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Chronic Constipation: What Your Gut Is Trying to Tell You

Medically reviewed by Elaine K Luo, MD on March 28, 2017Written by Jacquelyn Cafasso on March 28, 2017

Wouldn’t it be easy if you could blame your chronic constipation on one thing? While that typically isn’t the case, your irregularity could be pointing to either one or multiple causes. Read on to learn what your gut may be trying to tell you, and what you can do about it.

Lifestyle and diet

If you’re constipated, your gut might simply be in sharp disagreement with your lifestyle. Poor diet and lack of physical activity are the most common causes of constipation, so it’s a good idea to rule these out first before looking into other causes.

Here are some diet- and lifestyle-related factors that can make you constipated:

  • a diet heavy in meat and dairy products
  • a diet heavy in processed foods, which are high in fat and sugar
  • lack of high-fiber foods
  • not enough water and other fluids
  • too much alcohol or caffeine
  • lack of exercise
  • ignoring the urge to use the bathroom

Make a few changes to your lifestyle and see if they result in any positive bowel changes. For example:

  • Include more high-fiber foods in your meals: fruits, vegetables, whole grains.
  • Take a fiber supplement along with a tall glass of water each day.
  • Do some form of physical activity for 30 minutes each day, even if it’s just a long walk.
  • Use the bathroom as soon as you have the urge.
  • Avoid alcohol and caffeine.

Underlying conditions

Perhaps you’ve made changes to your diet and lifestyle and still aren’t getting any relief. At this point, it may be a good idea to visit your doctor to see if your gut symptoms are a result of something else going on in your body.

While having chronic constipation doesn’t necessarily mean you also have one of these conditions, it may be a good idea to have some additional diagnostic tests just to check. This is especially true if you’re having other symptoms like fatigue, hair loss, abdominal cramping, weight changes, or vision problems.

Chronic constipation could be a sign of the following conditions:

Underactive thyroid (hypothyroidism)

When your thyroid, a small gland near at the front of your neck, fails to produce enough hormones, it can have a drastic impact on your metabolism. A sluggish metabolism results in a slowdown of the entire digestive process, which leads to constipation.

The symptoms of hypothyroidism usually develop slowly over time. Aside from constipation, if you have an underactive thyroid, you may also experience:

  • fatigue
  • increased sensitivity to cold
  • dry skin
  • weight gain
  • irregular menstrual periods if you’re a woman
  • thinning hair
  • brittle fingernails
  • impaired memory
  • a puffy face

A blood test known as a thyroid function test can help assess the function of your thyroid. If you’re found to have hypothyroidism, your doctor will likely have to run more tests. Hypothyroidism can be caused by other conditions, including:

  • an autoimmune disease known as Hashimoto’s disease
  • radiation therapy
  • congenital diseases
  • pituitary disorders
  • pregnancy
  • iodine deficiency
  • certain medications, such as lithium
  • cancer
  • thyroid surgery

Hypothyroidism can be successfully treated with a synthetic thyroid hormone called levothyroxine (Levothroid, Unithroid).

Diabetes

Like hypothyroidism, diabetes is also a hormonal problem. In diabetes, your body stops producing enough of the hormone insulin so your body can no longer break down sugar in your blood. The high blood sugar levels seen in type 1 and 2 diabetes can lead to diabetic neuropathy, or nerve damage. According to the Mayo Clinic, damage to the nerves controlling the digestive tract can lead to constipation.

It’s imperative for diabetes to be diagnosed as early as possible. Diabetes symptoms will get worse if not treated. Along with constipation, look out for other symptoms including:

  • being thirsty all the time
  • frequent urination, particularly at night
  • fatigue
  • weight loss
  • blurred vision

Irritable bowel syndrome

Constipation can be a result of a bowel disease known as irritable bowel syndrome (IBS). The exact cause of IBS is not well understood, but it’s thought to be a result of problems with the way your brain and gut interact with each other. A diagnosis of IBS can be made by assessing your symptoms. Aside from constipation, other symptoms of IBS include:

  • abdominal pain and cramping
  • bloating
  • excessive flatulence
  • occasional urgent diarrhea
  • passing mucus

Anxiety

When you’re anxious or stressed out, your body goes into "flight or fight" mode. Your sympathetic nervous system becomes active, which means your digestion gets put on hold. Anxiety that doesn’t go away, sometimes called generalized anxiety disorder (GAD), can take a toll on your digestive process.

Other symptoms of GAD include:

  • excessive worry
  • restlessness
  • insomnia
  • irritability
  • difficulty concentrating

Anxiety can be treated with medications and psychological counseling or therapy.

Depression

Depression can cause constipation for a variety of reasons. People who are depressed might stay in bed all day and have decreased physical activity. They might also change their diet, eat a lot of foods high in sugar or fat, or not eat much at all. Such lifestyle and diet changes can likely lead to constipation.

Medications and psychological counseling are very effective for people with depression. Symptoms of depression include:

  • feelings of hopelessness, worthlessness, or despair
  • suicidal thoughts
  • angry outbursts
  • loss of interest in pleasurable activities
  • trouble concentrating
  • fatigue
  • reduced appetite

If you’re experiencing any of these symptoms, consider talking to a therapist. Once your psychological problems are addressed, your gut will respond.

Pregnancy

Constipation is common during pregnancy. At least two in five women experience constipation when they’re pregnant. This is caused by the body producing more of the hormone progesterone, which might make it more difficult for intestinal muscles to contract. If you’re pregnant, ask your doctor about ways to safely treat constipation without harming your baby.

Other conditions

In some cases, constipation symptoms can be a sign of a more serious problem. For example, problems with your brain or nervous system can affect the nerves that cause muscles in your intestines to contract and move stool. Alternatively, something blocking your bowel, like a tumor, can also lead to constipation. In most of these conditions, constipation is usually not the only symptom. Other conditions that could cause constipation include:

  • hypercalcemia, or too much calcium in your bloodstream
  • multiple sclerosis, a condition that affects your nervous system
  • Parkinson’s disease, a condition where part of your brain becomes progressively damaged
  • bowel obstruction
  • bowel cancer
  • spinal cord injury
  • stroke

Medications

Your constipation may not actually be caused by your medical condition, but rather by the medications used to treat the condition. The following medications are known to cause constipation:

  • opiate painkillers, such as codeine and morphine
  • calcium channel blockers for high blood pressure and heart disease
  • anticholinergic agents used to treat muscle spasms
  • drugs used to treat epilepsy
  • tricyclic antidepressants
  • drugs used to treat Parkinson’s disease
  • diuretics, used to help your kidneys remove fluid from your blood
  • antacids for stomach acid, especially antacids high in calcium
  • calcium supplements
  • iron supplements for treating anemia
  • antidiarrheal agents

If you notice a change in the frequency or quality of your bowel movements after starting on any of these medications, address your concerns with your doctor. They may want to adjust your medications, switch you to a new medication, or prescribe you an additional medication to manage your constipation symptoms.

Next steps

If diet and lifestyle changes don’t solve your bowel troubles, visit your doctor for more diagnostic tests.

Take a moment to think about any other symptoms you have that your doctor might want to know about, such as fatigue, thinning hair, or changes in your weight. Ask your doctor if any of your medications could be causing changes in your bowel movements. While chronic constipation doesn’t always mean you have another underlying condition, your doctor will want to perform some diagnostic tests just to be sure. If you’re diagnosed with another medical problem, don’t fret. Your doctor will get you on a treatment plan as soon as possible.

If you’ve been feeling depressed or anxious lately and you think it may be having an effect on your digestion, make an appointment to talk to a therapist.

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