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Construct at certain times to allow

the poo to come out They also need

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to respond to the urge to want to go.

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If these pelvic floor muscles don't

contract and coordinate at the same

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time with the surrounding muscles

and the nerves, then it's difficult

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to produce a normal bowel movement.

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So there is a type of constipation

called dysenergic defecation, and

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this is where The constipation is

down to pelvic health problems.

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It's not necessarily anything to

do with your diet, with your gut

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bacteria, with anything else.

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It's really down to the muscles and

how they're coordinating together.

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A pelvic health physiotherapist can

be extremely useful in this case.

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Particularly, they look at testing

your strength and weaknesses of the

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anal muscles, and they will get to

do some biofeedback, like just asking

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you to clench and to feel things.

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And it is important to get this treated

and there are things that you can do,

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but it does need to be a very specific

pelvic health trained physiotherapist,

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not just any physiotherapist.

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Sometimes you have constipation and then

all of a sudden you'll just get diarrhea.

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And this can be down to what's

called overflow diarrhea.

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So it's where you have a very, hard

impacted bit of stool that is literally

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blocking your intestines and then the

loose liquid watery diarrhea will spill

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over that and come straight through you.

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So sometimes this is why people get

confused and think oh my IBS is all over

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the place, but actually It is constipation

that is just overflowing in diarrhoea.

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That's the final type of constipation

that I wanted to explain in this episode.

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I am going to do part two which

will cover laxatives, it will cover

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a diet for IBS C, as well as some

supplements that can be helpful.

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So stay tuned for part two.